International Journal of Evidence Based Coaching and Mentoring
2020, Vol. 18(1), pp.103-122. DOI: 10.24384/pmth-g573

Academic Paper

Communication Modalities in Coaching for Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD): A Qualitative Examination

Micah Saviet (University of Maryland School of Social Work)
Elizabeth Ahmann (Maryland University of Integrative Health)

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Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neuropsychological disorder characterised by symptoms of inattention (difficulty staying focused) and/or hyperactivity-impulsivity affecting an individual's functioning and/or development (Barkley, 2015; National Institute of Mental Health, 2016). Additionally, ADHD increasingly is understood as a disorder of the executive functions (EFs), a set of mental skills comprising the “management system” of the brain, or the “neuropsychological processes needed to sustain problem-solving toward a goal” (Barkley, n.d., p, 4); these include skills such as organisation, time-management, planning, initiation, and others (c.f., Barkley, n.d.; Barkley, 2010; Brown, 2013).

Treatment for ADHD generally has consisted of medication use, primarily stimulants, but an increasing emphasis is being placed on a multimodal treatment approach including medication, therapy, and coaching (e.g., Barkley, 2015; Kooij, 2013; Murphy, 2015; Pehlivanidis, 2012; Pfiffner & DuPaul, 2015; Prevatt & Levrini, 2015; Sarkis, 2014).

Coaching for individuals with ADHD (hereinafter referred to as “ADHD coaching”) is an emerging subspecialty in the coaching field, first described in print in 1994 in Hallowell and Ratey’s book Driven to Distraction, and increasingly recognised in the clinical and research literature as both a stand-alone modality and a useful and important component of multimodal treatment for individuals with ADHD (Ahmann, Saviet & Tuttle, 2017; Ahmann, Tuttle, Saviet & Wright, 2018; Barkley, 2015; Kooij, 2013; Murphy, 2015; Pehlivanidis, 2012; Pfiffner & DuPaul, 2015; Prevatt & Levrini, 2015; Sarkis, 2014).

ADHD coaching is built on a foundation of life coaching and additionally incorporates both specialised education in ADHD and training in specific coaching skills for that population. While there is no single definition of this specialised type of coaching, the ADHD Coaches Organization defines it as follows:

ADHD Coaching is a collaborative, supportive, goal-oriented process in which the coach and the client work together to identify the client’s goals and then develop the self-awareness, systems, skills, and strategies necessary for the client to achieve those goals and full potential (ADHD Coaches Organization, 2017, para. 1).

Ahmann, Saviet and Tuttle (2017) and Ahmann, Tuttle, Saviet, & Wright (2018) identified 19 studies examining ADHD coaching outcomes, 16 of which examined coaching for individuals, as distinct from coaching for groups. While varying in methodology and strength of findings, each of these studies found that coaching contributed to improvements in ADHD symptoms and/or EF, and some found quality of life benefits as well. A, more recent, 20th study found that coaching was a more beneficial service impacting grade point averages among college students with ADHD than either academic advising or tutoring (DuPaul et al., 2017).

Given the common attentional, planning, and time management challenges faced by individuals with ADHD, the choice of communication modality (in person, telephone, video conferencing, or a combination of modalities, for example) may be a consideration of particular importance to success in coaching with this population.

Background: Communication Modalities in ADHD Coaching

Among studies exploring coaching for individuals with ADHD (Ahmann et al., 2017; Ahmann et al., 2018), 13 identified the communication modality used: the most frequently used communication modality was in person coaching, followed by an equal use of telephone or a combination of modalities; video conferencing was not reported in any of these studies (Ahmann & Saviet, 2019). Several of these studies also reported the use of phone, email, and/or texting as between-session communication modalities. Each of these studies, using varied approaches to ADHD coaching, found positive client outcomes (for details see Ahmann, Saviet, & Tuttle, 2017; Ahmann, Tuttle, Saviet, & Wright, 2018).

Ahmann and Saviet’s 2019 mixed method study directly examined coaching communication modalities (“delivery” methods) used by self-identified ADHD coaches. They reported on quantitative aspects of the study that explored coaches’ reports of the frequency and perceived effectiveness of use of in person, telephone, video conferencing, or a combination of modalities. In this study, many coaches reported the use of more than one modality, depending on various factors.

While a slightly higher number of coaches in this study reported using telephone than in person coaching, and fewer reported using video conferencing or a combination of modalities, the coaches surveyed perceived all four communication modalities as equally effective, generally between “very” and “completely” effective; no coaches identified any modality as “not at all” effective (Ahmann & Saviet, 2019).

The choice of communication modality identified in the Ahmann and Saviet (2019) study was most commonly driven by geographic considerations, and client factors impacted the choice more often than coach-specific factors. Client factors reported included age of client (younger/school-age), client preference due to time management/time saving, and client prefers the approach for other reasons, while coach considerations endorsed included personal time management or office space (availability or lack of).

This report focuses on the qualitative aspect of the same study (Ahmann & Saviet, 2019), exploring coaches’ perceived benefits and drawbacks of each of the four following communication modalities: in person, phone, video conferencing, and a combination of modalities.

Methods

Ahmann and Saviet (2019) conducted a three-component mixed methods study examining communication modalities used in ADHD coaching: in person, telephone, video conferencing, or a combination of modalities. IRB approval was obtained for this study. The full study included: 1) an examination of communication modalities used in the literature exploring outcomes of ADHD coaching; 2) a survey of ADHD coaches to identify the frequency of use of specific communication modalities, and their perceived effectiveness; and 3) as part of the survey, an exploration of qualitative data on coaches’ perceptions of both benefits and drawbacks of the varied modalities. Ahmann and Saviet (2019) reported on the first two components of this study. This report addresses the third component: the qualitative survey responses.

Survey

A 57-question anonymous online survey was administered via SurveyMonkey® to a convenience sample of 117 self-identified ADHD coaches. Recruitment procedures were described in Ahmann and Saviet (2019). Eight open-ended, qualitative questions explored coaches’ perceived benefits and drawbacks of varied coaching modalities: coaching only in person, only using telephone, only by video conferencing, or using a combination of modalities. The eight qualitative questions that were asked comprised two regarding each modality, phrased as follows:

  • “I have these additional thoughts on the benefits of coaching clients by [the specific modality].”
  • “I have these additional thoughts on the drawbacks of coaching clients by [the specific modality].”

Data Analysis

The two researchers/authors who analysed and coded the data had different backgrounds and resultant potential biases, a factor considered a strength in ensuring systematic, verifiable data in qualitative research (Creswell, 2009). MS is a student in a Masters in Social Work program with experience in coding qualitative research data, and EA is trained in life and ADHD coaching, with 12 years of coaching experience and a background in quantitative research (doctorate in public health). Responses to the survey’s qualitative questions were extracted from SurveyMonkey® as a spreadsheet, minimising the risk of transcription mistakes. This was then formatted for use as coding sheets.

An emergent approach to data analysis was used, meaning that no preconceived or a priori codes, themes or theories were used in exploring the data. This was done to avoid limiting the analysis, following recommendations of Creswell & Poth (2018, p. 193). Instead, the researchers looked at what participants actually said to develop an understanding of the data.

Saldaña (2016) has suggested that when there are multiple authors, coding the data “can and should be a collaborative effort” (p. 36). Initially, in this study, both authors independently reviewed all respondent answers to each of the eight questions. Data was reviewed manually on hard copies and formatted on word processing software (per Saldaña, 2016, pp. 28-9). The initial coding process involved identifying repeated keywords as a first step in developing codes to be used in analysing the data. After the first review of the data, the authors discussed the data and all repeated keywords they noted, as a first step in developing codes to be used in analysing the data.

In developing codes, an effort was made to use actual respondent wording and avoid interpretation, a process known as in-vivo coding (Padgett, 2008, p. 150). The authors/coders combined items close in wording into single codes, and, as needed, differentiated codes to develop a single initial coding book for the eight questions about benefits and drawbacks of varied communication modalities.

It is important to emphasise that the eight questions were all coded with the same set of codes (coding book). Thus, each individually identified benefit and/or drawback for any of the eight questions had a code in the main coding book, facilitating the eventual overarching goal of identification of common themes throughout the data.

Coding of the data was accomplished in a series of iterative steps involving two additional stages of independent co-coding, each followed by meetings involving discussion, resolution of discrepancies, and achievement of consensus (Creswell, 2009; Saldaña, 2016). This process resulted in further development and refinement of the coding book. Final inter-coder agreement (a measure of reliability) ranged from 83% to 97% for codes on the eight questions addressing perceived benefits and drawbacks of varied coaching modalities. Rates of 80-90% are generally considered evidentiary (Saldaña, 2016, p. 37). At this point, in-vivo codes were combined, or grouped, into broad themes based on similar meaning and topic, as determined through discussion and consensus. Creswell and Poth (2018) have defined themes as “broad units of information that consist of several codes aggregated to form a common idea” (p. 328).

A total of 15 key themes were identified for the eight questions exploring the benefits and drawbacks of the four communication modalities studied. While some quantitative researchers limit the identification of themes in a qualitative study to no more than five to seven (Saldaña, 2016, p. 25), in this study there was enough distinction in meaning to retain rather than consolidate any of the 15 distinct themes identified. Attempting to confine the data to a lesser number of themes would not have conveyed accurately the richness of data provided by coach respondents. As Saldaña (2016, p. 25) has explained, “a code that appears just two or three times […] may hold important meaning”.

Further, while some qualitative researchers do not use any quantitative approaches, Saldaña (2016, p. 72) has remarked that “qualitative data can sometimes be ‘quantitized’...[with] descriptive measures such as frequencies….” In this study, the number of times each key theme appeared in the qualitative responses was tallied, in order to provide a sense of comparative frequency of the themes and, thus, another lens for understanding the data (per Saldaña, 2016, p. 27).

A table was made to highlight the themes identified (Saldaña, 2016, p. 285), and quotations from respondents were extracted from the data to provide evidence of the themes (Saldaña, 2016, p. 285). Additionally, tables were constructed to identify both the number of benefits and drawbacks and the most frequent themes identified as benefits and drawbacks for each modality (see Results section). An audit trail was maintained by retaining all versions of the coding sheets leading to the final version, as well as evidence of discrepancies resolved.

Results

Survey (Descriptive Data)

One hundred and seventeen self-identified ADHD coaches participated in this mixed methods survey of coaching communication modalities (Ahmann & Saviet, 2019). Sixty-seven participants responded to the survey question about credentials; of these, 73% held an International Coach Federation (ICF), or other, credential. 86 participants responded to a question about meeting the ADHD Coaches Organisation definition of an “ADHD coach” (see Appendix); 87% met this definition.

Overall, 115 (99%) of coaches completing the survey reported working with individual clients, the focus of the survey. (Some also worked with families or groups.) Thirty-three percent had been coaching for over 10 years; 36% for 5-10 years; 24% for 1-4 years; and 7% for less than one year. The coaches in this study had varying numbers of clients, ranging in age from elementary school to older adult; nearly half of the clients were adults (43%) and nearly one quarter were college students (22%). Once weekly coaching was the most commonly reported session frequency. Further description of the study participants can be found in Ahmann and Saviet’s (2019) article addressing the quantitative aspects of this mixed methods study.

Among individuals beginning the survey (117), the completion rate was 74%. However, as not every question applied in all circumstances, completing all questions was not necessary for the survey to yield usable and relevant data. For example, if a coach did not use video conferencing with their clients, they would not respond to any of the questions related to video conferencing. Consequently, response rates were varied among individual questions and were sometimes higher than the overall 74% completion rate.

Survey (Qualitative Data)

Study participants (n=117) had the option to skip survey questions that they did not want to answer; thus, some respondents may have answered none, or only a few, of the qualitative questions, while others may have responded to all of them. Of the eight qualitative questions in the survey asking about the perceived benefits and drawbacks of varied communication modalities, the average number of responses per question was 34.25 and the range was 8 to 65 responses.

In the quantitative portion of Ahmann and Saviet’s (2019) study, a mixed methods study of which the present qualitative report is a component, coaches’ perceptions of the effectiveness of the four included communication modalities were not found to have statistically significant differences from each other. In this regard, it is interesting to note, as illustrated in Table 1, that, in the qualitative data, approximately the same number of benefits as drawbacks were identified for in person coaching. However, for telephone, video conferencing, and a combination of modalities, notably more benefits than drawbacks were identified. Combined findings related to all four modalities showed that coaches identified more than twice the number of benefits as compared to drawbacks.

Table 1: Number of Benefits and Drawbacks Identified by Communication Modality

In-PersonTelephoneVideo ConferencingCombinationTotals
Benefits68866733254
Drawbacks7153406123

Perceived Benefits and Drawbacks: Themes Identified

Fifteen key themes were identified in coaches’ responses regarding the benefits and drawbacks of the four communication modalities studied (in person, telephone, video conferencing, and a combination of modalities). As indicated in Table 2, the number of times each of the themes appeared was quite varied: for example, the most frequently occurring theme, Focusing and Distraction, was identified a total of 70 times throughout coaches’ responses, while the theme Note-taking only appeared 3 times in total.

Table 2: Themes Identified: Frequency, Codes, and Exemplar Quotations

Theme#Codes (Benefits & Drawbacks)Exemplar Quotations
Focusing and Distraction70• Greater focus
• Ability to move during session
• Difficulty focusing
• Multitasking
[Telephone] “[P]hone lends extra focus, keeping us both on track and making best use of our time.”  
[Telephone] “Removes other distractions (like visuals) for both coach & client”  
[Telephone] “Intense focus on the coaching and the coaching context”
Managing Time60• Time saving
• Greater time efficiency
• Travel time/traffic issues
• Ability to start/stop session promptly
[In person] “Travel time for both coach and client”  
[In person] “Drawbacks for me as a coach include: clients arriving late - or at the wrong time - to our meeting (much more common than when we work by phone or internet).”  
[Telephone] “I can manage the time better.”  
[Telephone] “Client and coach save time.” 
[Video conference] “It is easier for me to schedule more clients since I do not have to set up an office or coordinate schedules.”
Convenience and Flexibility53• Scheduling issues
• Convenience
• Increased flexibility
• More scheduling options
[Telephone] “Clients can continue to have sessions when traveling.”
[Video conference] “I have less [sic] cancellations and reschedules….”  
[Video conference] “I particularly like the lack of commuting required for the client to get to the coaching. I also find that I can schedule at earlier hours than if I needed to get to an office, since I do it [coaching] from my home.” 
[Combination] “We [coach and client] both like the flexibility.”
Nonverbal Observations44• Coach picking up nonverbal cues
• Body language
• Facial expressions
• Tone
[In person] “You can get a full picture (body language) of the client.” 
[In person] “All the additional intuitive info that comes from a face to face meeting: mood, level of stress/tension etc., general well-being, plus interactions that single particular distress or concern”
[Telephone] “There have been times when I wonder if I missed out on body language or facial expressions which would be important pieces of information. But there’s no way to know that for sure…”
[Video conference] “Face to face allows seeing more about the client’s reaction to questions and general demeanor than only phone.”
Tangible Information33• Shared visuals (e.g. screens)
• See the space
• Deal with tangible issues
• Hands on assistance
[In person] “I find it beneficial when client has a lot of papers to manage or we are working with paper planners.”  
[Video conference] “I can pull stored materials/resources, use a whiteboard, screen-share, document and track progress in session, collect data, set-up custom notifications, reminders, conduct real-time assessments, surveys, questionnaires, etc.”
[Video conference] “You can see the distractions and surroundings of their workspace. You can work with them in real time (i.e. in less than one minute, create a post it reminder and stick it on the bathroom mirror).”

Table 2 (continued)

Theme#Codes (Benefits & Drawbacks)Exemplar Quotations
Interpersonal Connection32• Coaching relationship
• Tuned in
[In person] “The face to face builds rapport and camaraderie.”  
[Telephone] “... [I]t is easier for me to be ‘full[ly] listening’ for my coachee, no distractions just total focus on their voice.”
[Telephone] “Clients seem more relaxed, willing to talk and elaborate more.”
Geography/ Location32• Geographic considerations
• Expanded geography/
location
• International clients
[In person] “It limits the outreach of a coach to only the geographical area where they live.”  
[Telephone] “It makes it possible for me to coach clients anywhere in the world. It makes it possible for clients anywhere in the world to work with me.”  
[Video conference] “It affords me the opportunity to work with clients from any part of the world.”
Technology Issues26• Technology glitches and difficulties
• Where to look on screen
• Hard to hear on phone & Background noise
[Telephone] “Possibility of technical problems (e.g., if cell phone reception is bad)”  
[Telephone] “[S]ometimes noise, background noise and cross-work interruptions”  
[Video conference] “The video streaming tends to be patchy, or stilted, not matching the exact words being spoken.”  
[Video conference] “It is sometimes confusing to know where to look. The placement of the client and coach on the other’s screen vs. where the camera can make people self-conscious about their eye contact.”
Intra-personal Concerns20• Privacy
• Safety
• Anonymity
• Self -Consciousness
• Greater comfort
[Telephone] “Some prefer it for privacy.”  
[Telephone] “The safety of anonymity for the coach.”
[Video conference] “Sometimes it ends up not being private (family members in the background).”  
[Video conference] “Clients are in a comfortable location.”  
[Video conference] “Self-consciousness about being on video is a real drawback for me and some of my clients”
Client Preference17• Flexibility
• What benefits the client
[Combination] “Clients have the flexibility… client centered choice.” 
[Combination] “If using a combination [of communication modalities] will benefit the client, then that is what I do.”
Client Age Level10• Age[In person] “…beneficial for kids only - need to engage with them in a different way than with adults.”  
[In person] “Depends on age of client and level of commitment”
Preparing for Session9• Dressing professionally
• Appearance of coach
• Tidying up/cleaning
[In person] “...[T]he appearance of my office and myself has to be a little more meticulous than if I was coaching virtually”  
[In person] “When I was doing in-person coaching in my home (not an office), I would be rushing around tidying and cleaning before the client arrived, which took my focus from preparing to be present for them as their coach”  
[Video conference] “Requires me to look presentable!”
Costs8• Expense of office space
• Increased costs/prices
• Financially viable coaching business
[In person] “My office is in my home. I don’t need the expense of a separate place”  
[In person] “The cost of office space near my location would drive my prices up”  
[In person] “Commute time increases costs”  
[Video conference] “I would not have a financially viable coaching business if it were not for the technology of video conferencing”
Quality of Intervention7• Commitment
• Continuity
• Faster change
• Better Intervention
[In person] “[P]erhaps more commitment when meeting in person”  
[Combination] “More contact sometimes makes faster change.”  
[Combination] “… [We] can do more intensive interventions when needed.”  
[Combination] “Working with clients as they need/desire and switching contexts as appropriate give us a much richer continuity of coaching support.”
Note-taking3• Not distracting for client[Telephone] “I can take notes without it being a distraction for the client.”  
[Video conference] “I take notes out of range of the camera, which isn’t a distraction for the client, and allows me to process information in a way that suits my strengths. I'm upfront about doing this & they can see me looking down from time to time, but somehow it seems less disruptive over video than in person.”

The seven most frequently occurring of the 15 themes related to benefits and drawbacks of coaching are described below in descending order of the frequency with which they appeared in the data. Exemplar quotations for each theme are provided both below and in Table 2. Table 2 also identifies and provides examples for the eight less frequently occurring themes. Additionally, Table 3 indicates the themes most frequently identified as benefits and drawbacks for each modality.

Table 3: Most Frequently Identified Themes by Modality

ModalityThemes
In personNonverbal Observations (Benefit)
Managing Time (Drawback)
TelephoneFocusing and Distraction (Benefit)
Focusing and Distraction & Nonverbal Observations (Drawbacks)  
Video conferenceTangible Information (Benefit)
Technology Issues (Drawback)  
CombustionConvenience and Flexibility (Benefit)
Convenience and Flexibility (Drawback)

Theme: Focusing and Distraction

The overarching theme of Focusing and Distraction appeared 70 times in the data. The ability to achieve greater focus appeared most often when coaches responded about the benefits of both in person and telephone coaching. Challenges with focusing and distraction appeared most often in relation to coaching via telephone and video conferencing.

One respondent clearly articulated focusing as an advantage of in person coaching, saying, “Clients are better able to stay attentive and away from distractions like smartphones and computers while working with a coach in person.” Another coach underscored this assertion by remarking, “[We] can cover more in a longer appointment because I’m there to anchor attention/focus.”

Other coaches emphasised the benefits of telephone coaching for improved focusing for themselves, as the following example illustrates: “I think I can concentrate better on what’s going on with the client when I don’t see them.” Several other coaches’ responses nicely summarised the sentiments of many respondents related to benefits of telephone coaching:

  • “[P]hone lends extra focus, keeping us both on track and making best use of our time.”
  • “Removes other distractions (like visuals) for both coach & client.”

One coach also described the benefit of being able to move during telephone coaching as a way to enhance focus: “It allows both my client and me to move around during the session to help increase focus.”

Two negative components identified in relation to the theme of focusing/distraction entailed difficulty focusing and multitasking. One coach articulated the range of potential distractions when coaching by telephone: “Sometimes noise, background noise, and cross-work interruptions impede our sessions.” Another coach compared video conferencing with in person coaching as follows: “I have coached clients in the past via FaceTime - interaction was not as focused as in person.” Several coaches indicated that staying in one place and lack of movement while coaching via video conferencing contribute to difficulty focusing: “It can be difficult to focus when client and coach both have ADHD and are forcing themselves to stay in one area for an extended period of time.”

Many coaches also identified challenges with clients multitasking when the coaching was conducted via video conferencing. For example:

  • “[There is an] opportunity for them [clients] to be doing something else on the call...as a coach I cannot really see if they are being distracted by cell phone or computer.”
  • “Clients can be distracted by notifications that pop up (although this can happen in in-person sessions as well).”

Theme: Managing Time

The theme of Managing Time encompassed a variety of time-related constructs identified in the data and appeared 60 times, expressed in relation to both difficulties and benefits of varied modalities. Managing time included difficulties such as travel time and traffic issues as well as challenges in the ability to start or stop a session promptly.

These challenging aspects of managing time were most often identified when participants were asked about the drawbacks of coaching clients in person. For example, one coach shared a litany of time-related problems in relation to in person meetings: “traffick [sic], risk of ticket, accident, being late, time consuming, parking.” Another coach voiced the following about in person coaching: “Drawbacks for me as a coach include: clients arriving late - or at the wrong time - to our meeting (much more common than when we work by phone or internet).”

Positive aspects of this theme, including both time saving and greater time efficiency, emerged from participant responses in relation to benefits of both telephone and video conferencing. For example, about coaching by telephone, coaches shared:

  • “I can manage the time better.”
  • “Client and coach save time.”

A similar benefit was identified in relation to coaching by video conference: “More efficient use of time for both client & coach (versus meeting in person).”

Theme: Convenience and Flexibility

The theme of Convenience and Flexibility was identified a total of 53 times in the data. Of particular note in relation to this theme was one coach’s comment about the benefits of utilising video conferencing technology: “Convenience. And that’s huge for people with ADHD.” Scheduling was one aspect of convenience and flexibility that bore a relation to, but was still conceptually distinct from, time management concerns. Convenience and flexibility were mentioned in other contexts as well.

Scheduling issues stood out as the predominant concern when it came to drawbacks of both in person and telephone coaching. One coach shared the following about in person coaching: “The main drawbacks for the client are having to schedule the time in keeping with traffic patterns….” Another coach explained that, when working with clients via the telephone, it “can be tricky working out differences in time zones.”

Greater convenience, increased flexibility, and more scheduling options were issues that most often appeared when coaches identified benefits of telephone coaching, video conference coaching, and using a combination of methods. For example, one coach suggested that “[p]hone coaching provides the greatest flexibility for the coach and client.” As an example of this, one coach shared the following about phone coaching: “The main benefit is convenience for the client - one adult calls me right before her lunch hour at work, another calls me ... because of poor internet connection where they are.” Coaches identified similar advantages of video conferencing for convenience and flexibility, for example: “[C]lients enjoy the flexibility of having session[s] from home, work, etc.”

When examining the theme of convenience and flexibility in relation to using a combination of approaches, coaches offered the following types of comments on benefits:

  • “There are multiple ways to connect so you have options.”
  • “Convenience for the client (or coach) - sometimes one of us will ask to use the phone instead of the internet because of that day’s circumstances.”

One coach described the versatility of a combination of communication modalities as follows:

You need the face to face to make a personal connection and the video conferencing for efficiency and reliable consistency in making appointments. The phone is a good backup solution, and works well for a quick checkin [sic] that requires something more than a text.

Theme: Nonverbal Observations

The theme of Nonverbal Observations, surfacing a total of 44 times in the data, appeared most often as a benefit of in person coaching, though also as a benefit of video conference coaching, and as a drawback of telephone coaching.

One coach identified a benefit of coaching in person as: “It is easier to read my clients [sic] comfort and to keep them engaged when coaching in person.” Another described the importance of observing nonverbal cues when working in person with children: “For young children I think it is extremely important especially to gain insights into their body language, loss of focus, and other observations.” The variety of benefits achieved with in person coaching in relation to nonverbal observations were nicely summarised in the following comment: “All the additional intuitive info that comes from a face to face meeting: mood, level of stress/tension etc., general well-being, plus interactions that signal particular distress or concern.”

Other coaches remarked about the benefits of being able to pick up nonverbal cues in person with statements such as:

  • “Better gauge of full body language and facial expressions”
  • “[S]ee and feel the energy”
  • “[I]ncreased perceptions”

Some coaches identified similar benefits of video conferencing, for example: “I can see their body language and facial expressions and have that as another source of information. I can still sense energy changes as if we were in person.”

Participants also discussed the drawbacks of not being able to observe nonverbal cues when coaching by telephone, as illustrated by comments such as:

  • “There have been times when I wonder if I missed out on body language or facial expressions which would be important pieces of information. But there’s no way to know that for sure…”
  • “Obviously you do not get a feel for what is ‘behind the words’.”

One coach’s response to the drawbacks of telephone coaching very clearly articulates the essence of not having nonverbal cues to rely on: “Only 7% of communication is the words we choose. The rest is tone, demeanor, body language. Phone beats text, but still too much missing communication.”

Theme: Tangible Information

The ability to observe/gather and share Tangible Information appeared as a theme 33 times in the data. Coaches most often remarked about this theme in relation to benefits of coaching in person and by video conference. Elements of this theme identified in the data included: having shared visuals (e.g., screens), seeing the space, dealing with tangible issues, and providing hands on assistance.

For example, in relation to in person coaching, respondents shared the following:

  • “I am working with one client in person right now. We work in her home, because we are working on clutter as well as time management.”
  • “It is nice to have the ability to “touch” a client’s calendar, or a student’s notebooks, and other assignments. It is also easier to incorporate art into my student sessions (or play games) when the session is in person.”

Another respondent expressed the following tangible advantage of working with a client in person (presumably in the workplace setting): the “[a]bility to meeting [sic] with supervisor.”

Respondents also expressed the benefits of being able to observe/gather and share tangible information when coaching via video conferencing. For example:

  • “[C]oach can see [the] space for organisational purposes or [can] detect issues like hoarding.”
  • “[The] ability to screen share; ability for the client to ‘show me around the room/office;’ because students are often on their computer, they can check assignments or syllabuses [sic] more easily [as] compared to coaching on the phone.”

Another coach respondent expressed excitement regarding the versatility that coaching by video conference provides in terms of tangible sharing as well as connection:

If it’s in the context of the goals of coaching, the client can show me their physical environment or projects they are working on. This has been SO helpful with a number of clients! - It allows for another level of connection: many of my clients get a kick out of showing the landscape and seasons outside of our windows. I’ve met pets, spouses, roommates, and children of clients!

Theme: Interpersonal Connection

The theme of Interpersonal Connection encompassed a range of coach-client relationship dynamics, and appeared 32 times in the data. Benefits and drawbacks of different modalities were identified in relationship to interpersonal connection.

Having a harder time connecting because of not being able to see the client’s face was exclusively raised as a drawback of telephone coaching. For example, one coach stated: “It’s harder for me to develop a relationship with just phone contact.” Another shared a similar point of view: “It’s harder to connect because I am only relying on their voice.”

However, in terms of increased interpersonal connection, a number of coaches pointed to benefits of coaching by both telephone and video conference in terms of leading to increased connection, relaxation, intimacy, rapport, and ease of communication. For example, when asked about the benefits of telephone coaching, several coaches illustrated these points as follows:

  • “[M]ore intimate… rapport can develop more quickly… it feels to me that I can go deeper with my in person clients.”
  • “[I]ncreased connection and intimacy (I have tissues handy!)”

Several coach respondents indicated that they were able to tune in more to their clients when coaching was performed via the telephone. For example:

  • “I think I can concentrate better on what’s going on with the client when I don’t see them.”
  • “They [clients] are always surprised by what I can detect over the phone!”

As a final example, one coach highlighted the skills, developed through a coach training programme, that changed the way they now connect with clients: “Through my … training I’ve been able to hone my listening skills and am now able to pick up more nuances in emotion and focus my intuition better [by phone] than working with clients in person.”

Benefits for Interpersonal Connection surfaced in regard to use of video conferencing as well:

  • “[G]reat for establishing rapport and trust”
  • “It allows clients to open up more easily because we are not in the same room together.”

Theme: Geography/Location

The theme of Geography/Location appeared a total of 32 times in the data and focused primarily on benefits of telephone and video conferencing as communication modalities for expanding the geographic range of clients available to coaches. Drawbacks of in person coaching were also identified in this regard.

One coach shared a particularly interesting comment about the benefits of telephone coaching and the theme of Geography/Location: “The coach can be a better fit, since geographic location is not a limiting factor.” Other coaches spoke to the ability to coach clients in a wide geographic range using telephone:

  • “Since it works so well it also offers the opportunity to assist clients regardless of location - including internationally (I currently have one client in Slovenia.).”
  • “I can coach clients nationally and internationally.”
  • “Convenience for clients especially because of how national my clientele is”

Similar benefits were identified for coaching via video conferencing. As one coach stated: “I can reach people all over the world and help them stop suffering :).” An additional interesting perspective addressed financial benefits to coaches related to drawing clients from a larger geographic range: “I would not have a financially viable coaching business if it were not for the technology of video conferencing. - I have clients all over North America (hoping to have them all over the world one day!)”

The geographic benefits of coaching via telephone and video conferencing were echoed when coaches spoke about drawbacks of coaching in person:

  • “Geographic constraints”
  • “If a coach were to only coach in person he or she would be limited to local clients and would miss out on the coaching clients who move away or go off to college, as well as having a national/international clientele.”

Discussion

This report focuses on an exploration of qualitative data obtained from a survey of 117 self-identified ADHD coaches about the use of varied coaching communication modalities. In particular, the qualitative data reported here explored coaches’ perceptions of the benefits and drawbacks of each of the following communication modalities: in person, by telephone, by video conference, or by a combination of modalities. Exploration of coaches’ perceptions led to the identification of a total of 15 key themes. The number of times participants had responses relevant to each of the themes ranged from 3 to 70, and all 15 themes were retained in the analysis so that all issues identified would be reported in this exploratory study.

For the most frequently identified theme of theme of Focusing and Distraction, coaches felt that telephone coaching supported focusing, while coaching via video conference too easily contributed to distraction. It perhaps is not surprising that Focusing and Distraction was the most frequently reported theme, because of its direct relationship to key impairments of attention and focus associated with ADHD and executive functioning challenges (Barkley, n.d; Barkley, 2010; Brown, 2013; Tuckman, 2009). Although this study did not explore whether the participating coaches in this study had ADHD, according to T. Rosier, President of the ADHD Coaches Organization (personal communication, November 3, 2019), anecdotally, a good number of ADHD coaches do have ADHD themselves, perhaps further explaining the frequent appearance of this theme throughout the data. It is interesting to note that several coaches indicated that coaching via video conference contributed to difficulty focusing because it inhibited coach and client movement during the session: movement is one strategy individuals with ADHD can use to regulate alertness and maintain attention (Rotz & Wright, 2005).

Managing Time was the second most often appearing theme in this data, and, while this could be a concern for any coach or client, it does represent a particular challenge for many individuals with ADHD (Barkley, n.d.; Barkley, 2010; Tuckman, 2009). Barkley (n.d., p. 4) has stated, “The organisation of [an] individual’s behaviour both within and across time is one of the ultimate disabilities rendered by the disorder.” The theme of Managing Time came up much more frequently in relation to coaching in person than with the other modalities explored, an understandable finding since arriving on time to an in person appointment requires time estimation and advance planning, challenges for many individuals with ADHD (Tuckman, 2009).

Convenience and Flexibility was identified as a theme in this study and is an important theme for both coaches and their clients. For example, Frazee (2008) has suggested that workplace “e-coaching [virtual coaching], conducted partially or entirely at a distance, offers convenience, cost-savings, efficiency, and improved access” (p.6). Similarly, in a discussion of alternatives to in person coaching approaches, Boyce and Clutterbuck (2010) identified convenience (comprised of accessibility, availability, flexibility, and affordability) as one of three client-centered factors associated with use of varied modalities. About convenience, one participant in this study stated: “Convenience. And that’s huge for people with ADHD.” In this regard, for clients with ADHD, common challenges with time management and organisation (Barkley, 2010; Tuckman, 2009) may make convenience and flexibility an issue of particular importance.

It may not be unsurprising that the bulk of the responses about the theme of Geography/Location in this qualitative exploration appeared as benefits of telephone and video conferencing. These included the flexibility to continue coaching when clients travel; the flexibility to work with clients across a wide geographic range, including nationally and internationally; and a greater overall flexibility of scheduling when not working in person. In the Ahmann and Saviet (2019) report, geography (location) was the factor most commonly identified as driving the choice of coaching communication modality. Frazee (2008) has reported that e-coaching (virtual coaching), in workplace settings, was “typically used to serve geographically-dispersed employees, … and reduce costs” (p. 6). Boyce and Clutterbuck (2011) also describe advantages of virtual coaching (for executives) as including lack of “geographical boundaries” and expanded coaching opportunities related to “travel, military deployment, third-world countries” (p. 291). Even outside of the workplace setting, flexibility in coach or client location can impact costs and broaden coaches’ income opportunities.

Nonverbal Observations is an important coaching theme supported by the ICF competency of “Listens Actively”, which includes the statement: “Notices, acknowledges and explores the client’s emotions, energy shifts, non-verbal cues or other behaviour” (ICF, 2019). In the present study, the majority of coaches felt that being able to see the client (whether in person or by video conference) was more effective, and even necessary, to gain important nonverbal cues and observations. However, several coaches felt that they could actually tune in better to their clients when they were able to listen to the client’s voice only (i.e. via telephone), a finding supported by Collett’s (2008) case study (series) finding that telephone coaching supported enhanced listening.

While some coaches felt that working via video conference was effective for building trust and rapport, many felt that the telephone had greater benefits because it was easier to develop Interpersonal Connection and intimacy using this modality. Similarly, McLaughlin (2013) found that some coaches reported a more rapid development of trust and rapport with telephone coaching, due to the lack of visual distractions. While telephone is a frequently used coaching modality (ICF, 2012; ICF, 2016), Lynden and Avery (2015) have argued that conversational analyses, such as theirs of workplace telephone coaching, are needed to enhance coach communication skills through “training based on an micro-level analysis of [what] ‘real-world’ telephone coaching conversations” entail (p. 5).

A number of coaches in this study spoke of Intra-personal Concerns—identified by codes encompassing words including safety, anonymity, self-consciousness, and greater comfort—for coach or client. Surprisingly, this theme arose for in person as well as telephone and video conference coaching, suggesting that a specific modality is not a clear driver of comfort across the board. It is unclear how to interpret this finding. One possibility is that different personalities may simply have comfort with differing modalities. This would not be surprising as neither coaches (Campone & Awal, 2012) nor, for that matter, clients, come to the coaching interaction as blank slates. As an analogy to comfort with communication modalities, Abbott and Rosinski (2007) found that that certain coaches may have more comfort with particular coaching perspectives or models than others.

For the relatively small number of coaches who mentioned the impact of modality in relation to Quality of Intervention, a combination of communication approaches was more frequently mentioned than in person or video conferencing; no mention was made of telephone. In fact, it has been reported elsewhere that use of a combination of in-person and telephone coaching is common (Munoz Obino, Pereira & Caron-Lienert, 2017) and may increase client motivation (Charbonneau, 2002, as cited in Kanatouri & Geissler, 2017; Kivelä et al., 2014). To the extent that the concept of quality of intervention may be related to outcomes, a number of coaching studies have reported that a combined in person and telephone approach demonstrates positive outcomes (e.g., Munoz Obino et al., 2017). Success has also been reported with interchangeable use of telephone and video conference coaching (Pande et al., 2015; Dennis et al., 2013), and three studies of ADHD coaching have found beneficial outcomes using a combination of modalities (Ahmann & Saviet, 2019). At the same time, Ahmann and Saviet (2019) reported that self-identified ADHD coaches perceived all communication modalities as equally effective; other research, particularly in the health coaching arena, also demonstrates comparable outcomes with varied communication modalities (e.g., Das et al., 2017; Sforzo, Kaye, Avers, Talbert, & Hill, 2014).

Some specific benefits identified in this study for in person and video conference coaching had to do with the theme of Tangible Information: working on tangible issues or using tangible approaches (e.g. sharing visuals, working on organising space, or other hands-on assistance). While this theme might be relevant for any client, it is of great importance to clients with ADHD. Because verbal and nonverbal working memory can be impacted by ADHD, making issues “external, physical and manual” is a key coping strategy that supports effective problem-solving (Barkley, 2010, p. 182).

As six of the eight questions in this study about communication modalities included the use of phone, video conference, or a combination of modalities, it is not surprising that Technology Issues was a theme appearing in the data. Technological drawbacks of coaching by video conference (e.g. poor connections and concerns about where to look on the screen) were commonly cited although, overall, more than 1.5 times as many benefits than drawbacks were identified related to video conferencing. Boyce and Clutterbuck (2105) explore issues of technology in coaching in detail.

Client Preference was an important theme, given that coaching is a client-centered profession (Bark, 2011; Belf, 2002; ICF, 2019; Newnham-Kanas, Morrow & Irwin, 2012). In fact, part of the definition of the ICF competency “Coaching Mindset” indicates that a coach “[d]evelops and maintains a mindset that is ... client-centered” (ICF, 2019). It is interesting to note that the theme of Client Preference was described by coaches in the current study in ways that relate, in part, to the theme of Convenience and Flexibility (i.e., providing options that most benefit the client). In their quantitative examination of communication modalities in ADHD coaching, Ahmann and Saviet (2019) also found that client factors (i.e., age of client [younger/school-age], client preference due to time management/time saving, and client prefers the approach for other reasons) impacted the choice of communication modality more often than coach-specific factors.

A benefit of in person coaching showed up as the theme of Costs, most often in relation to the cost savings of not having to pay for external office space or the added costs of commuting, all factors having an impact on a coach’s income. (A coach’s income was an issue noted not only in the Costs theme, but also in the Geography/Location theme, as described above.) A drawback of coaching in person was identified in the theme of Preparing for Session, involving the need for both greater time to prepare the work space and the time and effort spent on personal appearance. The National Board for Health and Wellness Coaching (NBHWC) has identified preparing prior to a session as a competency (National Board of Medical Examiners® and NBHWC, 2019), indicating the importance of mindful preparation and review of notes; NBHWC does not distinguish session preparation by coaching communication modality.

Strengths and Limitations

Strengths

This study is the first to explore the perceptions of self-identified ADHD coaches in relation to the benefits and drawbacks of varied coaching communication modalities. It builds on Ahmann and Saviet’s (2019) exploration of the perception of self-identified ADHD coaches in relation to the effectiveness of varied communication modalities and reasons for choice of modality, providing a fuller picture of coach views of varied communication modalities used in the coaching process.

The following strategies employed in this qualitative exploration - many of which are recommended by Gibbs (2007) and others and described in the Methods Section above - serve to strengthen the reliability of the study’s findings:

  • Responses were copied directly from SurveyMonkey to the coding sheets, minimising the risk of transcription mistakes.
  • To avoid drift in definition of the codes, in vivo coding was used through several rounds of coding, before broader themes were derived by combining several codes, a process that occurred based on several discussions among both authors/coders.
  • Communication among the two authors doing the coding was frequent, and meetings were held at each juncture between completion of one round of coding and starting another.
  • The coders cross-checked their coding with each other, discussing and resolving discrepancies at each juncture.
  • Inter-coder reliability was very high for all questions, meeting the criteria of 80-90% generally considered evidentiary (Saldaña, 2016, p. 37).
  • An audit trail was maintained by retaining all versions of the coding sheets leading to the final version, as well as evidence of discrepancies resolved.

Creswell and Poth (2018, p. 259) recommend that researchers use multiple, and at least two, validation strategies for any qualitative study. Validity of this study’s findings is supported by several of the approaches recommended by Creswell (2009) and Creswell and Poth (2018):

  • Face validity is one of the strengths of this study, and all qualitative research, in that the study reports directly on the perceptions of study participants, and makes direct use of participant language, to describe the findings.
  • Each theme identified in the data is reported using multiple quotations or ‘rich description’ (Creswell, 2009, pp. 191-192; Creswell & Poth, 2018, p. 263).
  • When existing in the data, contrary participant opinions are provided, an approach that supports the validity of the findings (Creswell, 2009, p. 192; Creswell & Poth, p. 261)
  • The researcher/coder backgrounds, and, thus, potential biases have been reported herein: the first author is a Masters of Social Work student and the second has a background that includes 12 years of experience coaching individuals with ADHD.
  • A high level of agreement between the two researchers/coders, despite differing professional backgrounds and research training, also adds validity to the findings.
  • The fact that one researcher has been a coach in the field for 12 years adds validity through “prolonged engagement” both in the field and with the topic under study (Creswell and Poth, 2018, p. 262).
  • Peer debriefing was provided by two highly experienced coaches who identify themselves as ADHD coaches (Creswell, 2009, p. 192).

Limitations

This qualitative exploration was part of a mixed methods study using a purposive convenience sample of self-identified ADHD coaches. Although it is not possible to be certain that survey respondents were a fully representative sample of ADHD coaches, this is not as much of a concern in a qualitative exploration as it would be in a quantitative study. As Creswell states (2009), “In qualitative data collection, purposeful sampling is used so that individuals are selected because they have experienced the central phenomenon” (p. 217).

In terms of the data in the study, many fewer responses (8 drawbacks and 18 benefits) were obtained from the questions about benefits and drawbacks of using a combination of communication modalities than were obtained in relation to the other three modalities explored. This may be because fewer coaches use a combination of modalities (Ahmann & Saviet, 2019). Alternatively, respondent fatigue may have contributed to lower completion rates on the questions related to a combination of modalities, since these were the last two of the survey questions about benefits and drawbacks.

It is important to note that an in-depth exploration of themes is the hallmark and overall strength of qualitative exploration, and generalisation is not its purpose (Gibbs, 2007). For this reason, caution is imperative in any effort to generalise from the findings of this study. In particular, because this study was conducted with ADHD coaches, that is, coaches who work with a distinctive client population, it is of importance to note that this study’s findings on coaches’ perceptions of benefits and drawbacks of varied communication modalities may or may not apply to coaches working with other populations.

Recent literature suggests an increase in the use of texting, email, mobile digital systems, and apps as coaching communication modalities (Bus et al., 2018; Geissler, Hasenbein, Kanatouri, & Wegener, 2014; Klaassen, Bul, van der Burg, Kato, & Di Bitonto, 2018). In fact, in the present study, one participant, who mentioned being a coach for 12 years, stated that, for purposes of client action and accountability, “...My practice [is] … set up now around online coaching on Google Hangouts with typing only, (no video).” However, this study explored only four coaching modalities; additional modalities were not examined.

In terms of gaining a broad understanding of the benefits and drawbacks of varied coaching communication modalities, one limitation of this study is that it did not obtain a key voice: that of coaching clients. Exploring the perspectives of clients who are coached presents an important direction for future research.

Conclusions

While not directly examining outcomes of ADHD coaching, Ahmann and Saviet (2019) reviewed the extant research literature on ADHD coaching outcomes in relation to varied communication modalities (in person, telephone, videoconferencing, and a combination of methods) used, and also reported their own survey findings on coach perceptions of the effectiveness of using each modality. Based on this, they suggest that positive outcomes generally seem to be associated with varied communication modalities used in coaching: in person, telephone, video conferencing, and a combination of modalities.

This qualitative exploration is the first study to examine ADHD coach perceptions of the benefits and drawbacks of varied communication modalities and, thus, represents a new contribution to the coaching literature. Fifteen themes were identified in relation to the benefits and drawbacks of varied communication modalities. While Technology Issues was, not surprisingly, one theme that arose, particularly in relation to use of videoconferencing for coaching, it was less prominent a theme than a number of others in relation to coaching communication modalities.

Focusing and Distraction and Managing Time were the two most frequently identified themes by coaches in this study. These may be issues in any coaching interaction, but are likely of particular concern when working with individuals having ADHD, since these themes relate directly to the specific challenges of attention, time-perception, and time management common among individuals having ADHD (Barkley, n.d.; Barkley, 2010; Brown, 2013; Tuckman, 2009). It is possible that the theme of Tangible Information is also more of a concern when coaching individuals with ADHD, since using physical, external tools is an important coping mechanism for many with this diagnosis (Barkley, 2010).

Other prominent themes identified in this qualitative exploration, such as Convenience and Flexibility and Nonverbal Observations arise in relation to communication modalities used in coaching with other populations (e.g., executives), as do issues related to the theme of Interpersonal Connection, key in any coaching interaction, and the theme of Geography/Location, identified largely in relation to coach access to a wider range of clientele when not tied only to coaching in person. Costs is a theme that some literature has related to Geography/Location.

The less frequently identified themes in this study, Preparing for Session and Note-taking might also be issues related to choice of communication modality for coaches working with any population, although literature exploring these themes was not identified. Client Age Level, typically identified in this data as children, and generally mentioned in relation to in person coaching, makes sense as a consideration in terms of child development, attention, and developing a relationship for this age group, whether or not the younger client has ADHD.

While not surfacing many times in the data, the important theme of Quality of Intervention, which respondents identified as better with either in person coaching or the use of a combination of modalities, deserves further research because of its potential relationship to coaching outcomes. Similarly, the theme of Client Preference deserves further study, since coaching is, at its heart, a client-centered profession. Additionally, this study examined four communication modalities, but the coaching literature has begun to examine others, including texting, email, mobile digital systems, and apps. For this reason, future research broadening the number of communication modalities explored would be beneficial.

The reasons that coaches select specific communication modalities - including client or other factors that could beneficially be considered in making that choice - were hinted at in the identification of benefits and drawbacks of varied modalities, but not specifically examined in this study. Future research exploring how and why coaches choose to use a particular communication modality would be valuable in further understanding the important issue of how coaching is offered. Most importantly, client perceptions of the use of varied modalities, the benefits and drawbacks of each, and reasons influencing their preferences would be important in understanding the impact and choice of varied coaching communication modalities. Such further exploration would assure that appropriate client-centered communication choices are available and can be individualised, even as technology continues to change.

Acknowledgements

Many thanks to Linda Anderson, MA, MCC, SCAC and Jodi Sleeper-Triplett, MCC, SCAC, BCC for reviewing the manuscript while in preparation to provide feedback to the authors.

References

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About the authors

Micah Saviet, BS, CNA, a student in the Masters of Social Work program at the University of Maryland School of Social Work, is interested in exploring client-centered, behavioral-based strategies aimed at helping individuals with Attention Deficit/Hyperactivity Disorder to thrive.

Elizabeth Ahmann, ScD, RN, PCC, NBC-HWC, a faculty member in the Health and Wellness Coaching Department at Maryland University of Integrative Health, is interested in research related to coaching for individuals with Attention-Deficit/Hyperactivity Disorder.

Appendix

The ADHD Coaches Organization outlines the following criteria for a “Professional ADHD Coach”:

In order to be recognized as a Professional ADHD Coach, one must either have completed a fully integrated ADHD Coach Training Program, or completed at least 60 hours of ICF-compliant life coach training plus at least 35 hours of ADHD coach training from recognized sources.

Source: https://www.adhdcoaches.org/adhd-coach-training-programs

Details

  • Owner: Hazel King
  • Collection: IJEBCM
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