Does ADHD Coaching Work?

There are three things to know about coaching.

First, if you read Russell Barkley, scholar and researcher on ADHD, the idea of coaching makes sense.  Barkley argues that what you need with ADHD is something external to guide your behavior right at the moment that the behavior’s needed.

Imagine you need to study for a job interview you have the next day and you are about to surf online.  Right at that moment, with your fingers poised to tap the keyboard, you need something external to stop you (or to guide you toward stopping).  This something will then need to remind you of your interview and reinforce studying over surfing.  This is ideally what a coach does…guides your behavior at the moment it most matters, which is when you play the game…of job-seeking or whatever it is.

A coach guides your action as it is happening.

baseball-1536097_1920Second thing to know is that the reality of ADHD coaching appears to approximate this at best.

You can get a coach working with you multiple times a week and the work can center around where you most struggle.  But, at best, it’s like having a coach available by phone some of the times you play the game.  It’s just unrealistic to have the ideal kind of coaching…unless you’re wealthy and want to pay someone to be with you, guiding your behavior at various points of the day, as needed.  Perhaps one day, we’ll have robots do this for us, should we choose…hmm.

The third thing to know is that the research on what makes for an effective ADHD coach is sorely lacking.  Only a few exploratory kind of studies, primarily focused on college students, seem to look at this, with the recommendation for future larger scale, more rigorous research.  So while you can find folks credentialed to be an ADHD coach, there’s no real research showing coaching clearly works and under what circumstances.

This leaves us all figuring out for ourselves, if we pursue coaching, whether it’s working. Actually, even if research clearly said it’s likely to be effective for most, we’d still have to figure out whether it was effective for us.

Fidgeting: Spin vs. Science

My local Memorial weekend festival had fidget spinners for sale, ranging from $12 to over $20, advertised to help with ADHD, anxiety and more.  It left me wondering what we know about their effectiveness.  It turns out very little.  On my go-to research source, pubmed, I could find no single study on fidget spinners or their kin (cubes, etc.).  But NPR published two articles exactly two years apart, one on fidget spinners and one on fidgeting.  ball-1023984_1920

On May 14, 2017, NPR published an article on fidget spinners.  Essentially, the article quotes a Duke professor suggesting to stick with what’s known to work.

The professor points out that there’s no evidence that fidget spinners work.  Though it’s said, what seems perhaps buried or likely to be easily overlooked is that the reason there’s no evidence is that there’s actually no trustworthy research on them.  See here.

Meanwhile, two years earlier, on May 14, 2015, NPR published an article describing a small study that shows that children with ADHD performed better on tasks requiring concentration when they fidgeted.  Specifically, the children worked while on a swivel chair that they, of course, spun and moved.

Overall, more movement meant better performance for these kids (kids without ADHD, on the other hand, did worse with movement).  The lead author, however, cautioned against both too little and too much movement.  See here.

Perhaps fidget spinners would fall into too much movement or the wrong kind (attracting eyes as well as fingers), but it’d be interesting to see some real research on them.  (Real added for my teenage son, who wanted me to buy a fidget spinner at the carnival.)

Something Fishy

ADHD comes with omega-3 and omega-6 fatty acid deficiencies.

But upping your omega-3 and omega-6 fatty acids may have little effect on your ADHD symptoms.  What gives? Recent research reveals that it’s all about the ratio.

ADHD means low levels of both but overall higher levels of omega-6 to omega-3.

So now you may say, well, I just need to increase my omega-3 levels, right? Oh, how I wish it were so simple.  Researchers have tried this with only some succesfish-2207845_1920s.  A supplement heavier on the omega-3 than omega-6 side may be better, as indicated by a study that found benefit from giving participants an omega-3/6 supplement containing mostly EPA and DHA (omega-3), with only 60mg of LA (omega-6).

Still, it seems you’re best off knowing your ratio.  And then knowing how much omega-3 (EPA and DHA, specifically) and omega-6 (LA or AA, specifically) you need to optimize it.

See here.

Medicating Children

As the mother of a teenager with ADHD soon entering high school, I want to know the pros and cons of medication.  If you are a parenpill-1254786t reading this, you likely do, too.  And I will admit, I’m torn.

The research seems too unfinished for me to rely on it as much as I might like.

Consider that over 40 scholars from the UK, USA, Denmark, Italy, Germany, Switzerland and Australia (told you it’s big) will be reviewing  various “pharmacological interventions” to rank how well they work and their “tolerability profiles,” looking at these things for children, teens and adults.  The scholars note that “there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank” with regard to their ability to deliver desired results and to do so with tolerable side effects.  See more here.

But do we keep waiting for what seem to be more definitive answers? At what cost?

Consider this…recent research suggests that school could be a more rewarding experience for children and teens with ADHD who use medication for their symptoms.  Examining about 10, 0000 12-year-old twins, some who’d been followed since 7 years of age, researchers found that medication-free children with ADHD showed lower educational achievement than children with ADHD using methylphenidate (Ritalin, Concerta), who showed lower educational achievement than children without ADHD.  That is, ADHD appeared to lead to lower educational achievement but especially so if it was unmedicated ADHD.  Plus ADHD symptoms also predicted a negative educational trajectory from 14 to 16 years of age.  See study here.

Where does this leave us as parents wanting our children to have the best chance at achieving what deep down really matters to them?

It leaves me leaning toward the test of experience.  I am willing to let my teen, when wishing to do so, swallow a pill as I (figuratively) swallow mine.

Meanwhile, I will keep combing the research….

Marijuana + ADHD = ?

My husband read my post below and, essentially, said, “Huh?” He suggested I keep it simple and get right to the answer to the question posed above.  Here it is:  A big-deal study showed that, contrary to expectations, marijuana (mj) had no effect on ADHD-related brain differences.  It had effects on the brain, of course, but these effects were separate from the effects of ADHD.  Details and other results, which are the ones of more interest to me, below.

An impressive group of scholars got together to examine the mj + ADHD question using 21-25-year-olds followed since elementary school as part of a large multi-site longitudinal study of ADHD known as MTA.  Comparing mj users (who used at least once/week) & non-users with & without ADHD, the group ventured they would find that mj intensifies ADHD-related brain alterations.  They thought mj would add insult to injury (injury being the decreased “integrity of functional networks” seen with ADHD).

networks

But they found no one-two punch.

ADHD was associated with decreased integrity of functional networks responsible for executive function and somatomotor control, but mj use affected different functional networks.

Interesting to me is that one of the mj-affected networks was the default mode network, which, when you have ADHD, fails to cooperate with the task-positive network (for more on this).  It raises the question of whether mj has an indirect effect on ADHD symptoms, even if no direct one.  (The other mj-affected network was the lateral visual one.)

Also interesting to me is that ADHD was associated with INCREASED functional network integrity for two networks:  1) “stronger integration of right posterior parietal cortex” within the dorsal attention network & 2) “stronger integration of left inferior premotor region within the cingulo-opercular network.”  Help with translation:  1) think spatial orientation toward what’s relevant; and 2) think maintaining alertness.

The researchers described the first strengthening as “maladaptive” because of its association with slower processing speed for those without ADHD.

They saw the second as helpful and suggest it “may reflect a compensatory adaptation – the strengthening of connections or recruitment of additional brain regions” for the sake of “maintaining normal cognitive performance.”

In almost a side-note kind of way, they note that their data support that ADHD-related differences seen within the somatomotor network “are a good candidate for imaging-based prediction of ADHD diagnosis,” as suggested by earlier research.  Wow.

Actual study here.