Over the decade, coaching has become a popular therapy in the treatment of ADHD. More and people are becoming professional coaches while a number of ADHD coaching schools are opening their doors. But what exactly is ADHD coaching and how does it differ from more traditional therapies?
Based on the coaching model in executive coaching and athletics, ADHD coaching is a present-focused form of ADHD treatment therapy designed to help individuals deal with aspects of their disability that interfere with daily and/or academic or work performance. Unlike psychotherapy, coaching is not intended to help clients work though painful feelings, negative self-talk or self-defeating behaviors. Rather, change is brought about through the coach-like practices of questioning, problem solving, modeling and practicing.1
Behavior treatment has been shown to reduce the symptoms of individuals with ADHD. In a 1998 study of psychosocial treatments for ADHD, researchers showed that behavioral parent training and behavioral interventions in the classroom meet the criteria for well-established treatments.2 A second study conducted by the National Institute of Mental Health in 1999 further supported the efficacy of behavioral treatments in reducing the symptoms of ADHD.3 Finally, in a review of the evidence of different treatment options, a third study showed that combined with stimulation mediation, behavioral treatments may help individuals with ADHD to function better to the point of lessening their reliance on stimulation medication.4
The efficacy of behavioral treatment relies on the emotional development of both the patient and their caretaker to implement change. Parents who themselves are ADHD may be less successful at administering behavioral treatment than their non-ADHD counterparts. In addition, not all kids respond well to behavioral treatment due to the severity of their problems. In some cases behavioral treatment can be modified although it may have to be abandoned altogether in the case of a child struggling with an associated condition such as autism or bipolar disorder.
Behavioral treatment is the second-most effective treatment for reducing the symptoms of ADHD. Studies show that whereas medication is more effective than therapy in reducing the symptoms of ADHD in children, the two combined are more effective than either one alone in obtaining an optimal response. 1
What is it? Behavioral treatment is a type of psychotherapy based on the concept of replacing undesirable behaviors with desirable ones through positive and/or negative reinforcement.
As stated, movement Movement has been shown to promote calmness and attentiveness in those with seeking ADHD treatment. Mind-body therapies, like yoga, especially seem to be helpful for treating Attention Deficit Disorder. On a purely physical level, the stretching and aerobic aspects of yoga can work and ultimately calm the muscles, while the meditative component can help to quite the mind.
According to acupuncture, life force circulates in the body along 12 major energy pathways called meridians. There are over 1000 acupuncture points within the meridian system that can be stimulated to optimize the flow of the life force or qi.
An trained practitioner of Traditional Chinese Medicine (TCM) or acupuncturist will typically diagnose the patient by studying a patient's pulse and using other diagnostic tools. Using the meridian system, acupuncture uses special needles placed into acupoints to rebalance the energy on specific meridian pathways. The intended effect is to correct the flow of energy, and restore health and function. Some practitioners use acupuncture for ADHD treatment.
The Hospital for Sick Children in London conducted a study and it was published in Lancet, a leading British journal. The study demonstrated that most children with severe ADHD were salicylate sensitive, but that 90 percent of these children have additional food intolerances. So while many may benefit from the Feingold diet, the majority of children with ADHD they have more than this one food sensitivity and may need to eliminate other food substances as well. The British researchers performed exhaustive dietary trials, closely supervised by hospital dietitians. After determining that 80 percent of the children had apparent food sensitivities that were causing their hyperactivity, they then performed double blind, placebo controlled challenges with the offending foods. Using this most rigorous clinical research method, the investigators confirmed the presence of food intolerance in the majority of children with ADHD.
The foods to which children with ADHD most commonly had allergic reactions were cow's milk (which included milk, cheese, yogurt and ice cream), corn (an additive in many prepared foods), wheat, soy and eggs. Altogether, 48 different foods were incriminated as triggers for hyperactivity.
The Feingold Diet, created in the 1960s, came about after a pediatrician, Dr. Benjamin Feingold, discovered that many of his patients with ADHD exhibited more symptoms after ingesting foods containing high concentrations of salicylates (a food preservative used in toothpaste, among other things).
Twenty-five years ago the National Institute of Mental Health convened a consensus panel which concluded that 8 to 10 percent of children with ADHD are sensitive to salicylates and benefit from the Feingold diet.
Homeopathy is among the most promising therapies in this category. A number of studies suggest that homeopathic remedies are an effective treatment for reducing the symptoms of ADHD. Additional therapies include:
Once considered a primary agent in the treatment of depression, tricyclics antidepressants (TCAs) have been found to reduce the symptoms of hyperactivity and impulsivity in individuals with ADHD. However, use of TCAs can be risky and should only be used under the strict supervision of a qualified physician.
Types Imipramine and nortriptline are the two type of TCAs most commonly prescribed for ADHD. Imipramine is distributed under the brand name Tofranil whereas nortriptline is distributed under under the brand names Pamelor and Aventil. Desipramine—a third type of TCA distributed under the brand name Norpramin—should only be used as a last resort as its been linked to sudden death syndrome in children.1
Stimulants enhance the speed and fluidity by which messages are passed through the brain’s neural network. They do this by either increasing the release or slowing the reuptake of the brain chemicals used in neurotransmission. The resulting neurotransmitter boost improves a variety of cognitive functions, including the ability to process information, slow down, focus, remember, self-monitor and self-motivate. Stimulants, however, by no means cure ADHD; they only work for as long as they remain in a person’s system. Although stimulant use does not increase intelligence, it can dramatically improve an individual’s academic performance. Stimulants facilitate the communication systems needed for an individual to access their intelligence. This is why so many ADHD dropouts are able to resume their studies once they begin stimulation medication.
Benefits
One of the benefits of stimulants medication is the speed at which it begins working—immediately. Stimulants are also highly effective. Research shows that stimulants work in 80 percent of individuals with ADHD. Many researchers argue that the benefit of keeping ADHD symptoms at bay outweigh the drawback of possible side effects. Indeed, some researchers believe the “side effects” of untreated ADHD in the form of academic failure, low self-esteem, loneliness, social isolation and depression far outweigh the side effects of stimulant medication. Some kids with ADHD have even been known to be suicidal. “Untreated or inadequately treated ADD syndrome often severely impairs learning, family life, education, work life, social interactions, and driving safely. Most of those with ADD who receive adequate treatment however, function quite well.”4
Stimulants are considered a first-line therapy for ADHD. In 1999, the National Institute of Mental Health conducted a study that showed that stimulation medication is the most effective means of reducing the symptoms of ADHD.1
The study is among 200 additional well-controlled studies confirming that stimulation medication as the fastest and most effective treatment against ADHD symptoms.2 That said some studies and anecdotal evidence have questioned its safety and long-term efficacy.
Types of Stimulants
Generally speaking there are two different types of stimulants: methylphenidate and amphetamines. A third type of stimulant—magnesium pemoline (Cylert)—lost its FDA approval due to its high risk of causing individuals to experience liver failure. A list of specific stimulants and their brand names is as follows:
Short- Versus Long-Acting Formulas
Stimulation comes in short-, medium- and long-acting formulas. However, the American Academy of Child and Adolescent Psychiatry (AACAP) recommends starting with the shorter-acting formulas before trying a longer-acting formula. There are several advantages to long-acting formulas:
In roughly 20 percent of the cases of people with ADHD, stimulants don’t work. This is the main reason why some individuals will turn to a non-stimulant instead. Individuals may also choose a non-stimulant due to the adverse side effects of stimulants. That said, all medications have side effects; non-stimulants are no exception. Finally, a third reason why individuals may choose a non-stimulant is to treat an associated disorder at the same time. For the purpose of treating ADHD, non-stimulants are grouped under the following types: antidepressants, antihypertensives, mood stabilizers and neuroleptic drugs. A fifth type, unceremoniously known as simply “non-stimulant,” is used to categorize the selective norepinephrine reuptake inhibitor atomoxetine.
Narcoleptic drugs are those specifically designed for the treatment of narcolepsy, a syndrome by which individuals involuntarily fall asleep. Modafinil—sold Modafinil—sold under the brand name Provigil for adults and Sparlon for chidren—is the narcoleptic drug most commonly used in the treatment of ADHD.
Methylphenidate works by blocking roughly half of the dopamine transporters in the brain. This results in slowing the normal reuptake process, causing an increase in the amount of dopamine available for neurotransmission.Dopamine is associated with a number of functions in the brain including cognitive function, voluntary movement, motivation, punishment and reward, sleep, mood, attention, working memory and learning.1 Using brain scan technology, Nora Volkow showed that methylphenidate increases the motivation to do math problems in healthy adults.2 Furthermore, methylphenidate is fast acting, reaching peak concentration anywhere from 30 to 90 minutes after ingestion.3
Antihypertensives were originally used to reduce high blood pressure. However they have since been shown to reduce the symptoms of excessive hyperactivity and impulsivity in children with ADHD. The two most commonly used in the treatment of ADHD are clonidine and guanfacine.
Amphetamine—along with methylphenidate—is considered to be a first-line therapy for controlling the symptoms of attention deficit hyperactivity disorder. Research shows that amphetamines are just as effective as methylphenidate for treating ADHD. The amphetamine medication for ADHD is sold under the brand names Adderall, Dexetrine, Destrostat and Vyvanse.
Clinical Interview An ADHD diagnosis begins with a clinical interview by a qualified mental health professional. During this interview, the identified patient will be assessed based on their adherence to the diagnostic criteria as outlined by either the American Psychological Association’s Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) or, in Europe, the International Classification of Diseases, Tenth Edition, (ICD-10).
Symptoms must be observed in two environments such as at home and at school or at home and at work in order to meet the criteria. Additionally, the practitioner takes a detailed history of the individual’s difficulties both directly (by talking to the patient directly) and indirectly (by talking to the patient’s family members). Ideally, the history would include a list of the patient’s potential strengths and talents. The interview should also include a thorough screening for other psychiatric disorders.
Psychological Tests In addition to the DSM-IV and the ICD-10 criteria, a number of psychological tests can help to diagnosis ADHD. Among the most popular include The Conner’s Parent and Teacher’s Rating Scale for children and the Brown Attention Deficit Disorder Scale for adolescents and adults. Individuals with ADHD may also benefit from the Wechsler Intelligence Scales for Children, Fourth Edition and the Wechsler Adult Intelligence Scales, Third Edition. Whereas ADHD is unrelated to an individual’s overall intelligence, both these tests offer certain subsets that are fairly sensitive to the areas of the brain most affected by the disorder.
Medical Exam In addition to conducting a clinical interview, all diagnostic evaluations should include a medical exam. A number of medical conditions can either mimic ADHD-like symptoms or complicate the treatment. Conditions that produce ADHD-like symptoms include thyroid dysfunction, hearing loss and psychiatric disorders such as bipolar disorder. People with ADHD may also suffer from associated health conditions such as migraines, irritable bowel syndrome and substance abuse.
Additional Testing In addition to the clinical evaluation, practitioners may order additional tests to help confirm the diagnosis. The following is a list of the different types of tests:
Individuals with ADHD are six times more likely to have another psychiatric disorder. “ADHD has extraordinarily high rates of comorbidity with virtually every other psychiatric disorder listed in the DSM-IV,” Brown states in the Attention Deficit Disorder: The Unfocused Mind in Children and Adults. (Comorbidity is when two disorders are present at once.) Children with ADHD are at a greater risk of the following conditions:
In addition, children with ADHD are two to three times more likely to have a learning disability such as reading disorder, mathematics disorder or written expression disorder. Some believe that some of the symptoms of ADHD such as impaired memory may contribute to learning disorders.
Similarly, adults with ADHD are at a greater risk of also suffering from anxiety, mood disorder, impulsive disorder or psychiatric disorder in addition to be more likely to abuse substances such as drugs and alcohol.
Other disorders associated with ADHD include language disorders, PTSD, bipolar disorder, obsessive compulsive disorder and Tourette’s syndrome.3
Genetics
ADHD is strongly associated with genetics. One in four children with ADHD has a close relative with the disorder whereas, parents and siblings of ADHD kids are two to eight times more likely to develop the disorder themselves.1 Molecular genetic studies have identified several genes that are believed to be associated with the disorder including those involved with the release, reuptake and transformation of dopamine and norepinephine. That said, of genes that have been identified, none have been found to have much effect, leading researchers to conclude that the disorder is likely linked to several.2
ADHD is believed to have a heritability rate of 76 percent. However, how much of the disorder is nature over nurture is questionable. Some researchers estimate that between 40 and 80 percent of the genetic variance for personality may be nature-based.3 Thus while ADHD has a strong genetic influence, environmental factors such as food additives, toxins and excessive stimulation play a significant in the disorder’s development and evolution.
Neurotransmission
ADHD symptoms are believed to be associated with what is known as the executive functions of the brain.4 Acting as a conductor, the executive functions prioritize, integrate and regulate the brain’s other cognitive processes such as planning, mental flexibility, abstract thinking, rule acquisition, initiating actions (both appropriate and inappropriate) and selecting relevant information.5 Non-localized, these executive functions are linked through a complex nerve network that communicates through neural transmission. A problem with the network of the chemicals used to send and receive messages can cause a breakdown in communication.
In his book Attention Deficit Disorder: The Unfocused Mind of Children and Adults, Thomas E. Brown suggests that ADHD is the result of a defunct network. Thus, even in the case where the individual has an ample supply of the chemical that fuel the system—neurotransmitters—messages still aren’t getting through. According to Brown, this conclusion is supported by more than 200 well-controlled medication studies that show that stimulants temporarily reestablish this circuitry:
The results from these many medication studies clearly indicate that ADD syndrome is essentially a chemical problem, specifically an impairment in the brain’s management system. Just as diabetes is a disease that reflects impairments in the body’s processing of insulin, ADD syndrome is a disorder that reflects impairments in the brain’s processing of dopamine and norepinephrine.6
Brain abnormalities
The brains of individuals diagnosed with ADHD are different than those in people without the disorder. One study showed that the brains of children with ADHD were slightly reduced, particularly in the prefrontal cortex on the left-hand side of the brain.7 Additional studies show abnormalities in the fiber pathways that connect the frontal lobes and the cerebellum.8 ADHD has also been linked to decreased levels of blood flow to the brain and low levels of cerebral glucose. In a 1990 study using proton emission topography (PET), researchers found that cerebral glucose metabolism was 8.1 percent lower in adults who had been diagnosed with ADHD as children than in normal adults.9 However, when the authors of this study repeated it three years later with adolescents, no significant differences were found between the “hyperactive” and “normal” brain.10
Diet
An exhaustive number of studies have linked ADHD to dietary factors such as low levels of essential fatty acids, mineral deficiencies, synthetic additives, food additives and refined sugar.
Perinatal/Neonatal Factors
Children born to women who smoke or drank during their pregnancy may be at risk of developing ADHD. Additional perinatal risks include moderate-to-severe physical illness during gestation, symptoms of miscarriage and/or premature delivery and respiratory infections. ADHD has also been linked to a number of issues related to a child’s birth and first month of life. Premature babies are at a greater risk of developing ADHD as are infants who suffer from seizures, decreased levels of oxygen to the brain, mild speech retardation, brain injuries and fever. Finally, studies show that infants who are exposed to lead or manganese and/or are weaned prior to three months are at a higher risk for ADHD.19
Thyroid Dysfunction
Thyroid hormones are vital to the regulation of nerve maturation. Research shows that roughly 50 to 70 percent of children who are resistant to thyroid hormones have ADHD. Similarly, studies showed that the offspring of rats that had hypothyroidism were more likely to be hyperactive and restless, and prone to panic. (Hypothyroidism is when the thyroid fails to make enough hormones.) Similarly, in a study comparing the children born to women from “moderately iodine deficient” versus “marginally iodine deficient” areas at the time of gestation underscores the critical role of the thyroid of warding off the symptoms of ADHD. The study showed that whereas none of the children bore to the mothers living in the marginally iodine sufficient area developed ADHD, a total of 68.7 percent of children born to the mothers from the moderately iodine deficient area did.20
Trauma
Children with ADHD are more likely to be abused than children without the disorder. According to Thomas E. Brown, author of Attention Deficit Disorder: The Unfocused Mind in Children and Adults, children with ADHD may be more at risk of emotional and/or physical abuse from fed-up friends and family members. In a study of girls with ADHD, a significantly higher number reported having been abused than those in the control groups.21 Similarly, researchers found that a greater number of children living in conflict zones such as the Gaza Strip were more likely to have ADHD than those living in areas free of conflict.22 Research shows that abuse is also more prevalent in ADHD adults. In a controlled study of 57 adults, emotional abuse and neglect was more common among the ADHD adults whereas sexual abuse and neglect was more common among the women with the disorder.23
Societal
A fair amount of evidence suggests that ADHD is a manufactured diagnosis. Child and adolescent psychiatrist Dr. Sami Timimi points out that there is no known cause for ADHD and there exists no specific cognitive, medical and/or neurological markers for diagnosing it. In addition, there is no specific treatment for ADHD and stimulation medication has been said to have the same effect on otherwise normal children. Finally, stimulation medication has generated huge profits for the pharmaceutical industry. “Thus the mainstream dogma on ADHD is contaminated and misleading.” Under the current medical model, ADHD becomes a convenient scapegoat for parents and teachers to shirk from their responsibilities as caretakers and for the community members to disregard societal flaws such as the loss of the extended family, the pressure on schools, the breakdown in the moral authority of adults and increasingly frenetic pace of family life.24
