Summaries of Research Poster Presentations by Dr. Brown

Cognitive Strengths and Impairments in 126 High-IQ Patients With ADHD

This study assessed children, adolescents and adults with high IQ who met DSM-IV criteria for ADHD, any type, to determine their relative impairment on standardized measures of three executive functions: working memory, processing speed and short-term auditory memory, and on five clusters of executive functions assessed by parent report (6 to 12 year olds) or self-report (13 to 40 year olds) on the Brown ADD Scales, standardized rating scales for ADD-related impairments of executive functions.

Results: Across age groups of this sample, 66% of individuals showed significant impairment on 4 or more of the 8 markers of EF impairment assessed, despite their superior cognitive abilities.
Presented by Thomas E. Brown, Ph.D., Candace Patterson, M.A., and Donald M. Quinlan, Ph.D. at the American Academy of Child and Adolescent Psychiatry in Miami, October, 2003.

Executive Function Impairments in High IQ Adults with ADHD

One hundred-three consecutive treatment-seeking adults (aged 18 to 63 years) who had fully met DSM-IV criteria for ADHD and had verbal and/or performance IQ of 120 or above (top 9% of the population) were included. Educational achievement included high school graduation (98%), at least 4 years of college (56%), and masters or doctoral degrees (22%). However, 42% of these high IQ adults had dropped out of post-secondary schooling at least once and 41% were currently employed at low-skilled or unskilled jobs.

Results: Eighty-eight percent scored in the severely impaired range on the Brown ADD Scale for Adults. Sixty percent showed impairments of concentration on standardized IQ test, at least one standard deviation below their verbal IQ. And 77% were significantly impaired in their ability to recall two brief stories just moments after they heard them. Despite their high IQ, these very bright adults with ADHD were significantly impaired on multiple measures of executive functions and in their ability to succeed in schooling and at work.
Presented by Thomas E. Brown, Ph.D. and Donald M. Quinlan, Ph.D. at the International Society for Research on Child and Adolescent Psychopathology in Barcelona, 1999.

Assessing the Effects of OROS Methylphenidate (Concerta) on Executive Functions in Adults With ADHD

ADHD-related executive function impairments (EF) were assessed in 30 treatment-seeking adults (18 to 60 years) who met DSM-IV ADHD diagnostic criteria. Charts were reviewed to compare baseline scores on the Brown ADD Scale with scores after 4-6 weeks of treatment with OROS methylphenidate (MPH). Patient reports of duration of medication effects and their daily responsibilities were also analyzed.

Results: At endpoint, 83% of subjects showed clinically significant improvements in the wide range of ADHD-related EF measured by the Brown Scale. For 60% of these adults, a single morning dose of OROS MPH provided insufficient duration of coverage for their daily tasks until supplemented by immediate-release MPH in the afternoon or BID dosing of OROS MPH.
Presented by Thomas E. Brown, Ph.D. and Donald M. Quinlan, Ph.D. at 56th American Psychiatric Association Institute on Psychiatric Services in Atlanta, October, 2004.

Atomoxetine (Strattera) Alleviates Executive Function Impairment Associated with ADHD

Usually effectiveness of medications for ADHD is assessed only with measures of DSM-IV symptoms. Effects of atomoxetine on executive function impairments in children and adults with ADHD were assessed using a parent-report/self-report measure that captures a wide range of executive functions often impaired in individuals with ADHD. The Brown ADD Scale was used in 3 trials of atomoxetine involving 703 patients aged 6 to 50 years with DSM-IV defined ADHD. The 2 child/adolescent trials were placebo-controlled; the adult trial was not.

Results: In both child/adolescent trials, mean Brown scores improved significantly on atomoxetine compared with placebo (P<.05). In the adult trial, mean Brown scores improved significantly from baseline (P<.001).
Presented by Thomas E. Brown, Ph.D., Virginia K. Sutton, Ph.D., Ann K. Rogers, Ph.D., and Calvin Sumner at 158th Annual Meeting of American Psychiatric Association in Atlanta, May, 2005

Expanded Targets for Monitoring Child Symptom Responses to ADHD Medications

ADHD-related executive function impairments were assessed in 197 children (aged 6-12 years) diagnosed with ADHD and enrolled in a randomized, placebo controlled study of atomoxetine (Strattera). Parents completed the Brown ADD Scale at baseline to assess their child's ADHD-related executive functioning in: 1) organizing and activating for work; 2) focusing for tasks; 3) regulating alertness, effort and processing speed; 4) managing emotions; 5) utilizing working memory and accessing recall; and 6) monitoring and self-regulating action. Parents completed the scale again at each post-baseline visit over 8 weeks of treatment with medication or placebo.

Results: Means for atomoxetine patients improved significantly more than placebo for total score and 5 of 6 clusters of ADHD-related executive function impairments.
Presented by Thomas E. Brown, Ph.D., D. Quinlan, Ph.D., V. Sutton, Ph.D., C.Thomason, Ph.D. and C. Sumner, M.D. at the American Academy of Child and Adolescent Psychiatry in Miami, October, 2003.

Validity of New Rating Scales and IQ-related Measures for ADHD

Brown ADD rating scales for children 3 to 7 years and 8 to 12 years were standardized on a national sample of 800 children representative of the U.S. population. These norms were compared with a clinical sample of 208 children who fully met DSM-IV diagnostic criteria for ADHD. Of these 37% were predominantly inattentive while 63% were combined subtype. Comparisons to widely used rating scales, e.g. Child Behavior Check List (CBCL) and Conners' Rating Scale-Revised (CRS) were made with subgroups of parents and teachers of ADHD children. Additional comparisons were made between index scores from the Wechsler Intelligence Scale for Children and from the story memory test of the Children's Memory Scale.

Results: Across age groups the Brown ADD Scales for Children differentiated between children diagnosed with ADHD and children in the general population at p < .001. Correlations with the CBCL Attention Problems scale were .64-.77; correlations with the CRS ADHD Index Score were .68 to .88. Sixty-one percent of children with clinical scores on the Brown scale had significant impairment on the relevant IQ index scores (vs. 24% of controls) while 58% were relatively impaired on story recall (vs. 32% of controls.)
Presented by Thomas E. Brown, Ph.D. and Donald M. Quinlan, Ph.D. at the American Academy of Child and Adolescent Psychiatry 2002.

ADHD Often Impairs Reading With or Without Comorbid Dyslexia

Sixty older adolescents and adults (ages 16-62 yrs) diagnosed with ADHD were given two measures of phoneme recognition, the Woodcock-Johnson (WJR) Word Attack and Word Identification tests, as well as two measures of reading comprehension, the shorter WJR Passage Comprehension Test and the Nelson-Denny Reading Test which uses longer passages.

Results: A significant majority of subjects showed no impairment on measures of phoneme recognition, but were significantly impaired on measures of comprehension, especially on the longer passages. Impairments of reading often reported by adults with ADHD tend to be secondary to their ADHD impairments in sustaining attention, processing speed and working memory, rather than to impaired phoneme recognition found in dyslexia.
Presented by Donald M. Quinlan, Ph.D. and Thomas E. Brown, Ph.D. at the American Academy of Child and Adolescent Psychiatry in New York, October, 2000.

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