This is part 2 of a 2 part article I was asked to write for the European Mentoring and Coaching Council:
Better late than never: the importance of an accurate ADHD diagnosis at any age, and how coaching can help. Part 2 What coaches need to consider
In the second of two posts based on her research on coaching women with a late diagnosis of ADHD, Helen Sander-Williams outlines how coaching can help and what coaches need to be aware of.
What has any of this knowledge about ADHD got to do with coaching? After all, we coach the person not the traits, right? Well yes…and no. When coaching anyone, we need to consider intersectionality – that is, the understanding that different social categories (e.g. gender, race and so on) interconnect and shape the experiences of each person. Neurodiversity ties into this – it’s important to understand the neuroscience behind ADHD, so that there is an understanding of the traits, what causes them, that it’s often a ‘can’t’ rather than a ‘won’t; strategies that work for a non-neurodivergent person may not work in the same way for a neurodivergent person.
So, what is ADHD?
There’s quite a lot of misunderstanding around what ADHD is, but to clear up something first – it’s not actually a deficit of attention but more a problem regulating attention and emotion. The Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR (American Psychiatric Association 2022) classifies ADHD as a neurodevelopmental disorder characterised by impairing levels of inattention, disorganisation, and/or hyperactivity-impulsivity. There are 3 sub-types, inattentive, hyperactive-impulsive and combined type. Whilst most of the traits involved in ADHD are experienced by most people at some point in their lives, in people with ADHD, the symptoms are severe, ongoing, and cause significant impairments in daily functioning.
Additionally, people with ADHD often say that it is the emotional dysregulation aspect of ADHD that has the most negative impact. Neuroimaging has revealed structural and functional variations in areas of the brain such as the prefrontal cortex…. in simplistic terms neurotransmitters such as dopamine, norephedrine and serotonin are implicated with dysregulation in the reward and motivation pathways of the ADHD brain primarily driven by dopamine.
So, for example, participants in my study mentioned that the idea of ‘eat the frog’, that is, do the hard thing first, would absolutely not work for them. In fact, it would lead to avoidance, stalling and de-motivation. A better strategy might be to start with small, quick, easy tasks, the completion of which create enough dopamine to enable the tackling of more challenging or uninteresting tasks.
The impact of living with ADHD
It’s essential to understand the impact that living with undiagnosed ADHD has on a person’s self-confidence and self-esteem. They are likely to have internalised negative messages and hold themselves to much higher account than they hold others (perfectionism is a big aspect of ADHD). Having been told all their lives that they are doing things wrong they may even be anxious about starting coaching. Psychiatrist and ADHD expert William Dodson M.D., estimates that children with ADHD are likely to receive 20,000 more negative messages than their neurotypical peers, and they are typically less well-liked and more likely to be bullied than their NT peers (Hoza, 2007). For example, one of the participants in my study told me that she was ‘scared (she) would fail at coaching’ and this was someone who on the outside appeared very confident and successful. Coaches should be aware of this in order to reassure coachees that the coaching relationship is non-judgemental, and that they do not have to fulfil the expectations of anyone else – including the coach.
This brings me to another aspect of ADHD – masking. Masking is a coping mechanism employed by neurodivergent people, often unconsciously, but sometimes consciously, in an effort to fit in and to hide their ‘difference’. The problems with masking are manifold. It is exhausting. The participants in my study spoke about masking at work, often having to go straight to bed when they got back from work and sometimes even had to spend weekends quietly by themselves, in order to summon up the energy to do it all over again the next day/week.
A coach should be aware that whilst someone might present as having everything under control, they might be expending a lot of energy on keeping up that facade; acknowledgment and understanding of this is important, as is the awareness that a lot of masking might be so ingrained as to be unconscious, with the coachee not realising why they are so exhausted, or why they find some things so hard. As this is one of the things that can lead to ADHD burnout, it is something that would need to be addressed.
Another problem with masking is that it can become so ingrained that the individual can no longer access their authentic selves – they have spent so long trying to change to fit in, that they can’t recognise their own emotions, needs or wants. This (among other reasons) can cause problems with boundaries – as mentioned before, neurodivergent people are more susceptible to abusive relationships. People with ADHD may be overly concerned with ‘letting down’ a coach, they may people please and tell the coach what they think they want to hear and they also may just drop out completely if they are late or if they forget a session; how the coach reacts can very much influence this.
ADHD coaching, in particular, needs to be guided by the Rogerian theory of ‘unconditional positive regard’, and a coach should be clear and explicit both about expectations and format right at the start of the coaching relationship. They need to model good boundaries themselves, whilst also demonstrating a level of non-judgement and acceptance. Often a written plan outlining what the coach expects and what the coachee can expect, delivered at the start (or before) the first session, can help remove the anxiety of the unknown, or of miscommunication, and create a secure base from which to start.
A lot of the above behaviours are triggered by Rejection Sensitivity Dysphoria (RSD), an emotion triggered by real or imagined rejection, which neurodivergent people report as feeling like physical pain. RSD stops neurodivergent people from progressing as well as they could in their careers, it negatively impacts friendships and relationships, as well as being a big cause of self-isolation and loneliness – it’s easier to cut oneself off from others, than to risk rejection. Again, this can be an unconscious coping mechanism, but add that to traits of ADHD such as organisation, timekeeping, and prioritisation all of which affect a person’s ability to make and maintain friendships. For example, not returning phone calls or messages, forgetting birthdays and important occasions, often being very late (although some neurodivergent people are so anxious about being late that they are extra early) and you can see why friendships and relationships can be difficult. A coach needs to be able to relay their understanding of this, and demonstrate that they won’t judge someone on behaviours caused on ADHD traits: they need to be able to balance a lack of judgement and unconditional positive regard with clear and fair boundaries.
Something to be aware of when coaching neurodivergent people is the ‘double empathy problem’. This is a phrase coined by autism researcher and expert Damian Milton (2012) who pointed out that the onus of responsibility for understanding and empathy has historically been placed on the shoulders of neurodivergent people. Neurotypical people expect neurodivergent people to behave like them, judging them negatively if they do not, rather than there being a shared relationality, a ‘2 way street’. If we use gaze direction as an example here – neurotypical people have an expectation that the ‘correct’ behaviour is to look into someone’s eyes when speaking or listening. However, some neurodivergent people may find it either uncomfortable or otherwise difficult to look at someone AND listen to them. They may have to concentrate so hard on maintaining eye gaze that they can’t concentrate on listening, so they have to choose between looking or listening. They then get blamed for either not listening, or not looking. The expectation is that the ND person is in the wrong; however the allistic (neurotypical) person has made no effort to accept that the neurodivergent person might have different responses, and blames them for being rude (or sometimes ‘weird’) in a similar way as they might when having no understanding or tolerance for the behaviours of someone from a different culture.
Those coaching people with ADHD, late diagnosed or not, need to be aware of, and have an understanding of, not just ADHD traits themselves, how these might present and challenge but also the impact that societal expectations, judgement and criticism are likely to have had upon that person. Of course, they need to balance this with understanding that every person with ADHD is an individual, with their own unique strengths and challenges. They need to be prepared to look beyond the mask, look beyond the traits, in order to really coach effectively.
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https://www.nice.org.uk/guidance/cg72
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