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Tara
04-23-03, 12:07 AM
http://www.sunspot.net/features/home/bal-hf.adhd23feb23,0,5275065.story?coll=bal-artslife-home

Paying attention


For some people with attention-deficit disorder, knowing that a coach will be checking in helps them keep on track.

By Peter Jensen
Sun Staff

February 23, 2003

Diagnosed with attention-deficit/hyperactivity disorder two years ago and worried that the condition was interfering with his work, Kirk Hadsell decided to try something new.

He called in a coach.

Neither a doctor nor a therapist, Hadsell's coach was more like a
personal trainer - only instead of encouraging him to exercise, she
focused mostly on ways to boost his career and, to a lesser extent,improve his personal relationships. They devised a structured plan for him to follow.

One year after first meeting his coach, the 52-year-old home inspector says he's doubled the size of his business and has made progress in his personal life.

"The coaching has been a stellar player in this," says Hadsell, a fatherof three living in Millersville. "It's been the most beneficial."

ADHD coaching has become a booming field in the past five years as a growing number of adults with attention-deficit/hyperactivity disorder look for ways to better cope with their condition. A decade ago, ADHDwas thought to be a problem only in childhood, but today, researchersbelieve the mental disorder persists in 2 to 3 percent of the adult population, too.

People with ADHD have an inability to stay focused on a task. They are often impulsive or hyperactive, and find it difficult to sustain interest. They may not be able to sit still, can get distracted easilyand, over time, may become depressed and develop low self-esteem.

"They often can't match the amount of time available with the amount of things they have to do," says Dr. Joel L. Young, a Rochester Hills,Michigan psychiatrist who treats children and adults with ADHD.

"You or I might have problems with that, too, but for people with ADHD,it's ... much more severe. They often can't get through a day
effectively."

They need consistency

The growth of coaching has not been without controversy. Health
professionals have mixed feelings about whether its benefits are worththe cost - potentially hundreds of dollars per month and none of it covered by health insurance - and whether coaches are adequately trained for the task.

Coaches "may be well-intended," but much of what they do can be handled by a parent or spouse at a far lower cost and perhaps more reliably,says Lutherville psychiatrist Dr. David Goodman of the Adult AttentionDeficit Center of Maryland.

"People with ADHD are by their nature inconsistent, and they may needsomeone in their life to inject that consistency," he says.

Hadsell had always felt like he was a bit different, but could never
understand why. It was not until one of his sons was diagnosed with the condition eight years ago that he began to suspect that he had it, too.

Once the diagnosis was made, he was prescribed a mild amphetamine - verysimilar to the well-known Ritalin - and that proved helpful. He also started seeing a psychologist and explored the ways ADHD had caused him problems - how it hurt his school performance and made him feel different from his peers.

That was helpful, too, he says but it only went so far. He wanted to find specific strategies to help him cope - and therapy wasn't geared to that.

Then came Kerch McConlogue, 50, a Baltimore ADHD coach whom he met at a conference. After an initial "discovery" session where they discussed his goals, they set up a system of regular contact -either by phone or in person to supervise his progress.

Hadsell remembers their first encounter like this: She asked him what he wanted for his business. He said he needed to get more referrals from real estate brokers. How could he get that done? He said he needed tocontact at least six each week.

"Fine," he remembers her saying. "You need to contact (six) brokers. Why don't I call you on Friday when that's done."

With that relatively modest goal made clear - and realizing he'd be held accountable by week's end - Hadsell made the calls to the brokers. This seemingly simple thing had been just what he needed - a structure and discipline imposed on his chaotic life.

"I might have been thinking about books or tools or all the other stuff. I knew Kerch would be calling - and be thrilled when I told her what I'd accomplished," he says.

'It's about performance'

McConlogue, who has been coaching for four years, received her training through a coaching program in California that involved five weekends ofclasses, six months of follow-up correspondence and practice, and thenpassing a final certification test.

She says her clients often are people who own their own businesses and simply need help staying on task. She charges them about $200 a monthfor about two hours of consultation.

"We don't look at the whys of the situation. Often it's a matter of
picking out the next thing they should be doing," she says.

Nancy Ratey, a Boston ADHD coach and a pioneer in the field, says the concept of "coaching" people with attention-deficit/hyperactivity disorder started six years ago as an outgrowth of the life coaching movement. She estimates that there are probably about 1,000 ADHD coachestoday, helping clients age 13 and older, at a cost of $50 to as much as
$300 an hour.

"Make no mistake, coaching isn't about medication or the emotionalissues, it's about performance," says Ratey. "Think of a coach as someone in the passenger seat for a long trip. It's his job to try to help the driver avoid detours on the road."

Most have received training through a handful of coaching schools -often correspondence programs that involve months of instruction. No government regulations or uniform standards have yet been developed. As a result, anyone can call himself a coach.

"A lot of people have glommed onto this term," Ratey admits. "It's a growing field, but it's not been a regulated one."

Still, it's not hard to find people who say they've been greatly helped by ADHD coaching. Linda Lewis, a Denver psychotherapist with ADHD, had a relatively simple goal - to cook Christmas dinner without the usual crises and panic that has accompanied her holiday meals in the past.

She consulted her coach. They decided that a big part of her problem was the distraction of having well-meaning relatives in the kitchen trying to help her.

So last December, she moved her Christmas tree far away from her kitchen, essentially banned her guests from entering her work space on Dec. 25th, and planned out the meal to reduce her stress to the minimum. The meal was a success; there were no frayed nerves.

"We planned it all out a month in advance. It was so exciting," says Lewis, 57. "I'd been working for 12 years to get things to work better."

Lewis' coach never witnessed the results, of course. She lives nearly 2,000 miles away in Ellicott<http://www.sunspot.net/entertainment/visitor/bal-guide-ellicottcity.html> City. They had done all the planning - and regular progress reports - by telephone.

"It's much easier to walk into somebody else's home and organize it than to manage your own," says Corine Schramke, who started working with Lewis last September.

Like many ADHD coaches, Schramke knows the condition from personal experience. She was diagnosed six years ago. She's grappled with many of the issues her clients bring to her today - a tendency to procrastinate,difficulty keeping organized, a desire to do many things at once.

Often, the goals her clients set are modest - a pledge to devote 15 minutes to cleaning up the kitchen counter, for instance, or to sort the mail. She might call them several times each week just to see if the daily goal was met.

"Gradually, you set higher goals," says Schramke, who juggles up to "a couple dozen" clients at a time, talking to each an average one hour each week. "There's a lot of cheerleading involved."

One of her first clients was a graduate student working on her doctoral thesis. She was a top student with a 4.0 average but was worried about getting derailed by the complex paper. On some days, Schramke called her hourly to keep her on track.

Helping people with ADHD become better organized is often a component of therapy, of course, but few if any therapists are likely to call a client four or five times a week the way a coach might. Coaches say they tend not to have long-term relationships with clients - often, they are just there to help a person with ADHD get through a challenging project or change in life.

Marian Herb, who counsels students at Community
<http://www.sunspot.net/entertainment/visitor/college/bal-hl-ccbc.story>College of Baltimore County Essex, says she uses the same coaching techniques to help new college students. Often, mothers fill the role of coaches for teens with ADHD, she says, and college if their first change to function independently.

Last fall, she coached 20 students diagnosed with ADHD and another 45 who had ADHD as well as some form of learning disability.

"With attention-deficit disorder, academics aren't usually the problem," says Herb, the school's coordinator of disabilities services. "It's getting the paper turned in, not missing a critical announcement, or organizing study time."

About empowerment

ADHD coaching has not been endorsed nor condemned by the American Psychiatric Association or by CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder, the non-profit advocacy groupfor people with the condition). Some physicians and therapists make referrals to coaches, but many others remain skeptical.

Dr. Young, the Michigan psychiatrist, says his experience with coaches has generally been positive and he has often recommended them to his patients with ADHD. He admits it's a departure from traditional treatment, "but maybe sometimes what people need is not 50 minutes in somebody's office, but a 15-minute phone call twice a week."

Still, he's had bad experiences with coaches, too. Most often, they've been the result of coaches who felt they could advise a client on matters of medicine. "They aren't trained as therapists and they can'tdiagnose the cause of a patient's problems," he says.

Leaders in the coaching field will be the first to admit they shouldn't be crossing that line. Yet, until the profession adopts standards, the quality of coaching will likely remain an issue.

"Yes, we need good training standards, but the anecdotal information just blares out that this is something that works for people," says Ratey, who has developed a curriculum she hopes can become the industrystandard. "It's simply about empowering people to get out of their own way."
_____

Drugs still recommended

How might coaching fit in with a treatment plan for
attention-deficit/hyperactivity disorder?

Dr. David Goodman of the Adult Attention Deficit Center of Maryland says treatment for someone with ADHD should involve a combination of medication, psychotherapy, education and behavioral therapy includingsome of the techniques coaches espouse.

It would be a mistake, he says, to think that most people with ADHD need only the behavioral therapy, (help with organizational skills, for instance) to cope with their condition.

"For most people, a combination of medication and therapy works best," says Goodman, who treats patients 16 years and older.

Medication for ADHD increases the availability of the brain's chemical neurotransmitters, dopamine and norepinephrine, through the use of stimulants. The most commonly prescribed include Ritalin (methylphenidate), Dexedrine(dextroamphetamine), and Adderall (amphetamine).

Recently, the Food and Drug Administration approved a new drug,
Strattera (atomoxetine), a non-stimulant, for treatment of adults,
adolescents and children with ADHD. Drugmaker Eli Lilly has touted the medication for having fewer side effects than Ritalin and the others. It is also the first drug proven to be beneficial to adults.

Prescribing Ritalin to children has been a controversial issue, but
recent studies sponsored by the National Institute of Mental Health suggest medication has been the most effective treatment of ADHD (but more effective still when combined with therapy).