Recommending Executive Function Coaching After an Evaluation: A Guide for Referring Clinicians
Last reviewed: 10/20/2026
Reviewed by: Dr. Kiesa Kelly
If you write evaluation reports for college students and adults, recommending executive function coaching may feel almost automatic. A line such as "consider executive function coaching" is easy to add to a report for a young adult with ADHD. The harder questions come after: what exactly the coach should work on, how anyone will know it is working, where the coach's role stops, and what the evidence can honestly support. Health care professionals already appear to refer regularly; in a 2026 national survey, nearly two-thirds of responding ADHD coaches reported actively receiving referrals from them [1]. This guide is about making those referrals specific enough to act on.
The short version: Recommend coaching when a specific, functional target, such as weekly planning or starting assignments, is the main problem and what is missing is a skill or a system rather than treatment for a mood or anxiety disorder. Name the target, the measure, the scope boundary and the point at which to re-refer. At ScienceWorks, coaching is delivered virtually.
In this article, you'll learn:
Three misconceptions about coaching that shape how it gets recommended
When coaching, therapy or both belongs in the recommendations
A four-part structure for a coaching recommendation a coach can act on
What the randomized evidence does and does not show, stated precisely
How to hand off, what to share, and when to bring the client back
The short answer: recommend coaching for a named target, with a measure and a boundary
A vague recommendation hands the hardest decisions to the person least equipped to make them. In our practice, we write a coaching recommendation in four parts: a target, a measure, a boundary and a re-referral point. The rest of this guide explains each one.
Three misconceptions tend to blur those parts:
Misconception 1: "Coaching is a lighter version of therapy." In reality, the two are different jobs. Researchers who surveyed the US coaching workforce cautioned that ADHD coaching "should not be viewed as equivalent to evidence-based psychotherapy for ADHD" and suggested clinicians might tell patients that coaching is currently most appropriate as an adjunct rather than a sole form of care [1].
Misconception 2: "Coaching has no controlled evidence at all." That is not quite right either. For college students and adults, ADHD coaching has been tested in one randomized trial, in college students [1,2,6]. That is a real finding and also a thin evidence base, which is why the evidence section below matters.
Misconception 3: "A coach works within the same professional rules as a therapist." Usually not. In the same national survey, 85.0% of responding ADHD coaches had no professional license and 90.5% operated without formal clinical supports [1]. Our guide to what coach and therapist titles can legally do covers the scope differences in detail.
🎯 Key takeaway: Coaching works best as a targeted adjunct. The recommendation should say what it is for, how progress will show, and where it stops.
When coaching, therapy, or both belongs in the recommendations
For adults with ADHD, UK guidance recommends, at minimum, a structured supportive psychological intervention focused on ADHD with regular follow-up when non-pharmacological treatment is indicated, and notes this may involve CBT [3]. That guidance does not mention coaching [3]. In college students, a structured CBT program delivered through group sessions and individual mentoring improved ADHD symptoms and executive functioning in a randomized trial, compared with a delayed-treatment group [4]. That is a clinical program, not coaching as it is sold in the open market, and the distinction belongs in your recommendations.
A rule of thumb we use for the recommendations section (a clinical judgment, not a published standard):
If the main barrier is a functional skill or system (planning, initiation, time tracking) and mood, anxiety and safety are not active concerns, recommend coaching for that target.
If depression, anxiety, trauma, substance use or a safety concern is active, recommend therapy first, and add coaching later or alongside it only for a separate functional target.
If both a skills gap and a clinical concern are present, recommend both, and say which clinician owns which goal.
A composite example: a 19-year-old sophomore is evaluated after a semester of missed deadlines. ADHD is confirmed, mood and anxiety screens are unremarkable, and she describes knowing what to do but not starting until the night before. Her strengths include strong verbal reasoning and steady attendance. This is a coaching case: the target is starting and pacing assignments, the barrier is a system rather than a symptom of another disorder, and nothing in the evaluation needs a therapist's scope.
A composite example: a 34-year-old engineer is evaluated for ADHD and also meets criteria for a moderate depressive episode. He has stopped answering work email, sleeps until noon on weekends and describes feeling like a failure. Coaching for email triage would not touch what is driving the shutdown. The recommendations here lead with therapy for depression and coordinated care for ADHD, and they name coaching as a later option once mood has improved.
⚖️ Key takeaway: Coaching fits a skills or systems target with no active clinical concern. When one is active, therapy comes first, and coaching is added only with a separate, named target.
Writing the coaching recommendation so it can be acted on
The four-part structure below reflects our clinical practice rather than a published standard; we have not found a guideline that prescribes the content of a coaching recommendation.
The target. Name one to three functional behaviors, in observable terms. "Improve executive functioning" is not a target. "Start each graded assignment at least three days before it is due" is.
The measure. Say how progress will be counted, preferably with something the client and coach can track weekly, such as assignments started on schedule or planning sessions completed. Goal attainment scaling is one structured option: each goal is rated on a five-point scale from -2 to +2, and goals can be weighted by how much they matter to the client [5]. The guide we cite describes it for rehabilitation, not coaching, so treat it as a framework, not a validated coaching outcome. The randomized coaching trial measured change with a self-report inventory of learning and study strategies [2]. Our article on how progress is measured in coaching describes what coaches track in practice.
The boundary. State what the coach should not take on, such as diagnosis, mood or anxiety treatment, medication questions or crisis response. This matters because coaches in the national survey reported discussing clinical topics including mental health crises, substance use, trauma and medication adherence [1].
The re-referral point. Name the check-in date and the signs that send the client back, such as no progress by that date or a change in mood or safety.
Here is how that can read in a report: "Executive function coaching, as an adjunct, targeting (1) starting graded assignments at least three days before the deadline and (2) a weekly planning session. Progress measured as the proportion of assignments started on schedule, reviewed at eight weeks. Coaching should not address mood, medication or crisis concerns; refer back to this evaluator or the client's therapist if mood worsens, substance use emerges, or there is no measurable progress at the review."
It also helps to tell clients what to look for in a coach, because there are no standards or regulations governing who can call themselves an ADHD coach [1]. Our guide to choosing an executive function coach is written for that conversation, and it is a good link to put directly in the report.
📝 Key takeaway: One sentence each for the target, the measure, the boundary and the re-referral point turns "consider coaching" into a plan a coach can carry out.
What the evidence does and doesn't show, for clinicians
For college students and adults, ADHD coaching has been tested in one randomized trial, in college students [1,2,6]. A 2018 review counted one other randomized trial of ADHD coaching, in high school students, where coaching was part of a broader intervention [6]. At 10 US colleges, 160 students eligible for ADHD accommodations were randomly assigned, about two to one, to roughly six months of weekly phone coaching or to a comparison group [2]. After adjusting for starting scores, coached students scored higher than comparison students on a self-report inventory of learning and study strategies, both overall and on its three clusters: Skill, Will (attitude, motivation and anxiety) and Self-Regulation [2]. Other sources agree for this age group. The 2026 survey paper describes the research as a few case studies, small before-and-after evaluations and one randomized trial in college students [1]. The 2018 review found most other studies small and without control groups [6]. A 2024 review counted a second randomized trial in college students, but that trial tested the CBT-and-mentoring program described above, not coaching [4,9].
What it does not show is just as important for a report:
No grades, retention or symptom outcomes. The trial measured self-reported study strategies and, after coaching only, well-being, not GPA, graduation or ADHD symptoms [2].
The large effect sometimes quoted is not the between-group effect. The coached group's own before-and-after change was large (d = 1.02). The between-group comparison, which adjusted for starting scores, was statistically significant (p = .048 for the total score), with effect sizes the authors described as moderate to large (partial eta-squared .04 to .08). The comparison group also started the trial with notably higher scores (a mean of 304.95 versus 236.93) [2].
Not everyone engaged. Of the 121 students assigned to coaching, 88 started it [2].
No randomized trial in adults outside college turned up in the reviews we read. Evidence in adults outside college is uncontrolled, such as a before-and-after study of 45 adults [7]. Among college students, a larger study of 148 students without a control group found improvements but called for randomized designs [8].
The authors of the national coaching survey concluded that randomized trials are "essential" to establish coaching's safety and effectiveness [1]. A 2024 systematic review of executive function coaching for college students with disabilities found mostly positive outcomes across 17 studies, while noting small samples and varied research methods [9]. A fair summary for your report: coaching is a promising adjunct for specific functional targets, with limited controlled evidence and no randomized trial in adults outside college that we found.
For a client- and family-facing explanation of how coaching differs from therapy, our article on executive function coaching versus ADHD therapy is a good one to share.
🔬 Key takeaway: One randomized trial in college students showed self-reported gains in study strategies. That supports coaching as an adjunct for specific targets, not as a treatment with proven academic or symptom outcomes.
The handoff: shared goals, a release, and when to re-refer
A recommendation only works if it reaches the coach in a usable form. Three practical steps help.
Get a signed release before you share anything. For clinicians covered by HIPAA, a valid authorization under federal rules names the information to be shared, who may share it, who will receive it, the purpose, and an expiration date or event, and it must be signed and dated [10]. It must also tell the client that information disclosed under it may be redisclosed by the recipient and no longer be protected [10]. Because most coaches in the national survey were self-employed and unlicensed [1], that redisclosure warning is the practical reason to send the minimum: the targets, the measures and the boundary, rather than the full report. Follow your own state and licensing-board rules as well; nothing here is legal advice.
Set shared goals at the start. The client, the coach and you should agree on the same targets and the same measure. Goal attainment scaling can support this, since goals can be weighted to reflect the client's view of their importance [5].
Agree on re-referral triggers. In coaching studies, not everyone who starts completes the program [6], so build in a check-in. Triggers to name in the report include no progress on the target by the review date, new or worsening mood or anxiety, substance use, any safety concern, or a pattern that suggests a different diagnosis. When a client is referred to us for coaching, we can share progress with you, with the client's written permission. Our information for referring clinicians explains how that works, and our page on executive function coaching in Tennessee describes the service for clients.
🤝 Key takeaway: Release first, minimum necessary, shared goals, and a dated check-in with named triggers for sending the client back.
A coaching line in a report is a small thing that carries a lot of weight. Written with a target, a measure, a boundary and a re-referral point, it gives a client a reason to start, a coach a job to do, and you a way to know whether it worked. At our practice, every ADHD and autism evaluation is completed by Dr. Kiesa Kelly.
How to refer: Your patient can book a free phone consultation (or text 931-223-1095) and mention you. No referral or prior authorization is needed.
Please don't send health information by email or web form; once your patient signs a release, we arrange a secure exchange. How to refer a patient to ScienceWorks →
Frequently Asked Questions
Should executive function coaching appear in an evaluation's recommendations?
It can, when a specific functional problem such as planning, starting work or tracking deadlines is the main barrier and mood, anxiety or safety concerns are either absent or treated separately. Write it as an adjunct with a named target, a measure and a re-referral point, not as a stand-alone treatment, because coaching's evidence in college students and adults is still limited to one randomized trial, in college students.
What should I share with a coach after an evaluation?
Share the minimum the coach needs to work on the recommended targets, such as the goals, the strengths to build on and the boundaries of the coaching role, and only after the client signs a release. Most coaches in a national survey were self-employed and unlicensed, and a valid release must warn that information disclosed under it may be redisclosed and no longer be protected. In our view, a short summary of targets serves the coach better than the full report.
When should a coached client be referred back to me?
Agree on the triggers when you make the referral. Triggers we suggest are no progress on the target by the agreed check-in, new or worsening depression or anxiety, substance use, any safety concern, or a pattern that suggests a different diagnosis. A coach who notices any of these should pause and route the client back to you or to a licensed clinician rather than work around it.
About the Author
Dr. Kiesa Kelly is a clinical psychologist and the founder of ScienceWorks Behavioral Healthcare. She earned her PhD in clinical psychology, with a concentration in neuropsychology, from Rosalind Franklin University of Medicine and Science, and completed practica, internship and an NIH-funded postdoctoral fellowship at the University of Chicago, the University of Wisconsin, the University of Florida and Vanderbilt University.
Trained as a neuropsychologist, Dr. Kelly has more than 20 years of experience with psychological assessment, and her NIH-funded postdoctoral fellowship focused on ADHD in both research and clinical work. She has sought out training in neurodiversity-affirming frameworks and modern assessments that capture ADHD and autism in previously undiagnosed adults, particularly women and non-binary people.
References
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7. Kubik JA. Efficacy of ADHD coaching for adults with ADHD. J Atten Disord. 2010;13(5):442-453. https://doi.org/10.1177/1087054708329960
8. Prevatt F, Yelland S. An empirical evaluation of ADHD coaching in college students. J Atten Disord. 2015;19(8):666-677. https://doi.org/10.1177/1087054713480036
9. Anderson K, Marino MT. Executive function coaching for college students with disabilities: a systematic literature review. J Postsecond Educ Disabil. 2024;37(2):131-142. https://files.eric.ed.gov/fulltext/EJ1445898.pdf
10. U.S. Department of Health and Human Services. 45 CFR 164.508: Uses and disclosures for which an authorization is required. Electronic Code of Federal Regulations. Accessed October 20, 2026. https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.508
Disclaimer
This article is for informational and educational purposes for clinicians and is not a substitute for individual clinical judgment or legal advice. Reading it does not create a clinician-patient relationship. If someone is in immediate danger, call 911. For a mental health crisis, call or text 988.