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    • "There is no single profile of emotions common to all individuals with ADHD."

      An 11 year old who went “on strike” when asked to write Eleven-year-old Sandy was the best goalie on her travel soccer team. She was well-liked by her teammates and often praised by her coaches for her skills and consistent effort. Yet she hated school. She got along alright with her classmates and usually got passing grades, but was seen by her teachers as stubborn and temperamental. Now in 6th grade she had been having increasingly frequent incidents of what the teachers called “going on strike.” When the class was asked to write paragraphs or brief essays, Sandy often wrote nothing. When the teacher asked what was wrong, Sandy just stared ahead and did not respond. When the class was given a timed challenge test for math problems, Sandy often started with the others and then suddenly stopped, tore up her paper, refused to talk, and began repetitively kicking the desk in front of her until the teacher sent her out to the principal who told Sandy to complete the work at home and return with a better attitude. Sandy’s parents reported that it often took them 5 or 10 minutes to explain the writing assignment to Sandy and help her get started, but she then was able to complete the task, producing results that the teacher said were fully satisfactory. When I first met with Sandy and her parents, she was initially unwilling to answer any of my questions, but as I continued to talk with her parents, she gradually warmed up and began to respond, first with just facial expressions and nods or head-shaking, then gradually with words. Her mother told me that Sandy had been slow to speak as a young child, producing no words until she was 3 years old, but at that point she began suddenly to speak in sentences. I also learned that both Sandy and her mother had been diagnosed with ADHD several years earlier and that both were taking stimulant medication that they found helpful. Over a series of conversations together, I found that Sandy readily spoke with me about how her soccer team was doing, yet she was unwilling to discuss any incidents in school where the teacher had complained to her parents about her behavior. When her parents told me how teachers were complaining about her being angry, stubborn, and going on strike, Sandy kept her head down and stared at the floor as her eyes began to fill up with tears. Gradually it became clear that Sandy’s teachers were mistaken when they interpreted her “on strike” behavior as anger and stubbornness. That behavior was covering intense feelings of shame and fear. Sandy had very high standards for herself, especially for expository writing and for math. She also had ADHD-related problems with working memory and processing speed. Her working memory problems often caused her to get confused about oral directions given for writing assignments so she did not understand and remember what she was being asked to do. Her slow processing speed made it very difficult for her to keep up with her classmates in doing tightly timed math challenges. When she saw her classmates working much faster on the timed math quizzes, she felt embarrassed and gave up. When she felt confused about how to start her writing assignments, she froze in shame and was unable to respond to the teacher’s offers of help. What appeared as oppositional behavior was, in fact, a diversionary maneuver that served to distract her, her classmates and her teacher from what Sandy saw as humiliating failure. I asked Sandy’s pediatrician to add an SSRI to the stimulant medication Sandy had been taking for her ADHD; gradually that helped to reduce her chronic anxiety. I also tried to help Sandy and her parents to understand the puzzling intensity of her reactions to confusion and perceived failure. Her mother then reported that both her sister, Sandy’s aunt, and also Sandy’s maternal grandmother, had longstanding reputations in their family for quickly getting angry and then pulling into their shell when they felt anxious, especially when stress was in a social situation. We had a meeting with Sandy’s team of teachers who readily agreed to give written directions for writing assignments and to provide extra help for Sandy to learn how to get herself started on writing assignments. Her pediatrician, her parents and I also arranged to make some adjustments in Sandy’s ADHD medications so she could have more support for her problems with working memory and processing speed. Summary: There is no single profile of emotions common to all individuals with ADHD. There is much diversity due to differences in age, temperament, personality style, family life, cultural background, and many other variables. Yet there are some ADHD characteristics and some situations often experienced by many with ADHD (and those involved with them) that cause particular patterns of emotional dynamics to emerge more frequently among these people. These case studies describe some emotional dynamics often reported by children, adolescents or adults with ADHD and those who interact with them. The palette of human emotions is rich and variegated. It includes happiness, enthusiasm, interest, disinterest, boredom, delight, worry, fearfulness, panic, terror, frustration, annoyance, anger, rage, pride, envy, embarrassment, shame, guilt, jealousy, disappointment, discouragement, grief, hopelessness, sadness, depression, longing, trust, optimism, expectancy, determination, affection, passion, love, hope, and many others. Emotions are dynamic in that they often change and interact, sometimes in an instant, sometimes over hours, weeks or years. Often they change in response to specific circumstances of a situation, what someone else says or does and how individuals perceive and react to one another in given moments and over time. Sometimes emotions are quite transient, a flash of anger or a moment of jealousy, pride or affection that may quickly be modified or replaced by other emotions which may be quite contradictory. Emotions also may be persistent over much of a lifetime, absorbed into the fabric of one’s personality across differing settings. Emotions vary not only in type, but also in intensity. Sometimes emotions arise with fierce or crushing intensity; at other times that same emotion may be scarcely noticeable. Emotions also vary in level of consciousness. Sometimes a person is fully aware of a particular emotion in a given moment, yet at another time that person may be totally unaware of an emotion that others readily recognize and respond to. In all persons, emotions tend to arise in multiple mixes and blends. Sometimes the blend is subtle and convergent—affection and longing, pride and hope. In other instances, emotions strongly conflict with one another— interest and fear, pleasure and guilt, pride and resentment, love and hate. Sometimes the conflict is immediate; in other instances, one emotion may be followed quickly or gradually with another, or a person may experience rapid alternation between one emotion and another. Examples described in this case study may be experienced by various individuals in many different ways, only some of which are included here. Brown, T. E. (2017). Emotional Dynamics in Individuals, Couples, and Families Coping with ADHD. In Outside the Box; Rethinking ADD/ADHD in Children and Adults (pp. 151–170). Arlington, VA: American Psychiatric Association Publishing.

    • Emotions Vary Not Only by Type, but Also in Intensity

      Case Study #2: An 8-year old exhibits rage outbursts followed by feelings of guilt. The parents of eight-year-old Michael explained “He’s very polite and well-behaved 90% of the time, but several times a day, like when we have to tell him to do a simple thing like to turn off a video game he’s playing so he can start getting ready for bed, he often, but not always, will fly into a rage, swear at us, and head-butt us, and then keep kicking against a door. This goes on for about 10 or 20 minutes and then he starts crying and says “I can’t move, I’m stuck, come help me.” He wants one of us to come hold him quietly for a minute or two, then he tells us he’s very sorry for being so bad and then it’s over and he’s all good again until the next time.” Michael’s mother shook her head and said “We’ve tried systems to reward him for any day without these meltdowns, but that didn’t help at all.” His father said, “When he does that stuff, it makes me so mad that I start screaming at him, even though I know that does no good at all and probably makes it worse.” Michael’s parents also reported, “He’s had a few episodes at school where he had meltdowns and hit other kids; he got suspended twice, but those are rare. Mostly, this just happens at home.” Two years prior to my seeing him, Michael had been diagnosed by another doctor as having ADHD; she prescribed some stimulant medication for him, but that had to be stopped because it intensified the meltdowns and anger outbursts. I arranged for Michael to begin a trial of a non-stimulant medication to help him control his intense episodes of anger; I also met individually with Michael, with his parents, and with the three of them together This was not just a problem with Michael; it was a problem for the whole family and was fueled by multiple factors. Michael clearly had a very short-fuse when he was frustrated; yet his impulsive angry outbursts were quickly followed by strong feelings of guilt and fear. His father reported that his own father, his father’s father and his brother all had struggled with brief, but intense outbursts of rage similar to what Michael experienced. This suggested that genetic factors were probably involved. Michael’s dad also reported that he himself felt overwhelmed with anger and screamed at Michael with intensity anytime Michael acted angry. This intensified Michael’s anger and his fear of his own temper and of his father. Michael’s father also acknowledged that he, himself had been diagnosed with ADHD and was taking medication for it. Unfortunately, his medication dosing was helping some, but not much. I suggested that he discuss the possibility of a change of medication or dosage change with his prescriber. The parents also explained that they were struggling with financial pressures. The husband had been laid off and had been unable to find a new job for more than a year. This was frustrating and embarrassing to him as his wife was working long hours to support the family while he was staying home taking care of the house and Michael. Meanwhile, Michael’s mother was clinically depressed and also frustrated that her husband often seemed not to be pulling his weight at home. Both parents were often in conflict, unable to provide much emotional support for one another or for Michael. Both clearly loved their son intensely and were committed to one another, but they were feeling increasingly frustrated with him, embarrassed that they could not control his outbursts or their own, and hopeless about how to help him and one another. There is no single profile of emotions common to all individuals with ADHD. There is much diversity due to differences in age, temperament, personality style, family life, cultural background, and many other variables. Yet there are some ADHD characteristics and some situations often experienced by many with ADHD (and those involved with them) that cause particular patterns of emotional dynamics to emerge more frequently among these people. These case studies describe some emotional dynamics often reported by children, adolescents or adults with ADHD and those who interact with them. The palette of human emotions is rich and variegated. It includes happiness, enthusiasm, interest, disinterest, boredom, delight, worry, fearfulness, panic, terror, frustration, annoyance, anger, rage, pride, envy, embarrassment, shame, guilt, jealousy, disappointment, discouragement, grief, hopelessness, sadness, depression, longing, trust, optimism, expectancy, determination, affection, passion, love, hope, and many others. Emotions are dynamic in that they often change and interact, sometimes in an instant, sometimes over hours, weeks or years. Often they change in response to specific circumstances of a situation, what someone else says or does and how individuals perceive and react to one another in given moments and over time. Sometimes emotions are quite transient, a flash of anger or a moment of jealousy, pride or affection that may quickly be modified or replaced by other emotions which may be quite contradictory. Emotions also may be persistent over much of a lifetime, absorbed into the fabric of one’s personality across differing settings. Emotions vary not only in type, but also in intensity. Sometimes emotions arise with fierce or crushing intensity; at other times that same emotion may be scarcely noticeable. Emotions also vary in level of consciousness. Sometimes a person is fully aware of a particular emotion in a given moment, yet at another time that person may be totally unaware of an emotion that others readily recognize and respond to. In all persons, emotions tend to arise in multiple mixes and blends. Sometimes the blend is subtle and convergent—affection and longing, pride and hope. In other instances, emotions strongly conflict with one another— interest and fear, pleasure and guilt, pride and resentment, love and hate. Sometimes the conflict is immediate; in other instances, one emotion may be followed quickly or gradually with another, or a person may experience rapid alternation between one emotion and another. Examples described in this case study may be experienced by various individuals in many different ways, only some of which are included here. Brown, T. E. (2017). Emotional Dynamics in Individuals, Couples, and Families Coping with ADHD. In Outside the Box; Rethinking ADD/ADHD in Children and Adults (pp. 151–170). Arlington, VA: American Psychiatric Association Publishing.

    • Emotional Dynamics in individuals, couples & families with ADHD

      Case Study #1: A 7-year old who feels picked on by adults. Seven-year-old Jimmy’s mother met him at the front door as he came home from school. She gave him a hug and asked “How was school today?” Jimmy dropped his school bag and jacket on the floor in front of the door and, without answering, headed toward the kitchen to find a snack. His mother called him back to pick up his jacket and school bag. Jimmy came back with a grumpy face and announced, “School was terrible; it’s always terrible. She’s always yelling at me just like you are now! His mother responded, “I wasn’t yelling at you, I just asked you to come back to pick up your jacket and school bag and put them where they belong, not just leaving them in front of the door.” Jimmy picked up his stuff grumbling, “It’s always that way, you and my teacher and my soccer coach, all of you are always yelling at me and saying that I did something wrong or didn’t do something I was supposed to do. Nobody else ever gets yelled at so much all the time.” Young children with ADHD, especially if it is not effectively treated, often complain that their parents, teachers, and other adults are constantly yelling at them. This “yelling” may sometimes involve angry comments with a raised voice; though often it is simply a matter of very frequent reminders and corrections that may be necessary, but they may leave the child feeling singled out, far more often than other children, as the one who is not doing what is expected. Many teachers and parents of children with ADHD report that they need to give reminders or corrections to those with ADHD as much a five to ten times more often than to most of their classmates or siblings. Even when these frequent corrections are done with minimal intensity and without any overt annoyance, the impact on the child’s view of self may be substantially impacted. When this pattern goes on with much daily frequency for many years, as it does for some children with ADHD, the result is often a combination of feeling picked on, unappreciated, and incompetent, relative to others of similar age. One antidote to this problem is for parents and teachers to find or create frequent opportunities to recognize when their child is doing something well so they can give recognition or praise for doing the right thing. In the routines of daily life, it is easy to mention mostly the actions one finds frustrating or wants to see changed, while not mentioning much at all those actions one would like to see more frequently. When a child complains about others being too critical or getting too irritable with them, it may be helpful to listen to the child’s complaint and perhaps offer some empathy or validation, “Yeah, it’s not much fun to feel like you’re always the one getting told you’re in the wrong. Sometimes it may be that you really are doing something you should change, but other times it may be that the grown up is just having a bad day.” Sometimes such complaints are an indirect way of asking for some recognition and encouragement to counter frustrations of the day. There is no single profile of emotions common to all individuals with ADHD. There is much diversity due to differences in age, temperament, personality style, family life, cultural background, and many other variables. Yet there are some ADHD characteristics and some situations often experienced by many with ADHD (and those involved with them) that cause particular patterns of emotional dynamics to emerge more frequently among these people. This chapter describes some emotional dynamics often reported by children, adolescents or adults with ADHD and those who interact with them. The palette of human emotions is rich and variegated. It includes happiness, enthusiasm, interest, disinterest, boredom, delight, worry, fearfulness, panic, terror, frustration, annoyance, anger, rage, pride, envy, embarrassment, shame, guilt, jealousy, disappointment, discouragement, grief, hopelessness, sadness, depression, longing, trust, optimism, expectancy, determination, affection, passion, love, hope, and many others. Emotions are dynamic in that they often change and interact, sometimes in an instant, sometimes over hours, weeks or years. Often they change in response to specific circumstances of a situation, what someone else says or does and how individuals perceive and react to one another in given moments and over time. Sometimes emotions are quite transient, a flash of anger or a moment of jealousy, pride or affection that may quickly be modified or replaced by other emotions which may be quite contradictory. Emotions also may be persistent over much of a lifetime, absorbed into the fabric of one’s personality across differing settings. Emotions vary not only in type, but also in intensity. Sometimes emotions arise with fierce or crushing intensity; at other times that same emotion may be scarcely noticeable. Emotions also vary in level of consciousness. Sometimes a person is fully aware of a particular emotion in a given moment, yet at another time that person may be totally unaware of an emotion that others readily recognize and respond to. In all persons, emotions tend to arise in multiple mixes and blends. Sometimes the blend is subtle and convergent—affection and longing, pride and hope. In other instances, emotions strongly conflict with one another— interest and fear, pleasure and guilt, pride and resentment, love and hate. Sometimes the conflict is immediate; in other instances, one emotion may be followed quickly or gradually with another, or a person may experience rapid alternation between one emotion and another. Examples described may be experienced by various individuals in many different ways, only one of which is included in the case study above. Brown, T. E. (2017). Emotional Dynamics in Individuals, Couples, and Families Coping with ADHD. In Outside the Box; Rethinking ADD/ADHD in Children and Adults (pp. 151–170). Arlington, VA: American Psychiatric Association Publishing.

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    • Documentation/Report Requests | Brown ADHD Clinic| California

      Documentation Requests Please complete the form below and provide details regarding your requests. if you are requesting a full report regarding diagnosis, recommendations, and/or accommodations, preparation can take between 2-4 hours and is billable at $400/hr. If you are simply looking for a brief summary of diagnosis, findings, and recommendations on medication there is no charge. Turn around time can take between 3-4 weeks for extensive reports. Please review and complete the form below if you have not already. Please note Report Policy & Fees Requesting Documentation- Existing Patients ONLY I am requesting the following: Initial Assessment Report (note: charges may apply) Requesting Records Requesting Superbill Requesting Individual Insurance Form Accomodations Report (preparation charges will apply) I understand turnaround can take 1-4 weeks, depending on the request Submit Thanks for submitting!

    • Brown ADHD Clinic | Diagnosis & Treatment | California

      Welcome to the Brown ADHD Clinic ​ Manhattan Beach, CA Thomas E. Brown, PhD Dr. Brown is a clinical psychologist who received his Ph.D. from Yale University and specializes in assessment and treatment of high-IQ children, adolescents and adults with ADD/ADHD and related problems. ​ In his 30+ years of experience, Dr. Brown has contributed over 30 journal publications, , and presented numerous speaking engagements and lectures throughout the US and in 40+ other countries. He was inducted into the CHADD Hall of Fame for outstanding contributions to research and professional education about ADHD in children and adults. Dr. Brown has also been elected a Fellow of the American Psychological Association. award winning books Read More Whether you're looking to help yourself, a loved one, or just here to learn more about ADHD, we have you covered! See Our Services Understanding ADHD New Patient Inquiry Additional Resources About Us Find Us A New Understanding of ADHD from Thomas E. Brown Although ADD/ADHD has been recognized for over 100 years, it has usually been seen as essentially a behavior problem. Yet many with ADD/ADHD suffer not from behavior problems so much as from chronic problems with focusing their attention, organizing their work, sustaining their effort, and utilizing short-term memory. ​ It’s time for a new understanding of Attention Deficit Disorder! ​ This website offers a new perspective on this disorder, one based on current clinical and neuroscience research. It presents a new definition and model of ADD/ADHD as essentially a problem with executive functions, the management system of the brain. It describes how a child or adult with ADD/ADHD can focus very well on a few activities that intensely interest them, yet be unable to focus adequately on most other tasks of daily life. It explains how ADD/ADHD often looks like a weakness in willpower, but isn’t. Brown ADHD Model See Other ADHD Resources 01. Initial Consultations Patients new to our clinic are welcome to an on site, 3-hour initial consultation to develop an understanding of their strengths, difficulties and to develop a diagnosis and treatment plan. 02. Follow up Appointments Psychotherapy, cognitive-behavioral therapy, family meetings, and medication management are available to all established patients. ​ We also offer medication monitoring and Cognitive Behavior Therapy sessions with Dr. Ryan Kennedy. ​ ​ *ZOOM sessions available for patients after at least one face-to-face appointment. Ask for details. View More Services 03. Testing & Report for Academic Accomodations In this clinic, those diagnosed with attention and learning problems can also receive expert psycho-educational testing which may be required to obtain accomodations in schools, universities, and for SAT, ACT, GRE, MCAT, LSAT, GMAT, or professional credentialing tests. Brown ADHD Clinic 500 S. Sepulveda Blvd. #218 Manhattan Beach, CA 90266 Monday to Friday 9:00 am - 5:00 pm (310 ) 590.7181 Fax (310) 590.7183 Info@BrownADHDClinic.com

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© 2020  by Thomas E. Brown, Ph.D. 

Manhattan Beach, CA

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