You’ve got ADHD.  Do you need therapy or coaching?

IMPORTANT: This blog is not a substitute for therapy, but provides evidenced-based education for the purposes of self-help, or to compliment the therapeutic process. ​ ​This blog is non-monetized.

Have a new ADHD diagnosis?

The road that leads to an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis can be a real journey – a long and sometimes confusing process. Now that you are here, you might be asking yourself: 

  • What kind of treatment do you need?
  • Who should you work with? Where do I find them? 
  • What is optimal ADHD treatment supposed to look like? ​

Maybe you were recently diagnosed with ADHD, or maybe you’ve decided you need some extra support with your ADHD, so you’re exploring coaching and therapy as an option, but not sure which to choose. 

If there’s anything that can discourage an ADHD brain besides complete disinterest, it is not knowing the next steps

​An ADHD brain tends to avoid things when any aspect is unknown or unclear (it turns out our brains uses dopamine to kick start the ability to perform cognitively complex tasks!), so it’s important to break down what these treatments entail with someone who can help.

The three pillars of ADHD treatment are medication, ADHD-adapted psychotherapy, and executive function coaching.

​The medication piece can take some time to figure out – the right medication and the right dose. The medication gives your brain what it needs to regulate important functional neurotransmitters and target common symptoms such as distractibility, procrastination, attention, mood lability and impulsivity.  But, as the saying goes, “pills don’t teach skills” …  which is where your ADHD-trained therapists and coaches come in.

​It’s especially important to work with a professional who knows ADHD because the strategies and treatment approach that work for people without ADHD don’t often work for those with ADHD, whose brains are wired differently.

“ADHD-adapted” therapy

Psychotherapy for ADHD falls under the umbrella of ‘psychosocial’ treatment with a regulated mental health professional. The goals include targeting various symptoms, understanding how they manifest in your life, and comorbid disorders such as depression, anxiety and trauma that can occur as a result of untreated ADHD.  Therapy is focused on healing, understanding, and managing the emotional aspects and challenges of living with ADHD, and processing feelings and past experiences. With any kind of therapy, your therapist should be using an approach based on your needs and goals.

​This should be a collaborative process that shifts, and changes as new information comes up.  Evidence-based therapy approaches for treating ADHD include behavioural therapies such as Cognitive Behavioural Therapy (CBT) and Dialectical Behavioural therapy (DBT).

While global guidelines for ADHD Treatment have often recommended ‘psychosocial’ interventions, none thus far have detailed what an ADHD-adaption should look like.  Most ADHD psychosocial clinical trials are conducted with children and adolescents. There are some emerging data coming on adults with ADHD, and it lines up with our clinical experience in working with a large population of adolescents, couples, families and individual adults with ADHD over the past 7 years. 

At Dig A Little Deeper, our therapy team has been training other therapists across Ontario (and beyond) on how to assess and facilitate ADHD-adapted psychotherapy.  We know when we are working with someone with ADHD, we consider where an ADHD person is at in a much more comprehensive way, including whether or not they are taking medication, when they were diagnosed, what their experience’s have been thus far, family history, relationship history and challenges, whether there are emotional barriers to work on to heal any past trauma commonly associated with ADHD and finally, what kind of support they have around them at home. 

ADHD coaching

ADHD coaching is also an individualized and collaborative process that targets building executive functioning skills. Our executive functions are the skills that allow us to plan, organize and start and finish tasks. When you have ADHD, these skills are usually under-developed (you were too busy trying to survive in your neurotypical world!). Things like regulating attention, organizing, planning, and regulating emotions are a lot more difficult.

​Coaching offers a practical way to help clients build the skills and apply strategies that help them manage executive function deficits and set and meet goals that are meaningful to them. When your primary goals are developing routines, getting tasks done, and managing time to meet deadlines, you may be looking for coaching.
 
Both ADHD coaching and therapy are often strength-based, which means we work to find your strengths to help you leverage them, compensate for the weaker areas, and develop new skills. Both treatments help clients build self-awareness.

So… should I start therapy or ADHD coaching?

First, think about what your goals are and what areas you want to target, or what changes you would like to see in your life. 

​Then you want to make sure your therapist or coach knows ADHD.  You may have to consult with multiple coaches and therapists to see who the right fit would be for what you’re looking to address (see more on fit at the end). 

​Some people work with a coach and a therapist simultaneously since there are often emotional blocks that can also impact clients’ ability to get tasks done.  However, not everyone has the time, resources, or energy to see both a therapist and an ADHD coach, so working with a therapist who knows ADHD and can incorporate both is the ideal option. 

​However, you should know, meeting your emotional needs in therapy and doing more practical work with ADHD coaching may require more frequent sessions to make space for both your emotional and day-to-day needs.

What to expect

When orienting clients to the process of ADHD therapy and coaching, there are a few things I like to go over and remind them of periodically throughout treatment.

Both ADHD therapy and coaching are not about “fixing” you or trying to make you better at doing things like everyone else… you’ve likely already tried that your whole life, maybe, and we know it’s not working. 

ADHD therapy and coaching is about learning about ADHD and how it presents for you. We are building self-awareness and learning about your unique brain and symptoms, and how they show up in your life, and how to work with your brain.  Then you are learning how to advocate for yourself and navigate your world to meet your unique needs, which can often include learning how to prioritize, delegate, automate and outsource.
 
So many clients come into session wanting all the ADHD tools and tricks and working with so many ADHD clients, we have collected a lot like the pomodoro method or body doubling. However, the strategies, tools and tricks are only effective when we really know ourselves and when we know why we are applying them.

​Since everyone presents so differently, there’s no one size fits all!  We often need to know root causes which can be a combination of lifestyle, upbringing, experience etc, in addition to ADHD.  This also means that we are learning about what works for you through the process of externalizing your thinking. 

​For example, it is often harder for ADHDers to think inside their head.  They usually need to externalize their thinking by talking it out or writing it down.  Because of this,  ADHDers may get labelled “chatty” or talkative, but this is just one of the ways they organize their thoughts since its harder to do it internally.

This is just one example of those “Aha! moments” and how learning about ADHD and its presentations, and your brain can eliminate so much shame while increasing self-awareness and understanding.

​This is also one of the reasons taking time for yourself, sitting, and processing your thoughts and feelings with a professional is so beneficial. Through this process we also learn what works for you through exploration, trial, and error.

One tool I always like to use with all my clients is coach Cameron Gott’s ADHD hierarchy of needs:

2019 Cameron Gott’s Hierarchy of ADHD needs

2019 Cameron Gott’s Hierarchy of ADHD needs  First things first. This tool helps conceptualize the idea of meeting their unique ADHD needs

We often neglect our most basic needs and should identify and build a strong foundation and meet these needs first so that we can meet our higher-level needs (which are often the things that people are seeking ADHD treatment for).  Since the physiological basics like sleep, nutrition, and movement/exercise can especially impact ADHD symptoms, spending time exploring those needs and finding ways to build a balanced lifestyle is important and usually one of the first steps.  I work with clients, personalizing Dr. Nowell’s SPECT acronym to further reiterate the importance of Sleep, Protein, Calendar, and your Team for thriving with ADHD.  These are just some of the tools I use to begin to build clients’ self-awareness and knowledge.
 
As a last note, it is always more convenient for other people when you do things in their way (teachers, parents, family, significant others, friends, etc).  Maybe the people in your life have an idea of how you “should” do things (based on how they’ve done things), but through this therapy and coaching process one of the goals is recognizing what helps you thrive and doing what works for you.  Further, how to connect and share this with the important people in your life, to deepen and improve your relationships. 

And the good news is, you probably already know what works for you! You have just felt shame about your brain’s unique ways of responding to your world, and the things that work for you have been hidden behind the expectations, assumptions, and misconceptions about how things “should” be done… which are usually the systems created by and for neurotypical brains.  Working with a professional that knows ADHD can help you reveal those truths.  It can take time to shed those old limiting beliefs and assumptions but it’s important because we cannot treat ADHD through the lens of shame and blame. It just doesn’t work!

​Next step: Find your best fit!

Some questions you can ask a potential ADHD coach/therapist:

  1. ​How long have you been working with ADHD?
  2. What ADHD specific training and continuing education and/or personal experience do you have?
  3. What is your basic approach to coaching/therapy?
  4. What should I expect in a session?

Learn more about all of the most up-to-date treatment, research and global perspectives and our approach at Dig a Little Deeper, through our ADHD Resource Hub

ADHD specific Resources

Start with our first ADHD coaching article from The Dig Deeper BlogChristina’s Pro Tips: Mastering your Beautiful Brain.​​​​​

References

Copper, J. (Host). (2022, February 22 7 Insights into the ADHD Brain That Transforms Life [Audio Podcast episode]. In On ADDitude: Inside the ADHD Mind

Gott, C. (2019). Hierarchy of ADHD Needs. Cameron Gott. https://www.camerongott.com/hierarchy-of-adhd-needs

Fullen, T., Jones, S. L., Emerson, L. M., & Adamou, M. (2020). Psychological treatments in adult ADHD: a systematic review. Journal of Psychopathology and Behavioral Assessment42(3), 500-518.

Fleming A, McMahon R & Moran L: Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students. J Atten Disord 2015; 19:260-271.  

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Picture of Julia D'Addurno, H.BA, MACP

Julia D'Addurno, H.BA, MACP

Registered Psychotherapist (qualifying) Julia is a Registered Psychotherapist (qualifying) with Dig A Little Deeper and also completed her graduate training with us.  Julia completed a double major undergraduate degree in Psychology and Creative Writing, before enrolling in her Masters program to become a Psychotherapist, and enjoys using her creative skills to bring mental health awareness & healing to her readers.

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