My wife was diagnosed several years ago at our 3rd marriage counselor. We found a physician that 100% believes in a medication based solution, went through 4-5 different medications to find the right one for her, and she's successful with Vyvanse. Mostly.

Vyvance is time release. She takes it in the morning and it wears off by the time she gets home. The behaviors at home that don't work well are still there but her stress level is way down now that she has a good handle on work. Good for her, better but not good for the kids and I.

I wouldn't say she needs anything like counseling because there isn't a problem with perception or emotional dysfunction. A "coach" on the other hand could help her and us quite a bit, if she had someone to talk to about "life". Maybe they could point out she's gone into work for the last 3 weekends and for this upcoming one she can take Saturday completely for herself to decompress, then do something meaningful and fun with her family on Sunday. That would make her feel a lot better and the the kids and I too.

The problem is the person with ADHD being willing to have some measure of accountability. The life coach needs to do that part expertly. In our case, it really does need to be someone else because I can say the same thing as a life coach and in the exact same way, but because I am "the husband" my wife's guilt ramps up and so does negative self talk and some anger. Even when I try to help kindly and thoughtfully she can become defiant or dismissive. Because I'm "the husband". I have tried stepping and helping her have a relax day followed by a family day but its exhausting as I'm the only adult doing it. Its a bit of a trap too because it starts to change our relationship to the dreaded parent/child dynamic. Although I tend to think of it as care giver and care needer. ADHD aside, she needs to own what she does or does not do because she is an intelligent capable adult. But she has to figure out how to do it without me stepping in all the time.

So while medication ought to be the first step for help, it is also probably the right thing to supplement with some kind of coaching, even if it is infrequent or done with a light touch. Ideally self reflection could eliminate the need for coaching but it's not a task that elevates dopamine levels in the executive function of the brain. Meaning, someone with ADHD is probably not drawn to or motivated to do it on their own. It's more likely involving an unbiased 3rd party is actually helpful.

ADHD is not a bad thing and I really don't want to call it a dysfunction. I'm in the neurodivergent camp. When her hyper focus kicks in whatever she is doing is done to the best degree anything like that can be done. There's another member of the family that has ADHD that is also competitive. When we do something together and there is the mere possibility of being competitive, their hyper focus kicks in and I can't keep up with them. In software development, an engineer with ADHD can out think and out code me by a noticeable distance if their hyper focus kicks in. Their problem isn't performing, it's being in control of when they perform and on what tasks. They make great pinch hitters by the way. Want a production issue fixed quickly? Grab the ADHD dev in a group meeting where they share their screen. Me though, I cave. I fold. Too much pressure and I don't mind admitting it. I'm too much of an empath. I just don't see ADHD as a dysfunction because its obvious that its a rebalancing of strengths and weaknesses. They'll get their electricity shut off by forgetting to pay the bill but they'll also decorate the best looking wedding cake when it's late and the decorator calls in sick.

I want to also mention, we have a friend that hasn't been diagnosed but swears he has ADHD. I can see that might be true but he also is an avid runner. The physical and mental exercise of running probably helps him manage well enough that he doesn't need medication. And I think that suggests that ADHD is not a switch where you have it or you don't, more that it is a spectrum. There are probably people that have a low level of ADHD and have figured out life just works better if they do certain things, like drinking coffee regularly and running.

edit: spelled Vyvanse wrong