Articles from Peer-Reviewed Journals

Extended time improves reading comprehension test scores in adolescents with ADHD

Reporting on a study of 145 adolescents with ADHD, this article shows how reading comprehension difficulties of those with ADHD are related not so much to weak verbal abilities or weak basic reading skills, but to impairments of working memory and processing speed that are characteristic of ADHD. Results show that only 43% of the sample  were able to score close to their verbal ability index when doing a timed reading test, but 78% were able to reach that goal when allowed modest amount of extended time on a standardized test of reading comprehension.  Thomas E. Brown, Philipp C. Reichel, and Donald M. Quinlan in the Open Journal of Psychiatry. (October, 2011). 1: 79-87. Click here to download a PDF of the full article.

Executive Function Impairments in High IQ Children and Adolescents with ADHD.

This article reports a study of 117 children and adolescents with ADHD, all of whom have IQ scores of 120 or higher, placing them in the top 9% of their age groups. The study shows that extremely bright kids can suffer from ADHD in ways that seriously interfere with their schoolwork, especially as they meet the challenges of junior high and high school. Most of these kids scored very high on verbal and visual spatial abilities, but were impaired by much weaker abilities in working memory, processing speed and a variety of other executive functions. Thomas E. Brown, Philipp C. Reichel, and Donald M. Quinlan in the Open Journal of Psychiatry. (July, 2011). 56-65. Click here to download a PDF of the full article.

Executive Function Impairments in High IQ Adults with ADHD.

This article reports a study of 157 adults aged 18 to 55 years with ADHD, all of whom have IQ scores of 120 or higher, placing them in the top 9% of their age groups. The study shows that extremely bright adults can suffer from ADHD in ways that seriously interfere with their higher education and/or employment. The study highlights impairments of working memory, processing speed, and a variety of other executive functions that that be assessed with standardized measures. It also notes that many of these high IQ adults did not show significant ADHD impairments until they got into high school or college. Thomas E. Brown, Philipp C. Reichel, and Donald M. Quinlan in Journal of Attention Disorders. (2009) 13 (2) 161-167. Click here to download a PDF of the full article.

ADD/ADHD and Impaired Executive Function in Clinical Practice

This article, intended for physicians or psychologists who are evaluating adults for ADHD, describes how executive function impairments associated with ADHD can be recognized in clinical practice. It emphasizes that diagnosis of ADHD does not require esoteric neuropsychological tests; it describes chronic difficulties in daily life that are characteristic of adults with ADHD. The article also notes that the DSM-IV requirement for age of onset “before 7 years has been shown to be invalid. Practical suggestions about initiating and monitoring medication treatment is also included.” Thomas E. Brown in Current Attention Deficit Disorder Reports, 1: 37-41, 2009. Click here to download a PDF of the full article.

Executive Functions and Attention Deficit Hyperactivity Disorder: Implications of two conflicting views.

Increasingly ADD/ADHD is being seen as a disorder involving impairment of the brain’s management system, its executive functions. However, among researchers there are two very different viewpoints about how executive functions are involved in this disorder. Some see impaired executive functions as impaired in only about 30% of those with ADHD.

The alternative view, advocated by Dr. Brown and by Dr. Russell Barkley, claims that ADHD is essentially a name for developmentally impaired executive functions, that all those with ADHD have such impairments. The difference between these two views rests upon how executive functions are to be measured. This article describes the differing viewpoints and argues that the “ADHD = developmental impairment of executive functions” view is a more adequate way to understand what this disorder really involves.

Reprinted with permission from the March, 2006 issue of the International Journal of Disability, Development and Education. Click here to download a PDF of the full article.

Circles Inside Squares: A Graphic Organizer to Focus Diagnostic Formulations.

This article describes a simple graphic organizer that can be used to help focus discussion between a clinician, patient and family about specific strengths, stresses and problems that are identified in a clinical evaluation. It is particularly useful for illustrating overlapping disorders and representing how much each contributes to the patient’s current difficulties. The diagram can be used to elicit reactions from the patient and family about how current problems should be understood and prioritized for treatment. It can also be utilized on an ongoing basis to evaluate responses to treatment. Thomas E. Brown, Ph.D. in Journal of the American Academy of Child and Adolescent Psychiatry (2005) 44:1309-1312. Click here to download a PDF of the full article.

Attention-Deficit/Hyperactivity Disorder Among Adolescents: A Review of the Diagnosis, Treatment and Clinical Implications.

Much of the literature about ADHD is still focused exclusively on children. At the invitation of the American Academy of Pediatrics (AAP), a team of ten specialists in ADHD reviewed research and standards of clinical practice to develop a summary of current information about how ADHD can be recognized and effectively treated in adolescents. M.L. Wolraich, C.J. Wibbelsman, T.E.Brown, S.W. Evans, E.M. Gotlieb, J.R. Knight, E.C.Ross, H.H. Schubiner, E.H. Wender, and T.Wilens. Pediatrics (2005) 115: 1734-1746. Click here to download a PDF of the full article.

Atomoxetine (Strattera) and Stimulants in Combination for Treatment of Attention Deficit Hyperactivity Disorder: Four Case Reports

Atomoxetine and stimulants have both been demonstrated effective as single agents for treatment of attention deficit hyperactivity disorder in children, adolescents and adults. However, attention deficit hyperactivity disorder symptoms in some patients do not respond adequately to single-agent treatment with these medications, each of which is presumed to impact dopaminergic and noradrenergic networks by alternative mechanisms in different ratios. Four cases are presented to illustrate how atomoxetine and stimulants can be utilized effectively in combination to extend duration of symptom relief without intolerable side effects or to alleviate a wider range of impairing symptoms than either agent alone. This combined pharmacotherapy appears effective for some patients who do not respond adequately to monotherapy, but because there is virtually no research to establish safety or efficacy of such strategies, careful monitoring in needed. Thomas E. Brown, Ph.D. in Journal of Child and Adolescent Psychopharmacology, (2004) Vol. 14: pp. 129-136. Click here to download a PDF of full article.

Fluoxetine and Methylphenidate in Combination for Treatment of Attention Deficit Disorder and Comorbid Depressive Disorder

Children and adolescents with attention deficit disorders and comorbid conditions who had shown inadequate treatment responses to methylphenidate (MPH) alone, were treated by addition of fluoxetine to the MPH. After 8 weeks in open trial, all 32 patients showed positive therapeutic responses in attention, behavior and affect. Thirty of the 32 children showed clinically significant responses and the other two had statistically, but not clinically significant responses. After 12 weeks of treatment one patient showed deterioration in clinical status. The children had improved report card grades in major subjects (p < .0001), and showed significant improvements (p < .0001) on the Children’s Global Assessment Scale (C-GAS), Conners Parent Rating Scale (CPRS) and Children’s Depression Inventory (CDI). No significant adverse effects were observed. These preliminary results suggest that fluoxetine and methylphenidate in combination may be safe and effective for some children with ADHD and with comorbid anxiety or depressive symptoms who do not show adequate responses to MPH or fluoxetine alone. G. Davis Gammon, M.D. and Thomas E. Brown, Ph.D. in Journal of Child and Adolescent Psychopharmacology (1993) Vol. 3, pp. 1-10. Click here to download a PDF of full article.

Attention Deficit Disorders and Sleep/Arousal Disturbances

Many children, adolescents and adults with Attention Deficit Disorders report chronic difficulties with falling asleep, awakening, and/or maintaining adequate daytime alertness. These problems may be due to a variety of factors, including environment, lifestyle and psychiatric comorbidities. Impairments in sleep/arousal may also be related more directly to the underlying pathophysiology of ADD. This chapter describes clinical manifestations of sleep/arousal problems often associated with ADD and reviews behavioral and medication options for treatment. Thomas E. Brown and William J. McMullen in Annals of the New York Academy of Sciences (2001) Vol. 931, pp. 271-286. Click here to download a PDF of full article.

Assessment of Short-Term Verbal Memory Impairments in Adolescents and Adults with ADHD

One hundred seventy-six adolescents and adults diagnosed with ADHD (DSM-IV criteria) were assessed with a measure of short-term verbal memory. The short-term verbal memory score of each subject was compared with their verbal abilities on two measures. Percentages of ADHD subjects with significant discrepancy between verbal IQ and short-term verbal memory were compared with the standardization sample for the verbal memory measure. Results: A majority of adolescents and adults diagnosed with ADHD demonstrated significant discrepancy between performance on the short-term verbal memory measure and verbal IQ. The percentage of ADHD subjects with a significant discrepancy between these two measures greatly exceeded the percentage of persons in the general population showing such a discrepancy. This brief measure of short-term verbal memory may be a useful measure to include in a comprehensive assessment for ADHD symptoms in adolescents and adults. Donald M. Quinlan, Ph.D. and Thomas E. Brown, Ph.D. in Journal of Attention Disorders, (2003) Vol. 6: pp 143-152. Click here to download a PDF of full article.

DSM-IV: ADHD and Executive Function Impairments

Attention-deficit/hyperactivity disorder (ADHD) is a medical condition that first appears in childhood, affecting 6% to 8% of children. In more than 60% of cases, impairments of ADHD extend into adulthood as well. Since it was first described 100 years ago, conceptualization of ADHD has gradually shifted from focus on hyperactive and impulsive behaviors to recognition of cognitive impairments as the central and most persistent symptoms of the disorder. Current research suggests that ADHD is essentially a developmental impairment of the brain’s executive functions-the management system of the brain’s cognitive operations. This article reviews the phenomenology of currently recognized symptoms of ADHD and suggests that there is one important executive function impaired in ADHD that is not included in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for the disorder: impairments in regulation of emotion. Thomas E. Brown, Ph.D. in Johns Hopkins University Advanced Studies in Medicine (2002) Vol. 2 (25): pp. 910-914. Click here to download a PDF of full article.