ADHD is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity that can persist into adulthood, affecting various life domains.
ADHD coaching is a supportive partnership that helps individuals with ADHD develop strategies, skills, and self-awareness to achieve their goals and manage their symptoms.
By providing structure, accountability, and an ADHD-informed perspective, coaching can improve functioning and quality of life.
Managing ADHD is crucial for reducing the negative impact of traits on relationships, work, and well-being, and for enabling individuals to harness their unique strengths and reach their full potential.
As a complement to other treatments, ADHD coaching offers a personalized approach to empowering individuals in their journey with ADHD.
Ahmann, E., & Saviet, M. (2024). Development of a manualized coaching intervention for adult ADHD. International Journal of Evidence Based Coaching and Mentoring, 22(1), 177–198. DOI: 10.24384/hd8r-gc79
Key Points
- Attention-Deficit/Hyperactivity Disorder (ADHD) poses challenges for individuals in varied functional arenas and life domains. While research demonstrates the benefits of specialized ADHD coaching across the age span, studies of ADHD coaching for adults have only focused on group coaching.
- The objective of this project was to bring together experienced ADHD coaches to identify common elements of a manualized intervention comprising a coaching engagement of individual sessions for adults with ADHD.
- Through an iterative focus group process, expert coaches identified key components of a 12-session individual coaching engagement for adults with ADHD, balancing the need for a well-characterized intervention with flexibility.
- The resulting “ADHD Coaching Engagement: Manualized Intervention” (ACE-MI) offers both best practice guidance for coaching adults with ADHD and a consistent approach useful in supporting quality research.
Rationale
ADHD is a neurodevelopmental disorder that continues to impact individuals into adulthood, with an adult prevalence of 2.5% to 6.8% (Kessler et al., 2006; Fayyad et al., 2017; Simon et al., 2009; Song et al., 2021).
ADHD is associated with executive functioning deficits that lead to challenges in organization, productivity, relationships, and daily life.
While medication is a first-line treatment, experts increasingly point to multimodal care, including medication, therapy, and coaching, as optimal for managing ADHD (Hinshaw & Arnold, 2015; Martinez-Nunez & Quintero, 2019; MTA Cooperative Group, 1999).
ADHD coaching is an emerging intervention recognized as a useful component of comprehensive ADHD care (Barkley, 2015; Kooij et al., 2010, 2019; Murphy, 2015; Sarkis, 2014). Research demonstrates the benefits of ADHD coaching across the lifespan (Ahmann & Saviet, 2021).
However, studies on ADHD coaching for adults are limited to group formats (Bloemen et al., 2007; Kubik, 2010).
Research is needed on individual coaching for adults with ADHD. Defining a consistent coaching “intervention” is a key first step to enable rigorous research.
This study aimed to engage expert coaches to identify common elements of a manualized coaching intervention for individual adults with ADHD.
Method
A participatory, collaborative research process with a qualitative focus group design was used.
Eight experienced, ICF-credentialed ADHD coaches with 5-26 years of coaching experience (M=12 years with adults with ADHD) were recruited.
Five weekly 90-minute focus groups were held online using an iterative process of idea generation, discussion, clarification and consensus development.
Discussions focused on identifying key components of a 12-session individual coaching engagement for adults with ADHD.
The Guidance for Reporting Intervention Development Studies in Health Research (GUIDED) checklist was used to ensure thorough, quality reporting.
Session recordings, notes, and participant feedback were used for data triangulation and validation.
Results
The focus group discussions yielded rich data that was synthesized into several key components of the manualized coaching intervention for adults with ADHD.#
Underlying assumptions
First, important frameworks and assumptions underlying the ADHD coaching process were identified.
Participants emphasized that the intervention should be grounded in a client-centric approach, always keeping the client’s agenda at the forefront.
They also stressed the importance of using an “ADHD lens” throughout the coaching process, meaning that the coach maintains an understanding of how ADHD impacts all areas of the client’s life.
Adherence to ICF coaching competencies and ethics was also considered an essential foundation.
Promoting growth and hope
A central theme that emerged was the importance of promoting growth and hope when coaching adults with ADHD. Participants saw this as critical for meeting the unique needs and challenges of this population.
They described weaving growth and hope into every session through psychoeducation, affirming strengths, encouraging self-advocacy, exploring limiting beliefs, and celebrating successes. This overarching theme was considered a key distinguishing factor of ADHD coaching.
Phases of coaching engagement
Detailed outlines were developed for three phases of the coaching engagement: the initial session, ongoing sessions, and the closing session.
For the initial session, essential elements included exploring the client’s history and current functioning, identifying strengths and values, envisioning goals, and establishing the coaching partnership.
Ongoing sessions were characterized by reviewing progress, exploring current challenges, brainstorming strategies, and committing to action steps.
The closing session focused on summarizing growth, consolidating learning, and planning for the future. Specific examples were generated to illustrate each of these components.
Unique materials and approaches
Throughout the discussions, coaches emphasized the need to individualize the process based on the client’s unique needs and context.
To support this, they compiled an extensive list of tools, assessments, and exercises that could be incorporated based on coach expertise and client goals.
Examples spanned executive functioning assessments, strengths inventories, mindfulness practices, and more.
Conclusions
Overall, the focus groups yielded a comprehensive framework outlining the essential components of a 12-session ADHD coaching engagement.
Central themes included maintaining an ADHD-informed, client-centric approach, promoting growth and hope, and allowing flexibility for individualization. Detailed session outlines and an array of tools provide a roadmap for implementing the intervention consistently while still allowing for personalization.
By synthesizing the collective wisdom of expert coaches, this manualized intervention offers a strong foundation for advancing both research and practice in the field of ADHD coaching for adults.
Insight
This study provides the first manualized coaching intervention for individual adults with ADHD. By engaging expert coaches, the resulting “ADHD Coaching Engagement: Manualized Intervention” (ACE-MI) is well-grounded in coaching best practices.
It offers structured guidance to ensure consistency and research validity while allowing flexibility to tailor the process to individual coaches and clients.
Key insights include the centrality of promoting growth and hope when working with adults with ADHD, and the importance of an ADHD-informed approach. The detailed session outlines, examples, and compilation of tools provide a comprehensive roadmap for implementing the intervention.
This work extends prior research demonstrating ADHD coaching’s efficacy by enabling the next step of studying a consistent intervention for individual adults.
Future directions could include piloting ACE-MI, refining it through continued research, and exploring adaptations for use with diverse populations.
Overall, ACE-MI provides an important foundation to advance the science and practice of ADHD coaching for adults.
Strengths
This study had several strengths, including:
- Engaging focus groups of expert coaches enabled the development of an intervention grounded in real-world best practices.
- Purposive sampling of coaches from varied training backgrounds supported identifying common elements of ADHD coaching.
- Use of Carroll & Nuro’s (2002) framework and GUIDED reporting guidelines strengthened the manual development and reporting process.
- Triangulation of data from session recordings, notes, and participant feedback enhanced reliability and validity.
Limitations
Despite strengths, this study also had some limitations:
- The number of coaches involved was relatively small (n=8), though they represented an average of 12 years of experience coaching adults with ADHD.
- All coaches were white females based in the United States, potentially limiting generalizability to other demographics and cultural contexts.
- The manualized intervention remains to be tested for feasibility and efficacy through further research.
Implications
This study provides a manualized coaching intervention that can serve as a consistent foundation for future research on ADHD coaching for adults, an important step for advancing the evidence base.
ACE-MI also offers a practice framework for coaches working with individual adults with ADHD, promoting best practices.
By providing flexible structure and concrete strategies, ACE-MI may support coaches in optimizing their work with this population.
Broader dissemination and use of the manual could enhance the quality and consistency of ADHD coaching, thereby improving client outcomes.
However, additional research is needed to establish ACE-MI’s efficacy and to explore implementation with diverse coach and client populations. Factors such as coach training, client demographics, and cultural context are important to investigate.
Overall, ACE-MI holds promise as a tool to advance both the science and practice of ADHD coaching for adults.
References
Primary reference
Ahmann, E., & Saviet, M. (2024). Development of a manualized coaching intervention for adult ADHD. International Journal of Evidence Based Coaching and Mentoring, 22(1), 177–198. DOI: 10.24384/hd8r-gc79
Other references
Ahmann, E., & Saviet, M. (2021). ADHD coaching: Evolution of the field. The ADHD Report, 29(6), 1-9. https://doi.org/10.1521/adhd.2021.29.6.1
Barkley, R. A. (Ed.). (2015). Attention-Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment (4th ed.). Guilford.
Fayyad, J., Sampson, N.A., Hwang, I. et al. The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. ADHD Atten Def Hyp Disord 9, 47–65 (2017). https://doi.org/10.1007/s12402-016-0208-3
Hinshaw, S. P., & Arnold, L. E. (2015). Attention‐deficit hyperactivity disorder, multimodal treatment, and longitudinal outcome: Evidence, paradox, and challenge. Wires Cognitive Science, 6(1):39-52. https://doi.org/10.1002/wcs.1324
Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O. … & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716-723. DOI: 10.1176/ajp.2006.163.4.716.
Keep Learning
Here are some reflective questions related to this study that could prompt further discussion:
- How might the ACE-MI manualized intervention be adapted for use with diverse cultural groups or in different global contexts? What factors would be important to consider?
- Given the finding that promoting growth and hope is central when coaching adults with ADHD, what theories or practices from positive psychology could further inform ADHD coaching?
- How could the detailed strategies and tools outlined in ACE-MI be most effectively disseminated to and implemented by ADHD coaches? What support might coaches need to adopt this framework?
- What outcome measures would be most appropriate and valid to use in future efficacy studies of the ACE-MI intervention? Consider measures of ADHD symptoms, executive functioning, well-being, and functional outcomes.
- Beyond individual coaching, how could the insights from this manual development process inform the design and delivery of group coaching programs for adults with ADHD? What unique factors come into play with a group format?
