The front page of the Sunday New York Times on December 15, 2013 includes a feature article on The Selling of Attention Deficit Disorder. Driven by pharmaceutical company advertising and other promotional strategies, attention deficit hyperactivity disorder (ADHD) is a leading long-term diagnosis in children (second only to asthma) and increasingly in adults as well. In 2012, nearly 16 million prescriptions were written in the United States for ADHD in young adults. Sales of prescription stimulants such as Adderall and Concerta exceeded 8 billion dollars that same year. It is no wonder that growing numbers of executive coaching clients are asking me if medication would be a helpful approach when they find themselves distracted and inattentive at work.

As both an executive coach and a psychiatrist, I am intrigued by this challenge and strongly committed to helping each individual client find the optimal solution in his or her own case. As noted in the NYT article, there is a growing tendency to diagnose ADHD too quickly, without careful medical evaluation and consideration of possible downsides to the medications (including addiction and side effects like insomnia, nervousness, loss of appetite, and agitation). Before starting medication, a comprehensive clinical evaluation is always warranted. Even if ADHD is suspected (or even diagnosed definitively), there are many behavioral strategies that can be implemented before and/or during the course of using stimulant medications.

There are many “attention deficit disorders” beside officially diagnosed ADHD. Executive coaches with some working knowledge of psychiatry and psychology are well positioned to help clients struggling with inattentiveness, poor concentration, procrastination, distractibility, difficulty starting or completing tasks, and a wide range of related complaints. Here are some common causes and potential remedies for these attentional problems, all of which can be incorporated into executive coaching instead of (or in addition to) use of prescribed stimulant medications.

1) STRESS. Regardless of the type of stress involved, stress hormones and other physiological factors can impair brain functioning and degrade executive functions such as attention, concentration, working memory, and strategic planning. Executive coaching can empower clients to understand the stress factors they face and to develop practical strategies to reduce the effects of those stress factors. For some clients, this may entail implementing such activities as regular exercise, yoga or meditation, and good nutrition. Some clients achieve stress reduction from better delegation of tasks to others, hiring of additional help, and enhanced communication skills to ensure that they get the most out of their employees. Frequently, these kinds of changes allow the executive to avoid prescribed medications. But these stress reduction strategies are equally important for those who decide to take medications, so that the medications are most likely to be effective.

2) MULTITASKING: Executives these days are continually rushing and pressured by multiple demands in their businesses. Neuropsychology research reveals that concentration and other executive functions break down when we try to do too much at once. Who among us has not been on a conference call while also checking email and perhaps paying bills at the same time? The ongoing explosion of social media technologies makes us all vulnerable to this. While I sit at my desk, I often catch myself with multiple windows open that I’m trying to attend to at once: email, Twitter, LinkedIn, an article I’m writing. Many of my clients report doing exactly the same in their weak moments. Instead of rushing to take potentially dangerous and addictive stimulant medications for ADHD, many executives can improve their cognitive performance and work productivity by doing one thing at a time. With the “default” position these days being multitasking for many of us, executive coaching can help clients prioritize, focus, and succeed by doing each individual task well. Some clients also need to be urged to give themselves down time so their brain can rest and recover. A growing body of research suggests that many of us suffer from “attention excess disorder” and failure to “reboot” our brains for best performance (see article in Scientific American at

3) WORK ENVIRONMENT: Without environmental conditions like proper lighting and temperature control, none of us can function at peak levels. Yet many executives and professionals spend little time or effort creating the environment that will empower effective work habits. It’s hard to concentrate on work when these conditions are not in place. Does the executive have adequate privacy and a quiet, comfortable work station? Executive coaches can come into the client’s work space to assess the situation in this regard and make recommendations about adapting the work space to optimize attention, concentration, and work performance. These changes might make all the difference in solving the client’s “attention deficit disorder.” Prescribed stimulant medication, even if clinically appropriate for ADHD, is unlikely to have any significant impact without such changes. Psychiatrists are often too quick to prescribe stimulants before assessing this dimension of the executive’s work life. This is another way in which executive coaching can make a major difference.

4) SLEEP PROBLEMS. Few executives that I know get adequate sleep on a consistent basis. There has been growing attention recently to the necessity of good sleep for mental health, and a recent study revealed that treatment of disordered sleep in itself is effective for treating major depression ( Stimulant medications for ADHD are unlikely to work if the person doesn’t sleep well and sleep long enough on a regular nightly basis. What’s more, one of the major potential adverse effects of stimulant medications is insomnia — so stimulants can actually make ADHD worse if this common side effect occurs. Executives sleep poorly for so many reasons: long work hours, worries about business issues, frequent travel across time zones, etc. Executive coaching must attend to sleep issues to support clients in managing stress, avoiding attention deficit issues, and maintaining good physical and mental health.

5) PSYCHIATRIC CONDITIONS. Multiple psychiatric illnesses other than ADHD interfere with attention and other brain-based executive functions. Among those conditions are anxiety, depression, bipolar disorder, substance abuse, and eating disorders. When people are anxious or sad, they clearly cannot give all their focus and attention to work tasks. When their mind is racing or their thoughts are disorganized because of a mental health condition, they similarly cannot perform optimally at work. Eating disorders and substance abuse negatively affect parts of the brain that are responsible for concentration, working memory, and other executive functions. Executive coaches who are savvy about these kinds of psychiatric conditions can refer their clients for appropriate mental healthcare. In my own practice as both a coach and a psychiatrist, I am careful to define what role I’m playing and whether another professional needs to be involved. Rather than simply going on prescribed stimulant medication for ADHD, many executives with attention deficits can benefit from treatment for anxiety, mood disorder, or other psychiatric challenges.

6) PERSONAL ISSUES: Even in the absence of a diagnosable psychiatric illness, emotional and relationship problems can interfere with the executive’s work performance. Personal crisis such as divorce or illness of a loved one can be all-consuming. The executive may find himself or herself completely distracted and spending large chunks of the work day on dealing with these situations. Some executives and professionals also find themselves so unhappy with their career choice and current work role that they simply cannot concentrate on job tasks. Rather than jumping to a conclusion that medications for ADHD are warranted on the basis of the client’s complaint that “I can’t focus at work,” the executive coach pays heed to personal issues and concerns. This is where executive coaching and personal coaching may overlap. By helping the client identify pragmatic strategies for coping with such challenges, the coach can help to free him or her to get refocused on work performance. Some clients may benefit from prescription medications, but virtually all are likely to respond to coaching around personal issues — and without any of the downsides like addiction or potentially toxic side effects.