Until this year, nobody could say with any precision who ADHD coaches were or what they did. The field had grown into a visible part of the ADHD care landscape, recommended by clinicians and named in professional practice guidelines, without anyone having systematically asked its practitioners a single question. In January, that changed. JAMA Network Open published the first national survey of the American ADHD coaching workforce, drawn from 481 coaches, and the portrait it produced is one the field will be arguing about for some time.

The study was led by Margaret Sibley, a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, with colleagues at Seattle Children’s Research Institute, Children’s National, George Washington University, and the University of Melbourne. Its findings are blunt. Fifteen percent of surveyed coaches held a professional license of any kind, meaning 85 percent did not. Only 10 percent had worked in mental health before becoming a coach, while roughly a third came from education. And 90.5 percent reported no formal clinical supervision, though about a third sought informal consultation with clinicians when they wanted a second opinion.

Those numbers alone would be unremarkable if ADHD coaching were plainly non-clinical work. The rest of the survey is what makes them consequential.

The Overlap With Therapy That Nobody Designed

When the researchers asked coaches what techniques they actually use, the answers landed almost entirely inside the cognitive behavioral therapy playbook. Executive function skills training and cognitive restructuring were each reported by 99.4 percent of coaches. Solution-focused approaches came in at 97.8 percent, motivational interviewing at 96.6 percent, and between-session homework assignments at 83 percent. These are not adjacent techniques. They are the core components of the psychosocial treatment that CBT for ADHD delivers.

The authors say so directly, noting that this redundancy could make it hard for prospective clients, and for some medical clinicians, to tell the two approaches apart. That is a significant admission in a journal read primarily by physicians, and it reframes the whole question. The issue is not that coaches are doing something unproven. It is that many appear to be delivering recognizable components of an evidence-based treatment, without the training, supervision, or accountability structures that surround that treatment when a licensed clinician provides it.

The subject matter follows the same pattern. Coaches reported addressing sleep at 98 percent, self-worth at 98.1 percent, emotional concerns at 97 percent, and health behaviors including nutrition and management of medical conditions at 97 percent. Medication adherence came up for 77.8 percent. Then the numbers move into territory that is unambiguously clinical: 53 percent reported addressing substance use or addiction, 48.7 percent trauma, and 41.6 percent suicidality, abuse, or harm to self or others.

Roughly four in ten practitioners in a field with no licensure, no required supervision, and no mandated training standard are working with clients on risk of harm.

What the Field Looks Like From the Inside

The workforce the survey describes is young as a profession and personal in its motivation. About 60.9 percent of currently active coaches began practicing during or after the COVID-19 pandemic, which is a striking concentration for any occupation. Most are self-employed, work from home, and deliver hour-long virtual sessions on a weekly cadence.

Lived experience is close to universal as a professional foundation. Some 72.7 percent of coaches said they had ADHD or suspected they did, 77.6 percent had a family member with ADHD, 58.9 percent had a formal diagnosis, and 44.5 percent had been ADHD coaching clients themselves. More than 90 percent said they draw on those personal connections during sessions.

It would be a mistake to read that as a weakness. Sibley has been explicit that the recognition a client feels when working with someone who has navigated the same difficulties is a genuine and hard-to-replicate benefit. The authors also suggest that clients who find conventional CBT too rigid, too generic, or too short-term may engage with coaching and stay engaged, which matters given how much of ADHD treatment fails at the point of adherence rather than the point of efficacy. Coaching appears to be reaching people that clinical services were losing.

The economics complicate the picture. The median session runs 150 dollars, comparable to psychologist reimbursement rates, and Sibley has noted that some coaches charge well above 500 dollars an hour. Fewer than 5 percent accept insurance, so nearly all of it is paid out of pocket. That places coaching, an unregulated service, at a price point that puts it out of reach for many of the people it might help most.

The Part That Makes This Report Different

Surveys that document an unregulated field are usually written by outsiders, and they usually read like indictments. This one does not, because the field helped write it.

Among the co-authors are Tamara Rosier, who was president of the ADHD Coaches Organization when the work began, and Roxanne Fouche, also of the ADHD Coaches Organization, along with Jami Demuth of CHADD. Sibley has described the origin of the project as a conversation with Rosier about how anyone could responsibly discuss the growth of coaching without first collecting basic information about who coaches are and what they do.

That authorship changes the meaning of the conclusions. When the paper calls for standardized education, credentialing, and clinical oversight, that is not an external profession attempting to fence in a competitor. It is a call that the coaching field’s own leadership put its name to.

The paper is equally clear about the stakes of leaving things as they are. The authors write that pivoting to unsupervised, lay-practitioner models carries many potential drawbacks, and they enumerate them: reduced effectiveness when evidence-informed approaches are delivered inconsistently or incorrectly, the spread of ADHD misinformation, the risk of harmful advice, difficulty maintaining professional boundaries, and ethical exposure including loss of client confidentiality.

None of those risks require a bad actor. Each is what happens when well-intentioned practitioners work without the structures that catch ordinary error.

What the Survey Cannot Tell You

The study is descriptive, and its authors do not pretend otherwise. It documents who coaches are and what they report doing. It says nothing whatever about whether ADHD coaching works.

That distinction gets lost quickly in coverage. A finding that most coaches are unlicensed is not a finding that coaching is ineffective, and a finding that coaches use CBT techniques is not a finding that they use them well or badly. The survey establishes a baseline. The effectiveness question is separate and largely unanswered. The authors state plainly that randomized clinical trials are essential to establish whether ADHD coaching is safe and effective, and they frame standardization as something the health care and coaching communities might build together, conditional on those trials returning positive results.

The methodological caveats matter too. Participation was voluntary and recruitment ran through coaching networks, which means the coaches who responded are plausibly the more connected and more professionally engaged end of the field. Everything reported is self-report, including the parts about scope. If anything, the picture is likely to be more favorable than the full population would produce, not less.

It is also worth noting that some early outcome data has begun to appear. A separate 2026 prospective study of a manualized 12-session adult coaching engagement reported statistically significant improvement in ADHD symptoms, executive functioning, and daily impairment, with gains holding at a six-week follow-up. That study had no control group, so it establishes far less than a trial would. But it demonstrates that the effectiveness question is being asked, and that structured engagements are the ones researchers can actually study.

What Standardization Would Actually Require

The paper’s call for standardized education, credentialing, safety practices, and oversight is easy to endorse and harder to specify. It is worth spelling out what each piece would have to mean in practice, because the gaps the survey documents are quite specific.

A defined scope of practice, stated as exclusions rather than aspirations. The most useful scope document names what a practitioner does not do and what they do instead. Given that 41.6 percent of coaches report addressing risk of harm, the exclusions that matter are concrete: not diagnosing, not treating trauma, not managing suicidality, not advising on whether to take or adjust medication. A scope statement that only describes what coaching is leaves every hard case to individual judgment.

Referral protocols with defined triggers. Coaches already refer at high rates, which is encouraging. What the survey cannot show is whether those referrals happen at the right moment. A protocol converts referral from an instinct into a rule: these specific disclosures end the coaching conversation and begin a different one, with a named clinician, a documented handoff, and a follow-up. The difference between a coach who refers well and one who refers late is usually the absence of a written trigger.

Baseline assessment and measurement. The study reports that a substantial share of coaches conduct no formal assessment at intake, and that fewer than half use any of the measurement-based practices the researchers asked about. Without a baseline, a coach cannot tell whether a client is improving, plateauing, or deteriorating, and deterioration is the case where the absence of measurement does real harm. Validated rating scales are inexpensive, widely available, and take minutes to administer.

Ethics and confidentiality training. The authors name boundary maintenance and confidentiality among the specific risks of unsupervised practice. Licensed professions address these through mandatory ethics coursework and enforceable codes. A field without licensure has to build the equivalent into training, because the exposure exists whether or not anyone has prepared for it.

Consultation structure. Full clinical supervision may not be a realistic requirement for an unlicensed field, but the gap between 90.5 percent with nothing and a workable alternative is wide. Peer consultation groups, case review, and named clinical consultants all provide the basic function supervision serves, which is a second set of eyes on the cases where a practitioner’s own judgment is most likely to fail them.

Competency verification rather than attendance. The distinction between having completed training and having demonstrated competence is the one credentialing exists to make. Verification means examination, observed practice, or both. Certificates that document hours attended tell a prospective client how long someone sat in a chair.

What This Means for People Hiring a Coach

For anyone considering ADHD coaching, the practical implication is that credentials in this field are not interchangeable and the burden of checking falls on the client. The ADHD Coaches Organization sets a benchmark requiring either a fully integrated ADHD coach training program or at least 60 hours of coach training compliant with International Coaching Federation standards plus at least 35 hours of ADHD-specific training. Slightly more than 60 percent of surveyed coaches had completed an ACO-endorsed curriculum, which means a substantial minority had not.

Useful questions to ask are the ones the survey exposes as variable. What training did you complete, and was competence tested at the end of it? Do you have supervision or regular case consultation? What do you assess at intake, and how will we know if this is working? What would make you refer me to someone else, and to whom?

A coach who answers those readily is describing the structures the study found missing across most of the field. A coach who finds them intrusive is answering the question a different way.

The Larger Point

The survey lands at an awkward moment for ADHD coaching, which is also a promising one. Clinicians are referring to coaches in substantial numbers, and 65 percent of clients now arrive that way. Practice guidelines mention coaching. Demand is real, driven by people whose executive function difficulties are not adequately addressed by medication alone and who often cannot access or tolerate conventional therapy.

What the field lacks is not demand or good intentions. It is the infrastructure that turns a collection of individual practitioners into a profession: agreed training, verified competence, defined limits, a mechanism for the moment a practitioner is out of their depth. The survey’s authors, including the ones who lead the field’s own organizations, have now said as much in the pages of a major medical journal.

Whether the field builds those structures for itself or has them imposed later, less sympathetically, by someone else is the question this paper quietly poses.