Search Results

33 results found

    Blog Posts (3)
    • "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.

    View All
    Pages (30)
    • The Brown Model of ADD/ADHD | Brown ADHD Clinic | United States

      The Brown Model of ADD/ADHD From more than 25 years of clinical interviews and research with children, adolescents and adults who have ADD/ADHD, Dr. Brown has developed an expanded model to describe the complex cognitive functions impaired in ADD/ADHD. This model describes executive functions, the cognitive management system of the human brain. ​ Although the model shows six separate clusters, these functions continually work together, usually rapidly and unconsciously, to help each individual manage many tasks of daily life. The functions appear in basic forms in young children and gradually become more complex as the brain matures throughout childhood, adolescence and early adulthood. Everyone has occasional impairments in their executive functions, individuals with ADD experience much more difficulty in development and use of these functions than do most others of the same age and developmental level. Yet even those with severe ADHD usually have some activities where their executive functions work very well. ​ They may have chronic difficulty with ADHD symptoms in most areas of life, but when it comes to a few special interests like playing sports or video games, doing art or building Lego constructions, their ADHD symptoms are absent. This phenomenon of “can do it here, but not most anyplace else” makes it appear it that ADHD is a simple problem of lacking willpower; it isn’t. These impairments of executive functions are usually due to inherited problems in the chemistry of the brain’s management system. ​ Utilizing clinical interview methods, Dr. Brown studied children, adolescents and adults diagnosed with ADHD according to the DSM criteria. He compared their descriptions of their problems with those of matched normal controls. Comparisons between the ADHD-diagnosed and the non-clinical samples in each age group yielded reports of impairments that can be recognized in the six clusters of this model of executive functions: organizing tasks and materials, estimating time, prioritizing tasks, and getting started on work tasks. Patients with ADD describe chronic difficulty with excessive procrastination. Often they will put off getting started on a task, even a task they recognize as very important to them, until the very last minute. It is as though they cannot get themselves started until the point where they perceive the task as an acute emergency. Activation: ​ : focusing, sustaining focus, and shifting focus to tasks. Some describe their difficulty in sustaining focus as similar to trying to listen to the car radio when you drive too far away from the station and the signal begins fading in and out: you get some of it and lose some of it. They say they are distracted easily not only by things that are going on around them, but also by thoughts in their own minds. In addition, focus on reading poses difficulties for many. Words are generally understood as they are read, but often have to be read over and over again in order for the meaning to be fully grasped and remembered. Focus ​ regulating alertness, sustaining effort, and processing speed. Many with ADHD report they can perform short-term projects well, but have much more difficulty with sustained effort over longer periods of time. They also find it difficult to complete tasks on time, especially when required to do expository writing. Many also experience chronic difficulty regulating sleep and alertness. Often they stay up too late because they can’t shut their head off. Once asleep, they often sleep like dead people and have a big problem getting up in the morning. Effort: ​ : managing frustration and modulating emotions. Although DSM-IV does not recognize any symptoms related to the management of emotion as an aspect of ADHD, many with this disorder describe chronic difficulties managing frustration, anger, worry, disappointment, desire, and other emotions. They speak as though these emotions, when experienced, take over their thinking as a computer virus invades a computer, making it impossible for them give attention to anything else. They find it very difficult to get the emotion into perspective, to put it to the back of their mind, and to get on with what they need to do. Emotion ​ : utilizing working memory and accessing recall. Very often, people with ADHD will report that they have adequate or exceptional memory for things that happened long ago, but great difficulty in being able to remember where they just put something, what someone just said to them, or what they were about to say. They may describe difficulty holding one or several things “on line” while attending to other tasks. In addition, persons with ADHD often complain that they cannot pull out of memory information they have learned when they need it. Memory ​ : monitoring and regulating self-action. Many persons with ADHD, even those without problems of hyperactive behavior, report chronic problems in regulating their actions. They often are too impulsive in what they say or do, and in the way they think, jumping too quickly to inaccurate conclusions. Persons with ADHD also report problems in monitoring the context in which they are interacting. They fail to notice when other people are puzzled, or hurt or annoyed by what they have just said or done and thus fail to modify their behavior in response to specific circumstances. Often they also report chronic difficulty in regulating the pace of their actions, in slowing self and/or speeding up as needed for specific tasks. Action ​ ​ Most children, adolescents and adults with ADHD report these six clusters of impairments as chronic, to a degree markedly greater than persons without ADHD. The clusters are not mutually exclusive categories; they tend to overlap and are often interactive. Executive Functions impaired in ADHD are complex and multi-faceted. This model is explained in detail in Dr. Brown’s book, Attention Deficit Disorder: The Unfocused Mind in Children and Adults, published by Yale University Press in 2005, in his 2013 book , published by Routledge, and in his most recent book, Outside the Box: Rethinking ADD/ADHD in Children and Adults—A Practical Guide published by American Psychiatric Publishing, Inc. in 2017. A New Understanding of ADHD in Children and Adults: Executive Function Impairments ​ Impairments of these executive functions can be assessed with The Brown Attention Deficit Disorder Scales, normed rating scales for children, adolescents and adults. Used in schools and clinics as well as by physicians and mental health practitioners throughout the U.S. and in many other countries, these scales and manuals that explain their use and interpretation are published by Pearson, the company that also publishes the Wechsler Scales for assessing IQ and memory. Brown EF/A Scales More ADHD Resources

    • Ryan J. Kennedy, DNP, NP-C | Brown ADHD Clinic | United States

      Ryan J. Kennedy, DNP, FNP-C Hi, my name is Dr. Ryan Kennedy. I started at the Brown Clinic since it opened its doors in 2017, however, I have been working with our Clinic Director, Dr. Brown since 2011. I see patients of all ages, starting with children as young as 3 year's old. I am a specialist in evaluations for ADHD and have developed expertise in clinical psychopharmacology for ADHD and Related Disorders. ​ ​ My Practice Philosophy ​ One of the most important things about my career is building strong relationships with my patients. I have heard from hundreds of patients who told me they had a poor experience with medication so they gave up on their treatment... ​ I have longer appointment times than most other doctors because I believe that listening carefully to my patients and their families is essential to long-term, successful treatment. My goal is to help provide you with the tools that will help maximize your true potential. ​ Professional Biographical Summary ​ Dr. Kennedy received his doctorate in Nursing Practice from Quinnipiac University. He has a special interest in assessment and treatment of ADHD and related problems across the lifespan. In 2011 Dr. Kennedy began working with Dr. Brown assisting in research for publications and traveling to national and international conferences on ADHD in the U.S. and more than 12 other countries. Since 2017 he has worked full-time as Clinical Associate in the Brown Clinic for ADHD and Related Disorders in Manhattan Beach, California. He has published articles in peer-reviewed journals and is co-author with Dr. Brown of a chapter in the first open-access eBook published by the World Federation of ADHD. He also provides mentoring regarding ADHD for Pediatric Resident Physicians from UCLA. With the integration of Dr. Kennedy’s experience paired with Dr. Brown’s expertise in clinical psychology, together they collaborate to provide a unique approach of medical and psychological care for patients and their families at The Brown Clinic.

    • Copy of The ESL: Brown Model of ADD/ADHD | Brown ADHD Clinic

      Modelo del Trastorno de Déficit de Atención desarrollado por el Dr. Brown Dr. Brown ha dedicado su trayectoria profesional a estudiar el Trastorno de Déficit de Atención y el Trastorno de Déficit de Atención con Hiperactividad (TDA/TDAH). ​ Basándose en más de 25 años de entrevistas e investigaciones con niños, adolescentes y adultos que presentan TDA o TDAH, Dr. Brown ha desarrollado un extenso modelo para describir las complejas funciones cognitivas que se ven afectadas por esta perturbación. Este modelo describe las funciones ejecutivas, el sistema de manejo cognitivo del cerebro humano. Aunque el modelo muestra seis conjuntos separados, estas funciones se desempeñan juntas continuamente, por lo general con rapidez y de forma inconsciente, para ayudar a cada individuo a manejar muchas de las tareas de la vida diaria. Las funciones se presentan en sus formas básicas en los niños pequeños y gradualmente se hacen más complejas a medida en que el cerebro madura a lo largo de la niñez, la adolescencia y la primera fase de la edad adulta. Todo el mundo presenta fallas ocasionales en sus funciones ejecutivas. Sin embargo, los individuos con TDAH experimentan mayor dificultad en el desarrollo y uso de estas funciones que la mayoría de las personas de la misma edad y nivel de desarrollo. No obstante, incluso los individuos con un severo TDAH usualmente tienen algunas actividades en las que las funciones ejecutivas funcionan muy bien. ​ ¡No hay que desanimarse! ​ Una persona puede tener una dificultad crónica con síntomas de TDAH en la mayoría de las áreas de la vida, pero cuando se trata de algunos intereses especiales como practicar un deporte o disfrutar videojuegos, hacer algo artístico o edificaciones con lego, no da muestras de los síntomas del TDAH. Este fenómeno de “puedo hacer esto aquí, pero no en la mayoría de los otros lugares” podría hacer suponer que el TDAH es un problema simple de falta de fuerza de voluntad; pero no es así. Estas fallas de las funciones ejecutivas usualmente se deben a problemas congénitos en la química del sistema que maneja el cerebro. Utilizando métodos de entrevistas clínicas, Dr. Brown estudió a niños, adolescentes y adultos diagnosticados con el TDAH según los criterios de DSM. Comparó las descripciones que ellos hacían de sus problemas con las descripciones de los controles normales. Las comparaciones entre las personas diagnosticadas con TDAH y las muestras no clínicas en cada grupo de edad arrojaron informes de fallas que pueden ser reconocidas en seis conjuntos de este modelo de funciones ejecutivas. : organizar las tareas y materiales, estimar tiempo, establecer prioridades de las tareas e iniciar la actividad.Los pacientes con el TDAH describen una dificultad crónica con excesiva dilación. A menudo aplazan el iniciar una tarea, incluso una actividad que reconocen como algo muy importante para ellos, hasta el último minuto. Es como si no pudieran empezar y sólo lo hacen cuando perciben la tarea como algo de aguda emergencia. Activación : centrarse, conservar la atención, mantenerse concentrado en las tareas. Algunos describen sus dificultades para mantener la atención como lo que sucede cuando tratan de escuchar la radio de un automóvil mientras se alejan de la estación y la señal comienza a perderse: se capta algo de ella y se pierde parte de la misma. Dicen que se distraen fácilmente no sólo por las cosas que suceden a su alrededor, sino por sus propios pensamientos. Además, concentrarse en leer es algo difícil para muchos de ellos. Generalmente entienden las palabras cuando las leen, pero a menudo tienen que releer una y otra vez para poder captar el significado cabalmente y recordarlo. Foco : regular el estado de alerta, mantener el esfuerzo y procesar la velocidad. Muchas personas con TDAH indican que pueden realizar proyectos de corto plazo, pero enfrentan mucha más dificultad a la hora de ejecutar un esfuerzo sostenido durante largos períodos de tiempo. También se les dificulta concluir las tareas a tiempo, especialmente cuando les piden que redacten un texto expositivo. Un gran número de pacientes experimenta una dificultad crónica en cuanto a la regulación del sueño y la vigilia. A menudo permanecen despiertos hasta tarde porque no pueden “apagar” sus mentes. Una vez dormidos, frecuentemente duermen como muertos y tienen grandes dificultades para levantarse por la mañana. Esfuerzo : manejar la frustración y controlar las emociones. Aunque el DSM-IV (clasificación internacional de los trastornos mentales) no reconoce ningún síntoma relacionado con el manejo de las emociones como un aspecto del TDAH, muchas personas con este desorden dicen experimentar dificultades crónicas con relación al manejo de la frustración, la ira, la ansiedad, la desilusión, el deseo y otras emociones. Hablan como si estas emociones se apoderaran de su pensamiento así como los virus de computadoras invaden un PC, lo que les hace imposible prestar atención a cualquier otra cosa. Les resulta sumamente difícil poner las emociones en perspectiva, colocarlas en la trastienda de la mente y proseguir con lo que necesitan hacer. Emoción : usar la memoria funcional y tener acceso al recuerdo. Con frecuencia, las personas con TDAH señalan que poseen una memoria adecuada o excepcional para cosas que ocurrieron mucho tiempo atrás, pero experimentan grandes dificultades a la hora de poder recordar dónde acaban de poner algo, lo que alguien les dijo un minuto atrás o qué estaban por decir. Pueden describir cierta dificultad para tener una o varias cosas “en línea” mientras atienden otras tareas. Además, las personas con TDAH a menudo se quejan porque no pueden extraer información que tienen en la memoria cuando la necesitan. Memoria : hacer seguimiento de la propia acción y controlarla. Muchas personas con TDAH, incluso aquellas sin problemas de comportamiento hiperactivo, notifican problemas crónicos a la hora de controlar sus acciones. A menudo son demasiado impulsivas en lo que dicen o hacen, así como en su forma de pensar, por lo que llegan muy rápidamente a conclusiones erróneas. Las personas con TDAH también dicen experimentar problemas cuando desean hacer un seguimiento del contexto en el cual están interactuando. No logran advertir cuándo los demás se sienten desconcertados, heridos o contrariados por lo que ellas acaban de decir o hacer, y por lo tanto no alteran su comportamiento en respuesta a circunstancias específicas. Asimismo, muchas veces dicen experimentar dificultades crónicas cuando desean controlar el ritmo de sus acciones: desacelerarse o acelerarse según lo necesiten para tareas específicas. Acción La mayoría de los niños, adolescentes y adultos con TDAH dicen experimentar estas seis clases de deterioro de manera crónica, a un grado notablemente mayor que las personas sin TDAH. Estas clases no son categorías mutuamente excluyentes; tienden a coincidir en parte y a menudo son interactivas. Las Funciones Ejecutivas que presentan deterioro en los casos de TDAH son complejas y multifacéticas. ​ Este modelo se explica detalladamente en el nuevo libro del Dr. Brown, Attention Deficit Disorder: The Unfocused Mind in Children and Adults (Trastorno de Déficit de Atención: la falta de concentración en niños, adolescentes y adultos), publicado por la Yale University Press en septiembre de 2005. ​ El deterioro de las funciones ejecutivas se puede evaluar mediante las Escalas del Dr. Brown para el Trastorno de Déficit de Atención, que son escalas de puntaje estandarizadas para niños, adolescentes y adultos. Estas escalas, que son utilizadas tanto en escuelas y clínicas como por parte de médicos y especialistas en salud mental en todos los Estados Unidos, además de otros países, y los manuales que explican su uso e interpretación, son publicados por PsychCorp, la compañía que también publica las Escalas Wechsler para evaluar el coeficiente intelectual y la memoria. Brown EF/A Scales

    View All

© 2021  by Brown Clinic for Attention & Related Disorders

Manhattan Beach, CA

  • YouTube Social  Icon
  • Black Facebook Icon