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4. Non-Pharmacological Interventions

4.6 ADHD Coaching

Clinical Questions

Is there a role for ADHD coaches?

Summary of narrative review evidence

ADHD coaching shares common elements with cognitive behavioural interventions, particularly with environmental modification and behavioural modification components as outlined in Box 4. The evidence highlights a range of frameworks applicable to the ADHD context targeting, motivation, implementation, self-regulation and self-actualisation. Varied approaches to coaching are evident in practice, most building on an in-depth or lived experience understanding of ADHD.

ADHD coaching combines three key coaching skill sets (Wright, 2014 p. 23):

  • collaborative, client-centred, client-driven process to support the person’s empowerment
  • education about ADHD and related topics, as well as tools and resources
  • skills coaching to build on the person’s strengths and resources, and develop conscious competence of new systems and strategies.

Ahmann et al (2018) provided a descriptive review of research in the area of ADHD Coaching. Of 22 studies identified on coaching for ADHD, 19 examined outcomes. Included research studies (N=19) varied in design, ranging from case studies to randomized controlled trials (RCTs). Others were qualitative studies and quantitative treatment studies with pre-test and post-test components.

Studies examined coaching for elementary (primary school), high school, and college students, as well as adults. Three of the studies examined coaching in groups and the other 16 studies examined outcomes of individual coaching. Of the 19 outcome studies, 18 studies found that ADHD coaching supported improvements in ADHD and executive functioning symptoms; 6 found improved well-being; 3 studies demonstrated maintenance of gains; and 6 showed high satisfaction with coaching; 4 studies examined factors associated with coaching success. Of note, two RCTs were identified with both reporting positive outcomes for participants.

Field et al., (2013) conducted a RCT of coaching with college students. This trial comprised 88 participants in the treatment group and 39 participants in the control group. The coaching group had a statistically significant higher total score on the Learning and Study Strategies Inventory (LASSI) including all three LASSI subscales measuring Skill, Will, and Self-Regulation than the comparison group. The second RCT was conducted by Evans et al (2014) with teenagers.

This pilot RCT comprised 24 participants with ADHD receiving dyadic coaching and 12 community controls. Overall, there was little evidence to suggest that the coaching group outperformed the control group with the exception of improved parent-rated family functioning relative to the control group. However, given the pilot nature of this study and the small sample size, additional research is clearly needed.

In summary, the review of the evidence from Ahmann et al (2018) reflected potential positive outcomes for people with ADHD in supporting their executive functioning, ADHD symptoms, self-esteem, wellbeing, and quality of life. Further evidence supported satisfaction with coaching and maintenance of gains.

The limited evidence suggests possible positive outcomes for people with ADHD. However, high-quality evidence is lacking and there was substantial variation in the coaching factors across the studies including how coaches were trained, how coaching programs were delivered (group versus individual sessions), variation in coaching duration and variation in the outcome domains assessed. Further robust research is needed to inform the broad application of this approach across populations with ADHD.

The GDG debated whether to include a recommendation regarding ADHD coaches. The GDG noted that some components of ADHD coaching include environmental and behaviour modifications as described in Box 4. They also noted these components were frequently provided by allied health professionals, particularly, occupational therapists and psychologists. As such, a recommendation regarding ADHD coaching was deemed more appropriate and consistent with the focus on therapeutic approaches rather than specific professions.


Clinical considerations for implementation of the recommendations

The evidence supporting coaching as an intervention for ADHD is currently relatively weak, which may reflect the amount of research undertaken rather than the lack of effectiveness of the intervention.

It was noted above that the intervention utilises environmental and behavioural modifications commonly employed by allied health professionals who have higher levels of training and education than ADHD coaches. ADHD coaching is generally provided within the private sector. Out-of-pocket costs could impact health equity in terms of access to coaching.

It is also noted that ADHD coaching, as delivered by an ADHD coach, is not regulated by a government body such as AHPRA and there is no oversight to ensure protection of the public, protection of privacy, or maintenance of health records. However, ADHD coaches are governed by the International Coaching Federation (ICF), a global organisation providing competencies, standards and ethics for their members. ICF coaches are trained to refer clients to therapists if appropriate, and also work collaboratively with clinicians.

The ICF Code of Ethics provides appropriate guidelines, accountability and enforceable standards of conduct for all ICF members, and there is a formal ethical conduct review process for alleged breaches of ethics. It was noted by the GDG that not all ADHD coaches are members of the ICF and therefore consumer caution is required. Refer to Principles and Assumptions section for further information regarding clinician competency and credentials.

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