“Pills Don’t Teach Skills”: ADHD Coaching, Identity Work, and the Push toward the Liminal Medicalization of ADHD

Abstract

Despite physicians’ near monopoly over medicalization historically, various stakeholder groups shape an increasingly complex process today. This study examines a relatively new initiative, “health coaching,” within the context of the changing nature of medicalization. Utilizing 51 in-depth interviews with attention deficit hyperactivity disorder (ADHD) coaches, participant observation from seven ADHD symposia, and ADHD coach publications, I examine coaching’s emergence as a partial challenge to medicalization. Findings reveal a field comprised mainly of individuals personally affected by ADHD whose dissatisfaction with institutionalized framings and practices underpins a push for liminal medicalization. Members move between medical and nonmedical discourses to frame ADHD as a paradox of pathology and gift. Additionally, they leverage and commodify personal experience alongside institutional and alternative knowledge into an adjunct or substitute to medication and potential challenge to therapy—one aimed at “self-actualization” versus “treatment.” Such efforts highlight (de)medicalization’s dimensionality, simultaneous medicalization and demedicalization, and a lay-driven enterprise’s role in such processes.