An Examination of the Effects of ADHD Coaching on University Students' Executive Functioning.

Seven undergraduates at a selective Midwestern university participated in a semester-long pilot study regarding the impact of ADHD coaching services on their academic experiences. Coaches in the study had extensive qualifications, including specific training to address the needs of college students with ADHD. Three major themes emerged from qualitative interviews conducted with participants. First, students reported that their goal attainment skills improved by working with their coaches. In addition, students stated that they enjoyed working with coaches, whom they found to be effective and supportive. Finally, coaching helped students achieve a greater sense of wellbeing and self-regulation. These findings from thematic analysis of interviews are supported by quantitative data including administration of the Learning and Study Strategies Inventory (LASSI), which resulted in a substantial mean gain pre/post in self-regulation, and analysis of students’ grade point average data. It appears that coaching holds promise as an emerging type of academic support for college students with ADHD to promote improved executive functioning. Institutions of higher education provide a range of services today to growing numbers of students with Attention-Defi cit/Hyperactivity Disorder (ADHD). In 2004, Harbour reported that students with this diagnosis had become the second largest subgroup of students receiving accommodations through Disability Services (DS) offi ces after students with Learning Disabilities (LD). Additional sources have reported a rapid rise in the numbers of postsecondary students with ADHD over the past decade (Quinn, Ratey, & Maitland, 2004; Wolf, 2001). Several factors help explain this trend. In 1991, the Department of Education formally recognized ADHD as a handicapping condition that could trigger Special Education services under the “Other Health Impairment” (OHI) category. The number of students served as OHI, including high school students with ADHD who received transition services, quadrupled by 2000 (Horn & Tynan, 2001). By the mid1990s, a wave of literature (e.g., Hallowell & Ratey, 1995) reported the new understanding that ADHD symptoms persisted into adulthood. Then-conventional wisdom that most children outgrew impairment from this disorder gave way to the recognition that adults with ADHD often needed disability-related assistance, too (Ingram, Hechtman, & Morgenstern, 1999). Such fi ndings have contributed to a rise in the diagnosis and treatment of adults with ADHD, including college students (Parker & Benedict, 2002). Campus professionals have sought to understand the nature of ADHD in order to provide the most appropriate support services for this emerging group of students (Quinn & McCormick, 1998). Undergraduates with ADHD are often at risk for becoming overwhelmed by new academic and organizational demands as they transition to postsecondary campuses, which provide substantially less external structure compared to high school and home settings (Katz, 1998; Wolf, 2001). Weyandt and DuPaul (2006) reported that college students with ADHD were at greater risk for academic diffi culties and psychological distress compared to students without disabilities. These transition phenomena can limit students’ ability to persist to graduation without effective academic assistance for attentional impairments. Recent research has replaced an earlier behavioral view of ADHD with a neurocognitive framework. Today, ADHD is widely viewed as a disorder of executive Journal of Postsecondary Education and Disability, 24(2) 116 functioning skills. Executive functioning is an umbrella construct refl ecting self-regulatory mechanisms that organize, direct, and manage other cognitive activities, emotional responses, and overt behaviors (Gioia, Isquith, & Guy 2001). Brown (2005) described six executive functions, including activation (organizing and starting one’s work), focus (sustaining or shifting one’s attention), effort (regulating alertness and adjusting processing speed), emotions (managing frustrations and modulating intense emotions), memory (retrieving, holding, or working with information), and action (monitoring and regulation of effort). The paradigm shift away from a behavioral view of ADHD to one of underlying executive functioning impairments has altered recommendations for practice. Whereas past interventions primarily involved pharmacology and behavior management, the literature now endorses pharmacology coupled with services that help individuals with ADHD enhance their self-management skills (e.g., organization, time management, and emotional self-regulation) (DuPaul, Weyandt, O’ Dell, & Varejao, 2009; Silver, 2010). Findings from a recent National Institute of Mental Health (2007) conference underscore the importance of identifying effective ways to assist students with executive functioning impairments as they transition to adulthood: Despite the short-term effectiveness of current treatments for ADHD, particularly stimulant treatments, the limitations of these treatments for long-term outcomes are increasingly recognized. Among these limitations are failures to achieve long-term gains in academic achievement (e.g., elevated high school dropout rates) and limited vocational opportunities and success (e.g., frequent job changes, greater unemployment). The persistence of defi cits in executive functions, motivational defi cits, and impairments in selfregulation are increasingly acknowledged. Non-pharmacological strategies that help adults with ADHD improve their executive functioning have received particular attention in the best practices literature (Wedlake, 2002; Wolf, 2001). Increasing numbers of campuses have investigated ADHD coaching, an emerging service delivery model that appears to provide this type of assistance (Parker & Boutelle, 2009; Quinn et al., 2000; Schwartz, Prevatt, & Proctor, 2005). Developed as a private practice model, coaches use specifi c types of questions to model effective executive functioning and to elicit students’ own ideas as they increase their capacity to clarify, plan, and take action on goals. This approach, with a greater emphasis on asking rather than telling, has been identifi ed as an “inquiry” model (Parker & Boutelle, 2009; Whitworth, Kimsey-House, Kimsey-House, & Sandahl, 2007). Coaches’ questions promote students’ ability to stop, refl ect, and develop more realistic plans, based on more accurate self-awareness of how they think and act. Coaches then hold clients accountable for taking action on these plans and learning, in the process, about factors that support or restrict their goal attainment (Quinn et al., 2000). Coaching’s inquiry approach contrasts with didactic models of academic services commonly provided to college students with and without disabilities, such as content tutoring or strategy instruction (Byron & Parker, 2002). Tutors and strategy instructors verbally describe and demonstrate how to solve problems, carry out pre-determined steps in a learning strategy, or organize one’s thinking about an academic task. Instead of telling students how to color-code a monthly calendar system, conversely, coaches would ask students questions such as, “What’s important for you to remember as you go through your week?” and “What would be helpful for you to see or be reminded of as the week unfolds?” A dialogue of this nature might lead to the student selecting time management software that sends text messages to his/her cell phones with ‘real time’ reminders the student had previously programmed. Coaches often provide brief phone calls, e-mails or text messages to ask students about their progress as they begin to develop new habits for following through on their plans (Quinn et al., 2000). This method has helped college students with ADHD and/or LD attain academic goals in more self-determined ways while also reducing their non-clinical levels of daily anxiety and stress (Parker & Boutelle, 2009; Zwart & Kallemeyn, 2001). A small but growing body of research on college ADD coaching refl ects the increasing interest campuses have expressed in this new form of academic support (Byron & Parker, 2002). Goldstein (2005) called for additional research to measure coaching’s effi cacy and to identify unique components of this emerging model. DuPaul et al. (2009) recommended research about non-pharmacological treatments involving college students with ADHD, given the sizParker, Field Hoffman, Sawilowsky, & Rolands; An Examination of the Effects of ADHD Coaching 117 able percentage of individuals who do not respond to medication. This issue is especially important due to the growing reports of the abuse of stimulation medication on college campuses (Tudisco, 2010). Frazier, Youngstrom, Glutting, and Watkins (2007) specifi cally recommended empirical investigations of coaching’s ability to help college students with ADHD minimize the impact of executive functioning impairments on their academic achievement. All people have and use executive functioning skills. The transition to rigorous postsecondary settings can trigger new challenges to how students plan, organize, and guide their own behavior in pursuit of their academic goals. Greater insights about the effi cacy of coaching may yield helpful knowledge that pertains to the needs of a wide range of postsecondary students, including but not limited to those with identifi ed executive functioning disorders. Research Questions Within the context of what is known about college students with ADHD and emerging knowledge about ADD coaching, this study explored three research questions. First, what are students’ perceptions about the effect of coaching on their process for achieving academic goals? Second, what benefi ts do students associate with the coaching services provided in this study? Third, did students’ work with coaches on academic success issues affect their sense of well-being?