Treating ADHD in high-functioning adults - coaching? Self-help?
October 18, 2013 1:11 PM   Subscribe

I am a high-functioning adult who recently got diagnosed with ADHD. I have started taking medication, but am also considering therapy and coaching. However, I'm feeling skeptical about a recent referral for an ADHD coach. Does anyone have experience with these folks?

My main issues are time management, organization, procrastination, planning, and I think transitioning to internal motivation rather than external motivation. I am on 30mg of Vyvanse and it has helped a lot, not just in the work I do, but I've noticed improvements in things like driving or keeping my house clean. But I still have trouble with big-picture planning and motivation.

I don't like the idea of just being on medication without some kind of therapy. (I also have a research background in clinical psychology so am biased in that way, I guess) But the neuropsychologist who diagnosed me only gave me a referral for one person, and it took forever for her to get back to me about it, so I'm not confident about more recommendations.

She recommended someone who is an ADHD coach/educational consultant, and who described herself as having a corporate background in sales/management. She definitely said "I am not a therapist." She doesn't take any kind of insurance, and her rate is $100/hour. I guess she works with clients to develop an individualized plan of treatment to focus on their strengths/weaknesses? She also mentioned being affiliated w/ the Hallowell Center in NYC. (I am in MA)

I would be happy to spend like $500 if I thought it would really help, but I honestly haven't read a lot of the self-help books on the topic, so haven't even tried that route yet. I also like my psychiatrist a lot - he actually listens to me and how I've been doing, and my appointments don't feel cursory. So maybe that in conjunction with my own research and strategies should be enough. Has anyone tried ADHD coaching and found it helpful? Are there specific kinds of therapy that I should look into? Related, are there any books that provide genuinely helpful strategies but DO NOT dumb down the material or shy away from evidence-based explanations? I have done a little research, but a lot of the material seems to be aimed at folks who are a lot more severe than I am.

In a larger sense, I am definitely concerned about being one of the "worried well." I am really very successful in most senses of the word (educational, occupational, relationships) and I definitely don't have severe ADHD. I have, at most, a mild case, and it is definitely causing some strain in my life, but I generally have good coping skills and resources already. I don't even know if I really NEED a coach or if I should basically try harder on my own first, basically. Also, I work in research, I endorse evidence-based therapy and medicine, and when I was talking to this person on the phone, my BS-meter was just dinging a ton. So - if you have any experience with this kind of treatment, I would appreciate your thoughts. Thanks.
posted by anonymous to Health & Fitness (10 answers total) 19 users marked this as a favorite
Are there specific kinds of therapy that I should look into?

CBT helps a lot, because ADHD necessarily makes you create coping strategies/patterns that "work" while you're dealing with it unmedicated, but can be very counterproductive when you're actively treating the disorder. And you've been establishing these patterns your entire life so it helps quite a bit to have someone point them out to you rather than try to look for them yourself.

The practicality of CBT is great because there's often no other reason to many of these behaviors save for "I had to do this to cope with my ADHD and now it's just a part of how I work." So you don't need to do any analytic soul-searching, you just need to re-train your brain to work alongside your new attention span.
posted by griphus at 1:23 PM on October 18, 2013 [1 favorite]

If a metaphor helps: treating ADHD with CBT (along with medication, of course) is very much like physical therapy after an operation for a lifelong ailment.

Picture that you've spent your entire life walking with a deformed knee. You hobble, and it's awkward and hell on the back and all your other body parts, but it's the only way you can walk because your knee is messed up. You can't walk right because your body won't let you, so you never learn to walk right.

Now, if you get the knee surgically replaced, you have the opportunity to learn to walk again. This time, without having to compensate for a bad knee, and without the extra stress and strain your bad knee put on your entire body.
posted by griphus at 1:30 PM on October 18, 2013 [4 favorites]

If you are motivated to change, you can do a lot on your own to change your habits. Try some books and the tips listed in many threads here regarding taking advantage of the focus that medication has given you.

If you are in a relationship, I would encourage you to ask that person if they think you'd benefit from ADHD coaching. One of the things about ADHD, even very high functioning, is that you are not as likely to see yourself from another person's point of view or see how your symptoms affect other people.

And find someone who responds quickly to your inquiries and has some training, at least, in helping people with ADHD. Psychology Today is probably a good place to start. Also this might be helpful: Your guide to ADHD coaching. That will tell you what coaching is for and what it can do, etc.
posted by AllieTessKipp at 2:34 PM on October 18, 2013

There is also a Hallowell Center in Sudbury, MA. The website looks a little too slick, but Dr. Hallowell is actually quite well-respected in the field of ADHD. I would recommend his book Driven to Distraction. I read it when someone suggested I might have ADHD and found it extremely informative (though maybe not as serious as you are looking for? He uses a lot of personal anecdotes about his own ADHD, as well as from his patients, to illustrate his points). I also read You Mean I'm Not Lazy, Stupid or Crazy?, which I remember as being ok - useful to learn about ADHD, but not as useful for practical steps on how to deal with it.

As for coaching, it is definitely a standard "treatment" for ADHD, though I don't have any personal experience. However, it sounds like you didn't get a good vibe from the woman you talked to and I would pay attention to that. Maybe see if you can talk to someone else who does coaching to get a second introduction to the field? Not sure where in MA you are, but I know Commonwealth Psychology Associates does ADHD coaching and CBT.
posted by dormouse at 2:45 PM on October 18, 2013 [2 favorites]

+1 to the suggestion for Driven to Distraction. It's a little dated now, but a decent book. I never found a "coach" that really worked for me, perhaps because, like you, I was already considered "high-functioning" when diagnosed and had coping mechanisms in place.

What was extremely helpful to me was meeting some other adults who had ADHD. I went with great reluctance to a meetup in my area. Those folks "knew me" in a way that it seemed no coach ever could, and some of the lifehacks from those conversations are ones in daily use, 8 years later.

Instead of trying to fix ADHD, maybe look at those areas of "strain in your life." Work with your therapist to figure out the root causes, ADHD or otherwise, and hack away at them. IMHO if you find a great coach, awesome, but with a little help from other ADHD'ers and some books, you'll be good.
posted by Kalatraz at 5:11 PM on October 18, 2013

why not meet with the coach once or twice and just see how it goes? The worst that could happen is that you'll have your suspicions confirmed about the coach playing too fast-and-loose and not being empirical enough for your tastes. In that case, you're none the worse off than you are right now. You're not seeing a coach anyway, and you're looking for help, so what do you have to lose besides a couple hundred bucks and an hour or two of time? If nothing else, you can use this coach to get a referral for another coach that might be a better fit.
posted by BadgerDoctor at 5:25 PM on October 18, 2013

Nthing Driven to Distraction but also for adult adhd I found You Mean I'm not Lazy Stupid or Crazy. It really is for adults and it is much more specific to adult issues. Therapy is great if you want it. If you don't IMO there's no reason to.

I use a professional organizer that I found through the my local ADHD support group (I never went to a meeting - just checked their website). She's not a coach per se but she has a lot of experience working with adhd adults. She worked with me on lots of stuff. I only worked with her at most 2 hours since I don't have the patience to do more then that. She came about dozen times but you could probably work in less time. I really found it useful because I can't set up a system but I have no problem following one. So she set up easy systems that I would follow. Not all her ideas worked but I would say the majority did.
posted by lasamana at 6:32 AM on October 19, 2013 [1 favorite]

you can read about any strategy in a book. the value added by any kind of therapist is that you have a person to but pressure on you to actually follow through. whether you need that or not is your call and no one on the internet can tell you the right answer.
posted by cupcake1337 at 10:07 PM on October 19, 2013

Meant to replyt to this a month ago, but eh, I have ADHD. Just found my draft again:

If: You *can* and do read non-fiction or self-help books (sounds like you do, having a research background)
Then: Read a few books on the topic.
This will
1) Familiarize yourself with the common types of ADHD. Help realise what applies to you, and what doesn't - a shared language will help you get the point quicker if you do work with a therapist (e.g. I have these problems with hyperfocus, but I don't get distracted during these activities, etc. Know thyself).
2) Provide the really common problem solving solutions from/for people in your shoes, so you aren't wasting time with a therapist on known-useful problems.

If: You *can't* read non-fiction or self help (many people with ADHD can't stay focused long enough, OR can, but keep putting it off, and off, and off...):
Check out a therapist OR ADD coach type person.
'ADD-Friendly Ways to Organize Your Life' actually discusses the different ways to get people to help you. Sometimes just having someone there keeps you on track (the 'body double'), without them having to do the same task.

Therapist versus coach/organiser-type person:
If you're having issues about what 'a failure you've been as a person' pre-diagnosis, then therapist is useful, or going over the emotional reactions you may have now you have time to breathe (sometimes when things are no longer hectic, all the old stuff can bubble up).
If you just want to structure your life/routines better, and adapt more to your personal way of dealing with life, then sometimes organisers etc spend more time just working on the nuts and bolts of that, make house calls etc.
Therapists can be good for that too, but when I spent about 6 months going over my routines, organisation, to do lists, setting up reminders for the week etc, with my counsellor, and not really talking about anything else, that's when she suggested I go get an ADHD diagnosis.
posted by Elysum at 7:25 PM on November 28, 2013 [1 favorite]

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