Review of Research Study Pertinent to ADHD Coaching

Prevatt, F., Lampropoulos, G. K., Bowles, V., and Garrett, L. (2011). The use of between session assignments in ADHD coaching with college students.

Journal of Attention Disorders, January 2011; vol. 15, 1: pp. 18-27., first published on December 17, 2009 

Introduction:

In 2011, a number of articles in the Journal of Attention Disorders addressed issues pertinent to coaching college students. These topics included time-estimation, study habits, self-concept, and resilience and well-being. One article addressed an important tool for coaches: the value of between session assignments (BSA) in predicting outcomes of treatment. This study examined the use of BSA in “coaching” for 13 college students with ADHD.

Brief Overview:

In the psychology field, some research suggests that compliance with between session assignments (BSA) predicts outcomes of treatment.

Method: This small study examined the use of BSA for 13 college students with ADHD in a university setting, participating in a program of 8 sessions of structured coaching, a process defined by Swarts and colleagues (2005). Sessions were held with supervised psychology doctoral students.

Measures: These doctoral students, referred to as coaches in the study, rated clients on motivation and functioning both before and after the series of sessions. At the end of the 8 weeks of coaching, these coaches also completed a coaching outcome form, developed for the study, for each client.

Outcomes: Most frequently utilized BSA areas included studying for courses, time management, organizational skills, healthy lifestyle choices, and social activities. Coaches reported quite variable compliance with BSA, despite their apparent use in helping clients with problem areas. Clients who paid for their own coaching, males, and clients whose therapists put BSA in writing were more likely to put time into the BSA although those characteristics did not predict coaching outcomes. Barriers to completing BSA included forgetfulness, lack of time, lack of motivation, fear or avoidance, and lack of ability. The primary factor accounting for improved client motivation and functioning over the course of the 8 weeks was found to be a client’s motivation to please parents.

Some Strengths and Limitations of this Study:

Strength

  • This study explores a topic of great importance in ADHD coaching: the use of between session assignments for clients.

Limitations

  • The coaching was done by psychologists, and it is not clear how this might differ from coaches working with clients. In particular, the flexibility of coaching to design a process tailored to each individual might impact outcomes.
  • As the researchers acknowledge, the very small sample size (number of participants) means that, statistically, correlations appearing not to be significant in this study might appear more notable were a larger group of clients involved. So, these findings cannot be considered definitive or complete.
  • Further, it is not known whether the measures (tools used to quantify a concept — in this case, ratings of function and motivation before and after the eight sessions and an outcome form completed after the sessions) used to quantify motivation and progress are actually valid measures of those concepts.
  • Additionally, this study only examined functioning, motivation and outcomes from the coaches perspectives. Examining the role of BSA and other variables on progress from the clients’ perspectives might have yielded other findings, as well as better acknowledged the client as the center of the coaching model.

Possibilities for Putting this Research into Practice:

  • Putting between session assignments (BSA) in writing for clients may improve the likelihood that clients will follow-through with these actions.
  • Successful BSA should be “concrete, specific, and appropriate for the client’s skill level and overall functioning” (Tompkins, 2002).
  • Assisting clients in examining and strategizing around potential barriers to completing BSA may be helpful.
  • Although not always practical, it appears that having clients commit some of their own money to pay for coaching, and examining the importance of clients pleasing parents by taking action, may encourage follow-through.

Questions for Coaches to Consider:

  • How frequently do you use BSA in your practice? For what types of issues?
  • What do you notice about client follow-through with BSA in your own practice?
  • What role might immediate and meaningful incentives (Mitchell, 2010; Tompkins, 2002) play in encouraging follow-through with BSA among your clients?
  • How valuable might it be to explicitly link BSA to a client’s longer-term goals (Prevatt, et al., 2011)?
  • What do you see as the relationship between completing BSA and eventual coaching outcomes among clients you work with?
  • If BSA are important in your practice, how might you strategize with clients around possible barriers to completing BSA?

References:

Mitchell, J.T. (2010). Behavioral approach in ADHD: Testing a motivational dysfunction hypothesis. Journal of Attention Disorders, 13(6), 609-617.

Swartz, S., Prevatt, F., & Proctor, B. E. (2005). A coaching intervention for college students with attention deficit/hyperactivity disorder. Psychology in the Schools, 42, 647-655.

Tompkins, M. A. (2002). Guidelines for enhancing homework compliance. Journal of Clinical Psychology, 58, 565-576.

Note: This review was written as a service to ACO members by the ACO research committee and represents the perspective of that committee. ACO members have free access to the Journal of Attention Disorders as an ACO member.