By David Rabiner, Ph.D.
Originally published in Attention Research Update
Many students with ADHD struggle to be successful in college. As noted in a prior issue of Attention Research Update by Linda Hecker of Landmark College, college environments tax executive functioning skills such as managing time and organizing tasks. The college day is quite unstructured compared to that of high school – students may have only 1 or 2 classes a day, with lots of “free time” in between. There are more long-range assignments, and no study halls or hovering parents making sure students are on track (see www.helpforadd.com/2006/july.htm ). As a result, students with ADHD must rely more on their own abilities to regulate their behavior over time in pursuit of important goals, and they frequently have greater difficulty than their peers engaging consistently in such self-regulated behavior.
Interventions that focus on developing and enhancing important self-regulation skills – as well as other important executive functions – may be especially helpful for college students with ADHD. One intervention that focuses directly on this is ADHD Coaching. Coaches help individuals with ADHD by providing them with a clear understanding of the nature of ADHD and how it affects their daily life. They work with clients to identify important goals and to develop plans and strategies for achieving them. They help clients to monitor their progress towards these goals, identify when they are getting derailed, and develop strategies to more effectively pursue goals over time. Thus, coaches can help students develop their ability for effective self-regulated behavior, and provide an important external source of regulation, as those abilities are developing. In theory, this should help college students with ADHD experience greater academic success.
How does this approach actually work for college students with ADHD? This question was addressed in a study recently published online in the Journal of Attention Disorders [Parker et. al., (2011). Self-control in postsecondary settings: Students perceptions of ADHD college coaching. Journal of Attention Disorders, DOI:10.1177/1087054711427561]. Participants were 19 students from 10 different campuses who were selected from a larger sample of 88 students with ADHD who had been randomly assigned to receive the coaching intervention.
Two primary questions were addressed:
1. What is the effect of ADHD coaching on students’ perceptions of the process they use to achieve or maintain academic goals such as GPA? And,
2. What benefits do students associate with coaching services?
The study made use of extensive interviews with students to obtain their impressions of the coaching experience and how it was helpful to them. There was also a quantitative component of the study that evaluated the impact of coaching on students’ reports on a variety of rating scales, as well as on objective indices of academic functioning such as GPA were collected. A summary of these findings is available at http://edgefoundation.org/information/research/ (Note – The study was sponsored by the Edge Foundation –www.edgefoundation.org – an organization focused on providing effective coaching to students with ADHD. I have no relationship at all with this foundation.)
What did coaching consist of?
Coaches focused on seven major areas when working with students: scheduling, goal setting, confidence building, organization, focusing, prioritizing, and persisting at tasks. These areas were selected to directly address the problems in executive functioning that many students with ADHD experience.
Coaches and students engaged in weekly 30-minute phone calls during which coaches routinely asked students about their academic goals as well as their physical and emotional well-being. Twenty-five coaching sessions were provided. Coaches worked with students to break larger goals into a sequence of smaller tasks and to create systems for remembering to act on those tasks. There was a focus on developing effective time management tools, and creating more balanced schedules that allowed for regular exercise and a good sleep routine. Although coaches empathized with students who reported feeling demoralized and stress, the focus was on helping students identify concrete steps they could take to address the cause of those feelings.
In addition to the weekly phone sessions, coaches communicated with students frequently via text, email, and shorter calls. Students thus received regular reminders about their goals and plans and developed a sense of being accountable for their progress. Frequent communication also enabled coaches to track students’ pursuit of their goals/plans with greater frequency and to intervene earlier when students were falling off.
This focus on immediate problem solving, as well as regular contact between scheduled sessions, are important distinctions between ADHD coaching and more traditional approaches to therapy with young adults.
As noted above, this portion of the study was qualitative in nature and involved one-on-one in person interviews with students at each campus. Interviews were transcribed and then coded using specially designed software that identified common themes across them. For example, themes that emerged included ‘goal setting skills’ and ‘time management tools’, indicating these were areas consistently discussed by the students.
Once important themes were identified, researchers carefully reviewed the transcripts to identify material that is directly relevant to each theme. This enabled the researcher to compile a comprehensive account of students’ feelings within each theme/category for review. By reading through the interview material relevant to each thematic area, the researchers develop an overall sense of students’ experience relevant to each area.
This is a very different method from tradition quantitative research that relies more on statistical analysis of quantitative data. However, when proper qualitative methods are employed, it can be a rigorous and systematic approach for learning about individuals’ experience that proponents would argue provides a very helpful complement to quantitative methods.
Key outcomes reported by a majority of the students included the following:
1. Coaching help them to work towards their goals more productively. Many reported that their coach helped them to think about and use their time more productively.
2. Students felt better able to manage multiple deadlines using the structures their coach helped them to create and follow.
3. Students felt that coaches helped them develop better organizational strategies.
4. Students felt that coaches helped them to persist towards attaining their academic goals when barriers initially impeded their efforts.
5. Students felt that the frequent contact between sessions facilitated their problem solving and strengthened their motivation to pursue their goals. It also helped them feel more accountable towards meeting their goals.
6. Coaches helped students to develop more realistic academic goals as well as more realistic plans for attaining them.
7. Students reported increased feelings of self-efficacy regarding their ability to successfully manage the demands of college life. As a result, most students reported greater feelings of well-being and increased confidence about their future success.
8. Students described more self-regulated behaviors as an important benefit. That is, they felt better able to consistently direct their behavior towards attaining the goals they had set for themselves.
It is noteworthy that despite the clearly positive impact of coaching that students reported, their comments were varied on whether coaching directly improved their GPA. This is consistent with the quantitative findings summarized at http://edgefoundation.org/information/research/ in that students’ self-ratings indicated significant gains in study and organizational skills compared to control participants but no significant changes in GPA.
This is important for several reasons. First, it indicates that students did not regard coaching as a panacea. Although they clearly found it to be helpful in the ways noted above, they were circumspect about its impact on their objective academic performance.
Second, this more nuanced view increases the credibility of the positive reports they provided. That is, the fact that they did not simply report that it helped with everything suggests that they were providing information about areas where it was helpful that truly reflected their experience.
Summary and conclusions
Results from this study indicate that college students with ADHD experienced coaching to be helpful. The qualitative findings parallel those from the quantitative study where students randomized to received coaching reported significantly greater gains than control participants in their executive functioning, study and organizational skills on a reliable and valid instrument called the Learning and Study Strategies Inventory. This was true even though differences in students’ GPA were not found.
The coaching model employed in this study has great intuitive appeal. The focus on academic goal setting, progress monitoring, dividing long-term projects into a sequence of specific and manageable tasks – along with frequent contact to help students stay on track – is consistent with the emerging consensus of ADHD as a disorder of executive functioning (for one extended discussion of this view go to www.drthomasebrown.com/brown_model/index.html ). From this perspective, coaching may be a better fit than traditional therapy models, and could certainly complement whatever benefits students may receive from medication treatment.
The method by which coaching was provided in this study, i.e., phone calls and contact between sessions via text and email, is also a clearly better match for students’ lives than driving off campus to meet with a mental health provider. This is another important aspect of its appeal.
Future studies of this method should follow students over a longer period to learn whether coaching leads to enduring gains in the skills targeted by the intervention. For example, it would be important to learn whether ongoing coaching is required to maintain the behavioral changes reported, or, whether students are able to maintain these changes on their own after working with a coach for a specified period.
Critics of this approach might argue that because the researchers found no effect on students’ actual GPA or on the number of credits that they earned during their initial year of college, the ‘real’ benefits of coaching are limited. However, it may be that more extended coaching is required to produce these changes as students employ their improved academic behavior over a longer period. In this regard, it is also worth noting that there is no research demonstrating positive effects of medication treatment on students’ GPA; in fact, the kind of study required to determine this has not even been done.
I would also suggest that regardless of how coaching may or may not ultimately impact GPA, the experience that students reported and is something that many parents would want for their child. The fact that students reported feelings of increased well-being and confidence strikes me as important and compelling in its own right.
David Rabiner is an Associate Research Professor, Dept. of Psychology & Neuroscience, Duke University. Attention Research Update is a newsletter available at www.helpforadd.com.