Molly Hartle

Yoga therapy is an emerging field in the U.S. that harnesses the power of yoga for healing purposes. Unlike regular yoga, yoga therapy is primarily administered in a clinical setting for the purpose of improving such conditions as anxiety, depression, insomnia and pain. Hailing from an Indian tradition, yoga therapists custom-design a series of movements based on their client’s physical, emotional and mental wellbeing. The patient is then taught the routine to do on their own, returning to the therapist as prescribed for regular “check-ups.” During these subsequent sessions, the therapist evaluates the patient’s health, reviews the routine, and adjusts the poses to reflect the patient’s current state of wellbeing. Yoga therapy is extremely gentle; movements are designed to relax, restore and re-balance the body. Yoga therapy also enlists patients in their own healing, encouraging healing from the inside out.

Yoga therapy is an emerging field in the U.S. that harnesses the power of yoga for healing purposes. Unlike regular yoga, yoga therapy is primarily administered in a clinical setting for the purpose of improving such conditions as anxiety, depression, insomnia and pain. Hailing from an Indian tradition, yoga therapists custom-design a series of movements based on their client’s physical, emotional and mental wellbeing. The patient is then taught the routine to do on their own, returning to the therapist as prescribed for regular “check-ups.” During these subsequent sessions, the therapist evaluates the patient’s health, reviews the routine, and adjusts the poses to reflect the patient’s current state of wellbeing. Yoga therapy is extremely gentle; movements are designed to relax, restore and re-balance the body. Yoga therapy also enlists patients in their own healing, encouraging healing from the inside out.

Attention-deficit hyperactivity disorder (ADHD) is associated with the neurological function of the brain. Strongly linked to genetic and environmental influences, researchers have yet to identify an exact cause. That said, researchers have found links between these potential cause and risk factor to attention deficit disorder:

• Genetics
• Neurotransmission impairment
• Brain abnormalities
• Dietary factors
• Perinatal/neonatal influences
• Thyroid dysfunction
• Trauma
• Society
• Societal
• Environmental factors

Genetics

ADHD is strongly associated with genetics. One in four children with ADHD has a close relative with the disorder whereas, parents and siblings of ADHD kids are two to eight times more likely to develop the disorder themselves.¹ Molecular genetic studies have identified several genes that are believed to be associated with the disorder including those involved with the release, reuptake and transformation of dopamine and norepinephine. That said, of genes that have been identified, none have been found to have much effect, leading researchers to conclude that the disorder is likely linked to several.²

ADHD is believed to have a heritability rate of 76 percent. However, how much of the disorder is nature over nurture is questionable. Some researchers estimate that between 40 and 80 percent of the genetic variance for personality may be nature-based.³ Thus while ADHD has a strong genetic influence, environmental factors such as food additives, toxins and excessive stimulation play a significant in the disorder’s development and evolution.

Neurotransmission

ADHD symptoms are believed to be associated with what is known as the executive functions of the brain.⁴ Acting as a conductor, the executive functions prioritize, integrate and regulate the brain’s other cognitive processes such as planning, mental flexibility, abstract thinking, rule acquisition, initiating actions (both appropriate and inappropriate) and selecting relevant information.⁵ Non-localized, these executive functions are linked through a complex nerve network that communicates through neural transmission. A problem with the network of the chemicals used to send and receive messages can cause a breakdown in communication.

In his book Attention Deficit Disorder: The Unfocused Mind of Children and Adults, Thomas E. Brown suggests that ADHD is the result of a defunct network. Thus, even in the case where the individual has an ample supply of the chemical that fuel the system—neurotransmitters—messages still aren’t getting through. According to Brown, this conclusion is supported by more than 200 well-controlled medication studies that show that stimulants temporarily reestablish this circuitry:

The results from these many medication studies clearly indicate that ADD syndrome is essentially a chemical problem, specifically an impairment in the brain’s management system. Just as diabetes is a disease that reflects impairments in the body’s processing of insulin, ADD syndrome is a disorder that reflects impairments in the brain’s processing of dopamine and norepinephrine.⁶

Brain abnormalities

The brains of individuals diagnosed with ADHD are different than those in people without the disorder. One study showed that the brains of children with ADHD were slightly reduced, particularly in the prefrontal cortex on the left-hand side of the brain.⁷ Additional studies show abnormalities in the fiber pathways that connect the frontal lobes and the cerebellum.⁸ ADHD has also been linked to decreased levels of blood flow to the brain and low levels of cerebral glucose. In a 1990 study using proton emission topography (PET), researchers found that cerebral glucose metabolism was 8.1 percent lower in adults who had been diagnosed with ADHD as children than in normal adults.⁹ However, when the authors of this study repeated it three years later with adolescents, no significant differences were found between the “hyperactive” and “normal” brain.¹⁰

Diet

An exhaustive number of studies have linked ADHD to dietary factors such as low levels of essential fatty acids, mineral deficiencies, synthetic additives, food additives and refined sugar.

• Essential Fatty Acids (EFAs): EFAs play an important role in the development of the protective surface coating that insulates the nerve fibers. Indeed, dietary intake is directly related to EPA levels in the nerves. As early as 1981, researchers observed that children who were hyperactive, particularly boys, struggled to absorb and metabolize essential fatty acids. They also found that many of the foods that the hyperactive children reacted to contained substances blocked the conversion of EPAs to eicosanoids, the signaling molecules used in the regulation of the central nervous system. Additionally, EPA supplementation relieved many of their symptoms.¹¹ A great deal of research is now underway to verify the link between EPA supplementation and the reduction of ADHD symptoms.

• Mineral deficiencies: Children with ADHD have a greater propensity to be deficient in zinc, iron and magnesium.
  • Zinc is vital in the growth of the developing brain. In addition to helping maintain the ongoing functioning of the brain, it plays a role in the production and modulation of serotonin and the metabolizing of dopamine. In a paper summarizing the finding of nine zinc studies conducted around the world, the authors found that not only were children more likely to be low in zinc but lower zinc levels also correlated to the severity of their symptoms.¹² High Fructose Corn Syrup consumption also results in lowered zinc levels.
  • Important for the structure and function of the central nervous system, iron plays a role in neurotransmission and is associated with cognitive development. Studies show that not only are children with ADHD more likely to be low in iron but that the severity of their symptoms correlated to lower iron levels. Iron deficiency is also linked to a higher rate of absorption of lead and restless leg syndrome.¹³
  • Suboptimal levels of magnesium have been linked to reduced energy metabolism, synaptic nerve cell signaling and cerebral blood flow. Several studies have linked children to low levels of magnesium.¹⁴

• Food allergies, additives, preservatives and dyes: The link between ADHD and food intolerance remains controversial. In 1982, the U.S. National Institute of Health concluded that elimination diets helped just 5 percent of children diagnosed with ADHD. However, more recent studies suggest that children’s reactions to certain foods and additives may be more pronounced.¹⁵ Additional, Dr. Benjamin Feingold has shown that 50 percent of hyperactive respond favorably to his elimination diet which recommends eating only those foods free of artificial flavors, dyes, preservatives and salicylates (a commonly used preservative derived from salicylic acid).¹⁶

• Refined sugars: The role of refined sugars in ADHD is hotly debated. Whereas numerous studies show no connection between the consumption of refined sugars and behavior, one study showed that children with ADHD are more likely to be hypoglycemic. In a study of 261 children, 74 percent were found to have abnormal levels of glucose tolerance.¹⁷ Metabolically, these children’s pancreases’ were releasing an abnormal amount of insulin to metabolize the sugar. As a result, their high insulin levels caused their epinephrine and norepinephrine levels to spike resulting in ADHD-like symptoms. While void in nutrients, sugar calls on a number of nutrients in its processing. Thus, sugar may play an indirect role in ADHD by robbing the body of the nutrients needed to support the cognitive functions of the brain.¹⁸

Perinatal/Neonatal Factors

Children born to women who smoke or drank during their pregnancy may be at risk of developing ADHD. Additional perinatal risks include moderate-to-severe physical illness during gestation, symptoms of miscarriage and/or premature delivery and respiratory infections. ADHD has also been linked to a number of issues related to a child’s birth and first month of life. Premature babies are at a greater risk of developing ADHD as are infants who suffer from seizures, decreased levels of oxygen to the brain, mild speech retardation, brain injuries and fever. Finally, studies show that infants who are exposed to lead or manganese and/or are weaned prior to three months are at a higher risk for ADHD.¹⁹

Thyroid Dysfunction

Thyroid hormones are vital to the regulation of nerve maturation. Research shows that roughly 50 to 70 percent of children who are resistant to thyroid hormones have ADHD. Similarly, studies showed that the offspring of rats that had hypothyroidism were more likely to be hyperactive and restless, and prone to panic. (Hypothyroidism is when the thyroid fails to make enough hormones.) Similarly, in a study comparing the children born to women from “moderately iodine deficient” versus “marginally iodine deficient” areas at the time of gestation underscores the critical role of the thyroid of warding off the symptoms of ADHD. The study showed that whereas none of the children bore to the mothers living in the marginally iodine sufficient area developed ADHD, a total of 68.7 percent of children born to the mothers from the moderately iodine deficient area did.²⁰

Trauma

Children with ADHD are more likely to be abused than children without the disorder. According to Thomas E. Brown, author of Attention Deficit Disorder: The Unfocused Mind in Children and Adults, children with ADHD may be more at risk of emotional and/or physical abuse from fed-up friends and family members. In a study of girls with ADHD, a significantly higher number reported having been abused than those in the control groups.²¹ Similarly, researchers found that a greater number of children living in conflict zones such as the Gaza Strip were more likely to have ADHD than those living in areas free of conflict.²² Research shows that abuse is also more prevalent in ADHD adults. In a controlled study of 57 adults, emotional abuse and neglect was more common among the ADHD adults whereas sexual abuse and neglect was more common among the women with the disorder.²³

Society

Societal

A fair amount of evidence suggests that ADHD is a manufactured diagnosis. Child and adolescent psychiatrist Dr. Sami Timimi points out that there is no known cause for ADHD and there exists no specific cognitive, medical and/or neurological markers for diagnosing it. In addition, there is no specific treatment for ADHD and stimulation medication has been said to have the same effect on otherwise normal children. Finally, stimulation medication has generated huge profits for the pharmaceutical industry. “Thus the mainstream dogma on ADHD is contaminated and misleading.” Under the current medical model, ADHD becomes a convenient scapegoat for parents and teachers to shirk from their responsibilities as caretakers and for the community members to disregard societal flaws such as the loss of the extended family, the pressure on schools, the breakdown in the moral authority of adults and increasingly frenetic pace of family life.²⁴

Five years ago, Sam Goldstein, editor-in-chief of the Journal of Attention Disorders called on the ADHD community to submit articles researching ADHD coaching. Wrote Goldstein, “It is time to investigate whether coaching is truly a treatment with specific positive benefits for those with ADHD.” ³ Since then, several studies have looked at both individual and parental coaching in the treatment of ADHD. Among the most promising was a study conducted on seven college/graduate students who underwent eight weeks of ADHD coaching. The study showed that all seven students found the coaching better than therapy or medication.⁴ More specifically, between session assignments or homework assignments were shown to be effective in the use of ADHD coaching with college students.⁵

People with ADHD have also been shown to benefit from peer and parental coaching. In a pilot study of parents of 124 children without ADHD, a technique known as parental friendship coaching (PFC) proved to be an effective therapy in boosting the social skills and friendship quality of children with ADHD. PFC also helped parents to be less critical and more constructive when dealing with their children in laboratory settings.⁶ In another study, the combined use of Classwide Peer Tutoring and peer coaching improved the social behavior of elementary students with ADHD.⁷

Over the decade, coaching has become a popular therapy in the treatment of ADHD. More and people are becoming professional coaches while a number of ADHD coaching schools are opening their doors. But what exactly is ADHD coaching and how does it differ from more traditional therapies?

Based on the coaching model in executive coaching and athletics, ADHD coaching is a present-focused form of ADHD treatment therapy designed to help individuals deal with aspects of their disability that interfere with daily and/or academic or work performance. Unlike psychotherapy, coaching is not intended to help clients work though painful feelings, negative self-talk or self-defeating behaviors. Rather, change is brought about through the coach-like practices of questioning, problem solving, modeling and practicing.¹

1. Frances Prevatt, Georgio K. Lampropoulos, Vernessa Bowles and Lori Garrett, “The Use of Between Session Assignments in ADHD Coaching With College Students,” Journal of Attention Disorders, December 17, 2009.

2. Nancy A. Ratey, “Specific Benefits of ADHD Coaching,” ADHD Coaching Organization, www.adhdcoaches.org, http://www.adhdcoaches.org/specific-benefits-of-adhd-coaching/

3. Sam Goldstein, “Coaching as a Treatment for ADHD,” Journal of Attention Disorders 9, no. 2 (November 2005): 379–381.

4. Abigail L. Reaser, “ADHD Coaching and College Students,” Dissertation Abstracts International Section A: Humanities and Social Sciences 70, no. 5-A (2009): 1557.

5. Frances Prevatt, Goergios K. Lampropoulos, Vernessa Bowles and Lori Garrett, “The Use of Between Session Assignments in ADHD Coaching With College Students,” Journal of Attention Disorders 15, no. 1 (December 17, 2009): 18–27.

6. Amori Yee Mikami, Matthew D. Lerner, Marissa Swaim Griggs, Alison McGrath and Casey D. Calhoun, “Parental Influence on Children with Attention-Deficit/Hyperactivity Disorder: II. Results of a Pilot Intervention Training Parents as Friendship Coaches for Children,” Journal of Abnormal Child Psychology 38 (2010): 737–749.

7. Pamela J. Plumer and Gary Stoner, “The Relative Effects of Classwide Peer Tutoring and Peer Coaching on the Positive Social Behaviors of Children With ADHD,” Journal of Attention Disorders 9, no. 1 (August 2005): 290–300.

8. Peter C. Thomas, “Coaching for Attention-Deficit / Hyperactivity Disorder,” in Earning a Living Outside Managed Mental Health Care: 50 Ways to Expand Your Practice, ed. Steven Wallfish (Washington, D.C.: American Psychological Association, 2010), 54–57.

9. Kevin Murphy, Nancy Ratey, Sandy Maynard, Susan Sussman and Sarah D. Wright, “Coaching for ADHD,” *Journal of Attention Disorders *13, no. 5 (March 2010): 546–552.

Individuals must be in reasonable good psychological health to benefit from this treatment. Those who aren’t risk wasting their time and resources in addition to not getting the help they need.

ADHD coaches come from a variety of backgrounds including life coaching, education and psychology. To date, there are no national standards for ADHD coaching. However, the ADHD Coaches Organization offers continuing education classes as well as an update-to-date database of available professionals. For more information, visit www.adhdcoaches.org.

The purpose of ADHD coaching is to help their client define and meet specific goals. Once the goals are defined, the coach’s job is to help their client create an organized plan of action. The client, in turn, starts to internalize this process to the point of being able to organize their day on their own. As the client starts to pick up new skills, they naturally are able to cut back on the number of hours they meet with their coaches. The first client meeting is generally an hour while subsequent meetings can be as short as five to 10 minutes a day. Sessions are generally conducted over the phone although with the proliferation of the Internet an increasing amount of communication happens online be it video calling or email.
Among some of the goals that can be addressed in ADHD coaching include getting clients to adhere to regular sleep and/or eating patterns, complete tasks, honor commitments and avoid distractions.⁸

That said, not everyone makes a good candidate for coaching. In “Coaching for ADHD,” Kevin Murphy outlines three conditions needed for a successful client-coach relationship. First, clients need to be reasonably healthy. Clients suffering from mental illness or some other type of disorder such as substance abuse may not possess the wherewithal to create change in their life. Second, clients need to own up to the fact the fact that they have a problem (ADHD) that needs to be managed. Such acceptance is key to the client becoming willing to make a change in their life. Third, clients need to commit to the process.⁹ According to the great behavioral theorist James O. Prochaska, a minimum of three months is needed for people to make changes in their life.