“Do the crap first,” she told me. “As soon as you sit down in the morning, tell yourself, ‘I have to do the crap first.’ Then do the crap.”
It was, perhaps, one of the most valuable pieces of advice I’d ever received, yet it was so simple. I struggled with paying the bills, reading important emails, making necessary phone calls, etc. But during my very first meeting with my ADHD coach, she got me on track. From that moment on, I knew I’d made the right decision.
I’ve known about my ADHD (attention-deficit/hyperactivity disorder) for many years. I was formally diagnosed towards the end of elementary school. But when I was young, it was essentially explained to me in a boiled-down way—that I had trouble focusing—and I never treated it. My parents never sought to explore medication or therapy for me at the time, nor was I provided with any sort of classroom aid or any special instruction on how to manage my symptoms. The only intervention, if you can call it that, I received was from my mother, who required me to do my homework at the kitchen table so she could refocus me when I became distracted. I barely gave my ADHD much thought growing up, and after college, I felt like I had forgotten about it completely.
But about a year ago, as I was exploring interventions for my own children who have ADHD, I began to research the condition in regards to adults, like myself. At 38 years old, I finally felt like I was really beginning to understand how this disorder impacted my work and personal life, and I knew I could benefit from real interventions in my adult age.
First, I did my research and found a psychiatrist who worked with patients with ADHD. He confirmed my diagnosis again (it had been many years since my childhood assessment) and we discussed medication. He initially prescribed a low-dose medication and slowly increased the dosage until we settled on a prescription that felt helpful and like a good fit for me.
But, medication alone doesn’t “fix” ADHD; it only helps me manage my symptoms temporarily. It cannot change the actual lifestyle habits and behaviors I had already developed as a result of my diagnosis.
“ADHD medications only act for as long as you have the chemical substance in your body, giving you several hours during which you can pick up skills, knowledge, and buildability,” Oksana Hagerty, Ph.D., an educational and developmental psychologist at Beacon College in Florida (a university designed around supporting people with learning disabilities, such as ADHD, dyslexia, and others), tells SELF. It can be beneficial to combine medication with other interventions, like therapy and coaching, to instill habits that help you manage your ADHD outside of the effects of medication, Hagerty explains.
So, I hired an ADHD coach.
How ADHD coaching works.
Building habits that aim to improve productivity and focus isn’t easy with ADHD. ADHD can present very differently from person to person—but in general, we may be quickly distracted from tasks that don’t interest us, have trouble meeting deadlines or completing assignments, instead jumping around from task to task and letting our minds wander. My brain, like many others with the disorder, also prefers instant gratification. So, doing things that don’t bring me immediate joy or satisfaction and that I don’t have a genuine interest in, like paying the bills on time, are a true challenge. For instance, while I know the lights may get turned off, it’s not until I receive a notice in the mail that I’m actually motivated to pay—late fees aren’t enough.
But coaching can help change that mindset and motivation block. How? Hagerty provides this metaphor: When a child comes home covered in dust after playing outside, they want to go to bed, or watch TV, or do whatever the next thing is that interests them. But, mom tells them that they need to shower first. Mom does this every time. When they become an adult and do the same thing (say, coming home exhausted after a long hike), they want to shower because mom instilled that routine, tying in the natural contingencies—they feel better when they’re clean.
This is essentially what ADHD coaching does, Hagerty explains. “They build those routines artificially so you can touch the positive consequences, taste them, like them, and get used to them,” she says. “And then these routines become your own routines because you want those consequences all the time.”
There are plenty of online courses available that offer to teach you how to organize and declutter your life, but behavioral coaching in this sense is different. It offers a one-on-one approach designed to teach and improve executive functioning skills that can be tailored to fit the individual and the specific symptoms and behaviors associated with their ADHD. Coaches may employ a set “curriculum” or address the biggest problems first (or the smallest issues, depending on the person and what approach they think makes the most sense for their case). There may be homework assignments, check-ins with your coach, and some coaches provide mental health counseling geared towards understanding your ADHD, too. (Coaches may also work with parents of kids with ADHD.)
“Generic interventions [such as general courses that teach organization] assume that a person has the motivation and ability to get going and activate, things [a person with ADHD] struggles with,” Joel Nigg, Ph.D., professor of psychiatry and behavioral neuroscience and director of the ADHD program at Oregon Health & Science University, tells SELF. “ADHD coaches implement motivational activation tactics to help you break this down and do it in chunks that work for you.”
What coaching looked like for me.
I typically gave my coach, Andrea Jaffee, LCSW, (I connected with her through someone else I knew who had success with coaching) an update on both my professional and personal life at the beginning of each session. I shared my successes and challenges, and she always offered a tremendous amount of empathy, pointing out the areas where it seemed that my ADHD may have played a role in why I thought or felt a certain way.
Then we got to work. During my first session, for example, we walked through my current approach to how I was organizing and getting work done in regards to my business as a freelancer—and we figured out why those approaches weren’t working for me. In the past, I’d taken a business course designed specifically for freelance writers, which came with several very useful spreadsheet templates to monitor my finances, invoices, story ideas, and assignments. There was also a template for my biggest struggle—to-do lists—complete with a suggestion for how to map out my days as a freelance writer. But it just wasn’t working for me, and I never understood why.
I explained all of this to Jaffee, and she analyzed why these tools weren’t benefiting me. Even though the spreadsheets were great, I wasn’t motivated or interested enough to use them, so I rarely did.
That’s when we talked about getting the crap out of the way first: Those spreadsheet templates were part of what needed to get done first each day, even though I didn’t find them exciting. There was no instant gratification for me in organizing a spreadsheet, but I needed to do it in order to decrease my stress, and ultimately improve my quality of life and happiness. If I did the crap first each morning over a period of time, then it would eventually become a habit that I would appreciate, just like a child who is required to bathe eventually appreciates that feeling of being clean. “It’s such an effective tool and so many of us, even those without ADHD, never learn it,” Jaffee told me. “If you leave everything you don’t like until the end of day, week or month, you’ll be really unhappy. You’ll think about it all day, week or month, and it puts a strain on you. But if you do it first, that stress is lifted. It gives you a happier life.” That sense of happiness had to become my motivation activation.
The other things I needed to get done first included opening my mail and paying the bills on time, reading and responding to my emails, and making phone calls. Because I was so behind in each category, she told me to pay the bills and then spend just one hour each morning catching up on those other things. I was to tackle one category, such as updating the financial spreadsheets or organizing my email inbox, until I was caught up. I got started the next morning, and she texted me regularly to keep me accountable. When we met two weeks later, I was caught up on bill payments and had begun updating those spreadsheets. I felt better already.
A different session focused on time management, another common challenge associated with ADHD and a big struggle of mine. Jaffee explained how to plan and prioritize my days, create a weekly schedule and even how to properly use a timer. We started by discussing my typical to-do list approach: write a long list of a million things I knew I needed to get done at some point, but with no real structure or strategy. It left me feeling overwhelmed and disappointed when I got (what I believed was) too little accomplished each day.
Jaffee began by helping me understand that my expectations were unrealistic. Something I’ve learned about myself and in speaking with others with ADHD: We often expect to be able to do things quicker than we can actually accomplish them. Jaffee also pointed out that I was diminishing the large number of things I did accomplish each day. She reminded me of my achievements in raising my two children as a single mom, managing a household, and running my own business. She put things into perspective and told me that I was accomplishing so much, which was an “Aha” moment for me. Instantly, I felt better about myself and understood that I was making myself miserable by trying to do the impossible. That realization helped frame the entire session and motivated me to finally understand time.
Next, we retooled my to-do list approach. The business course recommended that I spend a few hours each day on the four main categories necessary to run my business (pitching story ideas, interviewing and writing, client work, and new business outreach). But, I explained that I would get caught up in tasks related to one category and skip the next one to make up for the lost time. Instead, Jaffee suggested that I set aside one day a week for each category, leaving the fifth weekday to finish up whatever wasn’t accomplished on the other days. And I needed to be flexible, she reminded me. The day’s category could vary each week depending on my deadlines or other variables; and if I needed two days to write one week, that was OK.
Lastly, in order to help me better manage my time, I needed to understand exactly how long it actually took me to accomplish each task. She recommended that I time each task over the course of a week so I could more accurately plan out how much I could accomplish daily. I was, quite frankly, shocked at how long things actually took. But it helped me put less on my daily and weekly to-do lists. And because I regularly lose track of time, I began using an alarm to mark the end of my breaks, or when I needed to be reminded of what time it was at various points throughout the day.
But by a later session, I’d regressed and had stopped regularly doing the tedious crap first—I was overwhelmed. I felt awful. I’d let her down. I hadn’t yet experienced the positive consequences long enough for me to truly crave the benefits of the new system I was trying to implement. My impulsive tendencies had taken over. But instead of being disappointed, Jaffee encouraged me to practice a little self-love. Often, people with ADHD can be highly anxious, have perfectionist tendencies, experience symptoms of depression and/or suffer from low self-esteem, all of which can distort our sense of what should be accomplished and make us even more critical of ourselves.
Jaffee helped me accept that there may be days when deadlines and other demands will take the entire day and the crap will need to be postponed. But, when those days come, I should remember how good it feels when I do get the crap done first—and then return to doing the crap first the next day, without being hard on myself for having missed a day.
I had six total sessions with my ADHD coach, spread out over several months, as we didn’t meet every single week. During our “off” weeks, I worked on the skills we had discussed and regularly checked in with Jaffee. At the end, I was much more organized and understood how to better manage my time. I procrastinated less and, most importantly, I no longer felt overwhelmed and frazzled. My inboxes (I have three) went from thousands down to less than a hundred. I have a handle on my finances. I no longer pay late fees. I rarely work late. And I even create a daily schedule for my work and personal lives.
How to find an ADHD coach.
Begin by doing a self-assessment to determine your needs. For example, do you think you might benefit from mental health care to manage your emotions and morale within your coaching? Do you work with a therapist already, and are you looking to explore separate coaching for executive functioning purposes? The former requires a mental health professional, while the latter could be handled by an educator with a specialization in providing support for people with ADHD.
Once you’ve determined what type of coach might work best for you, it’s time to begin your actual search. This can be tricky, as there isn’t one accredited website or organization that acts as a roster of ADHD coaches. That being said, there are many organizations that provide excellent resources for connecting with ADHD coaches, such as Edge Foundation (which connects students with ADHD with coaches), as well as the Institute for the Advancement of ADHD Coaching (IAAC), and the International Coach Federation, and ADDitude, which have online directories that are good places to start. You can also ask any mental health professionals and/or medical doctors who you work with personally for their recommendations or referrals. And, of course, there is always word of mouth, which is how I found my coach. If you cannot find a coach you like in your area, you can also consider working by phone or Skype with a coach in another city or state.
Once you’ve compiled a list of a few names, make sure to get information about their training, background and continuing education. You should also ask them how they structure their coaching and what specific types of skills you will learn. “Fortunately or unfortunately, we don't yet have standardized licensing for ADHD coaches, and the certifications that do exist are not dependable as far as quality at this point, so there's a little bit of buyer beware right now,” Nigg cautions. “It’s important to be careful, especially because people with ADHD may sometimes end up in deep waters, which may be beyond what some of these coaches can handle.”
For example, some people with ADHD also deal with other mental health issues simultaneously, such as anxiety and depression, and they may also need to manage symptoms associated with those conditions at the same time. So, a coach from a strictly educational background/setting may not be equipped to handle these problems, and it could be really beneficial to also work with a therapist if your ADHD coach cannot offer mental health interventions. “Therapists are trained in all emotional issues, so if something comes up during a coaching session that is not specifically related to the skills the coach is teaching, a therapist can handle it and doesn’t have to refer out or not address the problem,” Jaffee explained to me when I spoke to her again for this article. “These issues are often brought to the surface during coaching sessions because the client is listening, understanding, and asking questions.”
The price of coaching varies depending on where you live and who you hire, but the cost is typically similar to talk therapy. While ADHD coaching is not covered by insurance, some experts may be able to offer a sliding-scale payment plan, and others may be willing to discuss possible ways to work with your insurance company.
You won’t necessarily need a coach forever. “Coaching is a short-term proposition,” says Hagerty. “If it works, it will work within months. If it doesn't work, something needs to change. The purpose of any coaching would be to improve the individual's life. So if you don't see any improvement, then it isn’t working.”
When it’s not working, Nigg says you should review your self-assessment to determine if you are correct about what you need, and if you hired the right professional for those needs.
The results of ADHD coaching, if it’s working for you, will be fairly obvious to you, and probably even the people around you, like colleagues and family, Jaffee says. “[A client’s] procrastination will be pretty much eliminated. Their organizational skills, time management and prioritization skills will greatly improve,” she says. “Their self-esteem will go up and anxiety will go down. They will feel that their life is in balance and manageable.”