Articles on ADD/ADHD

Magazine Articles by Dr. Brown

Executive Functions: Six Aspects of a Complex Syndrome

This article, published in ATTENTION magazine, provides many examples from everyday life to illustrate the various types of cognitive impairments typical of children and adults with ADD/ADHD. Descriptions and explanations of these "executive functions" are edited excerpts from the 2nd chapter of Dr. Brown's book, Attention Deficit Disorders: The Unfocused Mind in Children and Adults. Download a PDF of the article by clicking here.

Inside the ADD Mind

Dr. Brown's new model of the management system of the brain is described in this edited excerpt from the first chapter of his recent book, Attention Deficit Disorder: The Unfocused Mind in Children and Adults. The article includes a diagram of the new model of executive functions and describes why people with ADD/ADHD can pay attention very well for tasks that really interest them, while they have great difficulty in making themselves pay attention to other tasks that they recognize as important.

Reprinted with permission from the April/May issue of ADDITUDE magazine. Click here to download a PDF of the article.

AD/HD and Co-Occurring Conditions

Individuals with ADHD are six times more likely to have at least one additional psychiatric disorder sometime during their lifetime. Dr. Brown’s edited book, ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults, published in January, 2009, describes how ADHD is different when the person also has an anxiety disorder, a mood disorder, a learning disorder, OCD, a sleep disorder, etc.  In February , 2009 ATTENTION magazine published this article that summarizes key points from a section of the first chapter of that new book; it describes a new model for understanding ADHD and co-occurring conditions.

Download a PDF of AD/HD and Co-Occurring Conditions by clicking here.

A New Approach to Attention Deficit Disorder

Written for educators, this article describes how ADD is no longer seen as a simple behavior disorder, but as a complex syndrome of impairments in the management system of the brain. Examples of students in elementary and high school illustrate how ADD can impact learning and academic productivity at different ages and stages in school. Some guidelines for assessment are included and the importance of early identification is emphasized.

Reprinted with permission from the February, 2007 issue of Educational Leadership, a magazine for leaders in education. Click here to download a PDF of this article.

Attention Deficit Disorders: The Myths, the Facts

This list of 10 common myths about ADD and facts to counter those myths was published with the article above in Educational Leadership magazine. The information comes from Dr. Brown's book, Attention Deficit Disorder: The Unfocused Mind in Children and Adults (Yale University Press, 2005).

Reprinted with permission from the February, 2007 issue of Educational Leadership, a magazine for leaders in education. Click here to download a PDF of this article.

AD/HD and Challenges of Early Adulthood

The late teens and early twenties present multiple challenges to every young adult, but for those with ADD/ADHD, these challenges may be especially difficult. This article describes specific ways in which those with ADHD often have difficulty with linking school to a career, managing money, developing and sustaining satisfying relationships, seeking and keeping a job, moderating substance use, and utilizing adequate medical care.

Reprinted from the February, 2006 issue of ATTENTION! Magazine, with permission from CHADD. Click here to download a PDF of the full article.

Articles from Peer-Reviewed Journals

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.

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