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Dr. Brown's ADHD Model of Executive Functions, created from 30+ years of experience with his patients The Brown Model of Executive Function Impairments in ADHD. From more than 25 years of clinical interviews and research with children, adolescents and adults who have ADHD... Dr. Brown has developed an expanded model to describe the complex cognitive functions impaired in ADHD. This model describes executive functions, the cognitive management system of the human brain. Although the model above shows 6 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 ADHD experience much more difficulty in development and use of these functions than do most others of the same age and developmental level. 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 or hard to notice. 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. How was the Model created? 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: Here are some examples to describe each cluster of the model Activation: 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. Focus : 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. Effort: 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. Emotion : managing frustration and modulating emotions. Although the DSM-5 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. Memory : 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. Action : 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.

Learn about our expert assessment, diagnosis and treatment methods for ADHD and related problems for all ages 1. Initial Evaluations * required for all new patients View More 2. Therapy Psychotherapy Cognitive- Behavioral Therapy Family Sessions View More 3. Expert consultations & specialized fine-tuning & titration for medication optimization View More 4. Psych-Ed Testing Cognitive Abilities, Intelligence, and Achievement testing. Narrative Written Reports for accommodations View More 5. Behavior& Family Therapies B ehavior Management , Parent Training , & Social Skills Training View More Medication Treatment

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Here are some resources in print or on the web that we recommend for a variety of topics related to ADHD Helpful Links International US . International UK . National Focus The websites listed here offer offer a variety of free information about attention deficit disorders. Most specialize in issues concerning children and adolescents; some focus more on adults. Many are sponsored by ADD support and advocacy organizations and provide detailed, downloadable information that has been evaluated and approved by a professional advisory board; others are less selective and may include reports that are not adequately supported by scientific research. Some list contact information for local support and advocacy groups concerned with attention deficit disorders. Many have links to related organizations, and all are nonprofit. International Websites Based in United States Children and Adults with ADHD (CHADD) , is the largest ADHD support and advocacy organization in the United States that offers scientifically reliable information about ADHD in children adolescents, and adults. Their site offers downloadable fact sheets for parents, educators, professionals, the media, and the general public. The site also includes contact information for two hundred local chapters of CHADD throughout the United States. Chadd.org Add.org ADDA is a resource in English for adults with ADD. Sponsored by Attention Deficit Disorder Association (ADDA), the world’s largest organization for adults with ADHD, it provides information, resources, and networking opportunities. International Websites Based in the United Kingdom addiss.co.uk ADDIS presents information in English about ADHD across the lifespan. It serves patients, parents, teachers, and health professionals, and questions received by phone or email are answered. This site is sponsored by the National Attention Deficit Disorder Information and Support Service in the United Kingdom. adders.org adders.org provides a wide variety of information about ADHD in English, French, German, and Spanish. It posts websites and email addresses for support groups in forty different countries. Websites with a National Focus The following websites are sponsored by ADHD education and advocacy organizations in various countries. Some are much better established and provide much more reliable information than others. Many list addresses for local groups within their country. Usually the material is presented in the dominant language of the country listed. Argentina TDAH Australia Learning and Attentional Disorders Society (LADS) Learning Difficulties Coalition NSW ADHD Foundation Austria ADAPT Belgium ADHD Europe Brazil The Brazilian Association for Attention Deficit Disorder (ABDA) Canada Canadian ADHD Resource Alliance (CADDRA) Centre for ADHD Awareness, Canada (CADDAC) China ADHD-China Denmark Danish ADHD Association Estonia Estonian Children's Fund Finland The ADHD Association France HyperSupers - ADHD France Germany JUVEMUS ADHD-Deutschland Hong Kong Focus Hong Kong Ireland HADD Italy AIFA Japan Ejison Club Mexico Deficit de Atencion The Netherlands Balans Brainwiki New Zealand ADHD New Zealand Northern Ireland ADD-NI Spain ADANA Fundación ANSHDA APNADAH

欢迎查阅托马斯·E.·布朗博士的网页 该网页对认识注意力缺陷障碍症提供了一个新观点。 网页指出：患有注意力缺陷障碍症（ADHD）和注意力缺陷障碍伴多动症（ADHD）的群体具有以下特征：经常性延误活动，在极度压力下方可开展活动，难以掌控首要事务，对日常安排注意力分散，经常失去要点，沮丧和效力低下等等。 一百多年以前人们就对这种功能紊乱有所识别，可时至今日，还经常错误地认为这并不是一种行为障碍。 那么，这种紊乱究竟是不是一种行为障碍呢？许多患有注意力缺陷障碍症（ADHD）和注意力缺陷障碍伴多动症（ADHD）的人并未表现出行为问题，也未被视为慢性病患者，因为他们有时是可以集中精力，有序工作，善始善终，运用短期记忆。 是应该从一个新的角度认识注意力缺陷障碍症的时候了！ 据该网页，布朗博士在临床经验和当今神经科学的基础上，对认识这一病症提供了一个新视角。主张以一种模式来判断注意力缺陷障碍症（ADHD）和注意 力缺陷障碍伴多动症（ADHD），从根本上将这一病症定义为是一种执行功能的障碍，也就是说，是大脑指挥系统的问题。网页描述了患有注意力缺陷障碍症 （ADHD）和注意力缺陷障碍伴多动症（ADHD）的儿童或成年人是如何高度集中精力投入其特别感兴趣的少数活动，而对大部分日常事务却因缺乏相应的注意 力而无法从事。此外，博士还解释了为什么这一病症被习惯性地视为缺乏毅力的表现，而实际上远非如此！ 致专业人士： 关于注意力缺陷障碍症（ADHD及发病率一书节选及销售成果 关于诊断注意力缺陷障碍症（ADHD）的评定及程式表 供您下载的PDF档案中有关注意力缺陷障碍症ADHD）的文章 关于注意力缺陷障碍症（ADHD）和注意力缺陷障碍伴多动症（ADHD）的诊断和用药研究目录 致患者及家属： 布朗博士就注意力缺陷障碍症（ADHD）举行的圆桌会议光盘 布朗博士为患者和家属提供的服务及讲习班、研讨会 关于注意力缺陷障碍症（ADHD）的推荐书目及读物 与注意力缺陷障碍症（ADHD）相关其它网页的链接 目前袖珍本已上市 托马斯·E.·布朗博士的著作 注意力缺陷障碍症：儿童和成年人的精神涣散 （耶鲁大学报）（请从这里登陆，了解这本书的更多情况） “布朗的这本书是深沉的，充满了同情心。如果您要面对一个患有此症状的儿童或成年人，那么这就是一本必读之物。” THE BALTIMORE SUN “这本书智慧地解释了注意力缺陷障碍伴多动症（ADHD，是时下最好的一本书。对所有无论是出于个人原因还是职业需要而关注注意力缺陷障碍伴多动症（ADHD）的人均是一本必读物。” ADDITUDE MAGAZINE “布朗博士的最新著作，是对注意力缺陷障碍伴多动症（ADHD）现有定义的挑战，为判断和理解这一病症提出了明确的框架，认为注意力缺陷障碍伴多动症（ADHD）的患者的大脑功能网络经常处于损坏的状态中。” JOURNAL OF ATTENTION DISORDERS 如果您想了解如何购买这本书： 自美国，请点击这里 自英国和其它欧洲国家，请点击这里 自世界其它地方办理国际订购，请点击这里 Brown EF/A Scales

Information in this section outlines our description of services for an Initial Psychological Evaluation for ADHD and related problems. Step 1: Intake Call & Registration Before new patients are seen for their initial evaluation, prospective patients are first scheduled for a brief intake appointment via phone call with our office staff for screening and completing registration forms. Step 2: The Initial Evaluation During initial 3-hour consultations, your clinician begins with a clinical interview. All patients are then administered a few objective assessment measures including the Brown Attention/Executive Function Rating Scales (patients will be given a copy of the report by the end of the appointment). Additionally, patients are assessed using memory & cognition sub-tests to measure short-term, working memory abilities; and lastly a screening for other possible related problems or co-occurring disorders. By the end of the consultation, your clinician will provide some education about ADHD, answer any questions and provide you with a diagnostic impression and any recommendations for treatment including follow-up appointments. A brief summary report for initial consultations are provided upon request. If you are seeking a more analytical and extensive report (typically needed for accommodations), this can be provided at an additional fee and prepared within a few weeks. We require all new patients under 18 to come with at least one parent or caregiver; for adult patients we highly encourage you to come with a close friend, family member or partner to provide additional perspective of the patient's presenting difficulties.

The Brown ADHD Clinic is a private clinic in Manhattan Beach, CA. Our Director is Thomas E. Brown, PhD, Clinical Psychologist, and our Assocate Director is Ryan J. Kennedy, DNP, FNP-C. Our clinicians specialize in assessment, diagnosis, & treatment of ADHD & Related Disorders in children, teens, & adults. About Us We are a private practice clinic located in Southern California. Our clinicians are internationally recognized specialists in their field for assessment and treatment of ADHD and Related Disorders. Our clinic is for children, teenagers and adults, and we have sub-specialty for those those with ADHD and have a high IQ. ABout Our Specialty After serving over 20 years on the clinical faculty of the Yale Medical School, Dr. Brown relocated with Ryan J. Kennedy, DNP, FNP-C in 2017 from Connecticut to re-open this specialty clinic in Manhattan Beach, California. Our clinicians offer expert assessments and treatment for children, teenagers and adults using their specialized approach and up-to-date knowledge of neuroscience, research & evidence-based practice. In the Brown Clinic, during the comprehensive evaluation, we also assess for the common conditions that often accompany ADHD & contribute to the various difficulties that undermine success in one's life - during school, college & grad school, career/employment, home, social settings, peer-relationships, sports/hobbies/social events, and interactions with family & friends. These difficulties may include the following listed below: Attention, Memory, & Motivation Academics/Work/Social under-achievement problems Anxiety Disorders Generalized & Social Anxiety Asperger's Syndrome High IQ-Autism (level 1) Cognitive Problems in Menopause Emotion Regulation Quick to Frustration/Irritability Sensitivity to Rejection Depressive Disorders Bipolar Disorders Obsessive-Compulsive Disorders Parenting & Family Conflict Specific Learning Problems Math, Reading, & Writing Sleep & Awakening difficulties Alcohol & Drug Use Problems In this clinic those diagnosed with attention and learning problems can also receive expert psycho-educational testing which may be required to obtain accommodations in schools, universities and for professional credentialing tests. Other available services include psychotherapy, cognitive behavioral therapy, family therapy, and medication monitoring. Meet our team Our Team Meet the team Thomas E. Brown, PhD Director Thomas E. Brown earned his Ph.D. in Clinical Psychology at Yale University and then served on the Yale faculty for 25 years. He is the Director of the Brown Clinic & Clinical Professor of Psychiatry & Neuroscience, University of California, Riverside School of Medicine He has published 30 peer-reviewed scientific journal articles and 5 ground-breaking books on ADD/ADHD. Dr. Brown is is an elected Fellow of the American Psychological Association. Liza Somilleda, MA Educational Consultant Liza is an experienced educator with both Special Education & Education Administration Credentials. She has over 17 years of school based experience, and extensive training & credentials in ABA. She assists parents in understanding the needs of their children with problems in attention, learning and behavior. Liza is also a certified PEERS social skills provider, and she specializes in working with children in middle and high school. Ryan J. Kennedy, DNP, NP-C Thomas E. Brown, PhD DIRECTOR Thomas E. Brown earned his Ph.D. in Clinical Psychology at Yale University and then served on the Yale faculty for 25 years. He is the Director of the Brown Clinic & Clinical Professor of Psychiatry & Neuroscience, University of California, Riverside School of Medicine He has published 30 peer-reviewed scientific journal articles and 5 ground-breaking books on ADD/ADHD. Dr. Brown is is an elected Fellow of the American Psychological Association. Bio Summary Ryan J. Kennedy, DNP, FNP-C, PMHS ASSOCIATE DIRECTOR Ryan J. Kennedy is a board-certified, family nurse practitioner and received his doctorate in nursing practice from Quinnipiac University. He specializes in assessment and psychopharmacology treatments for ADHD and comorbid disorders. Ryan has collaborated in research and writing with Dr. Brown for over 12 years. Their work is published in books, medical literature and peer-reviewed articles, and present their research & posters at national and international conferences, universities & lectures. At the Brown Clinic he provides assessment, treatment, medication management and therapy treatments for ADHD and related problems. Bio Summary Corrine Gach, ASW Associate Therapist Corrine Gach, ASW is an associate therapist, under the supervision of Dr. Thomas E. Brown, PhD (PSY29849) offers individual psychotherapy for children, teens, and young adults patients (CA-based only), previously evaluated at our clinic. Corrine earned her MSW at the University of Southern California and has been associated with our clinic since 2019. She has had additional training in cognitive behavioral therapy through the Beck Institute and is a PEERS for Adolescents certified provider through UCLA’s PEERS program. Contact Info. Liza Somilleda, MA Educational Consultant Liza is an experienced educator with both Special Education & Education Administration Credentials. She has over 17 years of school based experience, and extensive training & credentials in ABA. She assists parents in understanding the needs of their children with problems in attention, learning and behavior. Liza is also a certified PEERS social skills provider, and she specializes in working with children in middle and high school. Contact Info.

A collection of highly recommended articles from scientific research journals and respected sources for up-to-date information about topics in ADHD Top of Page ADHD Overview Executive Functions Comorbidities Assessments Medication Magazine Articles & Peer Reviewed Journals ADHD Overview Read More Read More Executive Functions Comorbidities Read More Assessments Read More Medications Read More ADHD Overview ADHD Overview The Marshmallow Test, "Willpower" and ADHD The most puzzling feature of ADHD is that it is situationally specific. Virtually all children and adults with ADHD have at least a few specific activities in which they are able to focus their attention very well for long periods of time, are able to keep several different things in mind simultaneously, are able to sustain their efforts for challenging tasks, and can prevent themselves from acting too impulsively—all this even though they have great difficulty in demonstrating those same skills for many other tasks that they recognize as important. Growing Up With ADHD: Clinical Care Issues “Growing Up With ADHD: Clinical Care Issues,” was published in the January 2016 issue of Psychiatric Times, a publication distributed to all psychiatrists in the U.S. It describes why young adults with ADHD often do not get the help they need when they are no longer being cared for by their pediatrician. It includes some suggestions for how they can be provided more adequate care. 10 Myths about ADHD This article, reprinted with permission from ATTENTION magazine (June, 2013 issue), is comprised of excerpts from the first chapter of Dr. Brown’s book, A New Understanding of ADHD in Children and Adults: Executive Function Impairments (Routledge, 2013). ADHD: From Stereotype to Science This article describes an updated understanding of ADHD. Published in Educational Leadership, a national magazine for teachers and school administrator, it describes how ADHD is not primarily a problem of behavior, but more a problem with the management system of the brain. The article explains how ADHD involves working memory problems which impact reading and writing. Parents may want to share this with teachers and read it for themselves. 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 The World Federation of ADHD Guide This 124 page ebook sponsored by the World Federation of ADHD was written by leading ADHD experts around the world. It provides accurate information about the causes of ADHD, assessment of ADHD over the lifespan, as well as medications and psychosocial treatments for children, teens, and adults with ADHD. Chapter 4 was contributed by Dr. Thomas E. Brown and Dr. Ryan J. Kennedy regarding Psychooscial Treatments for ADHD. 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. The Myths & Facts about ADD/ADHD 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. Executive Functions Executive Functions 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. 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 AD/HD Early Adulthood Challenges 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 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. Comparison of Two Measures of Working Memory Impairments in 220 Adolescents and Adults with ADHD Working memory is one of the most significant impairments of ADHD in adolescents and adults. This study demonstrated that a brief standardized story memory test is a more sensitive and relevant measure of working memory than is the digit span test often used for assessment of working memory in those with ADHD. Despite high IQ, most participants with ADHD scored significantly lower on the story memory test than do others in the general population. Ryan J. Kennedy, D. M. Quinlan, and T.E. Brown. Journal of Attention Disorders (2016) Executive Function Impairments in High IQ Children and Adolescents 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. 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. 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. 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. Comorbidities Comorbidities 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. Assessment and Management of Sleep Problems in Youths With Attention-Deficit/Hyperactivity Disorder A research work-group report. 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. Unrecognized Attention-Deficit/Hyperactivity Disorder in Adults Presenting with Other Psychiatric Disorders+ Many adults with a diagnosed psychiatric disorder also have attention-deficit/hyperactivity disorder (ADHD). In many cases, comorbid ADHD is unrecognized and/or undertreated. Differential diagnosis of adult ADHD can be challenging because ADHD symptoms may overlap with other psychiatric disorders and patients may lack insight into their ADHD-related symptoms. Current ADHD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision may prevent appropriate diagnosis of many patients with significant ADHD symptoms. Adults may not be able to provide a history of onset of symptoms during childhood, and it may be difficult to confirm that ADHD symptoms are not better accounted for by other comorbid psychiatric conditions. Comorbid ADHD is most prevalent among patients with mood, anxiety, substance use, and impulse-control disorders. ADHD can negatively affect outcomes of other comorbid psychiatric disorders, and ADHD symptoms may compromise compliance with treatment regimens. Furthermore, unrecognized ADHD symptoms may be mistaken for poor treatment response in these comorbid disorders. In these individuals, ADHD pharmacotherapy seems to be as effective in reducing core ADHD symptoms, as it is in patients who have no comorbidity. Limited evidence further suggests that ADHD therapy may help to improve symptoms of certain psychiatric comorbidities, such as depression. Therefore, management of ADHD may help to stabilize daily functioning and facilitate a fuller recovery. CNS Spectr CNS Spectr. 2008;13(11):977-984 . 2008;13(11):977-984 By Russell A. Barkley, PhD, and Thomas E. Brown, PhD 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 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. Assessments Assessments 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. 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. 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. Medication Medication 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. Clinical utility of ADHD symptom thresholds to assess normalization of executive function with lisdexamfetamine dimesylate treatment in adults This analysis assessed the relationship of various cutoff scores of the ADHD Rating Scale IV (ADHD-RS-IV) to levels of improvement in ADHD-related executive function (EF), measured by the Brown ADD Scale for Adults (BADDS), which may provide a measure of clinically meaningful EF improvement after ADHD treatment. Impact of atomoxetine on subjective attention and memory difficulties in perimenopausal and postmenopausal women Perimenopausal and postmenopausal women frequently report midlife onset of impairments of attention, organization, and short-term memory. We sought to determine whether these cognitive symptoms in healthy women in the menopause transition without a history of ADHD would respond to treatment with atomoxetine(ATX), a medication demonstrated to be effective in reducing similar cognitive impairments in adults with ADHD. New onset executive function difficulties at menopause: a possible role for lisdexamphetamine Reports of cognitive decline, particularly in the domains of executive functions (EFs), are common among menopausal women. This study aims to detertime the impact of the psychostimulant lisdexamfetamine (LDX) on subjective and objective cognitive function among menopausal women who report new-onset EF complaints. Open-label administration of lisdexamfetamine dimesylate improves executive function impairments and symptoms of attention-deficit/hyperactivity disorder in adults. Executive function (EF) impairment in attention-defi cit/hyperactivity disorder (ADHD) may account for behavioral symptoms such as poor concentration, impaired working memory, problems in shifting among tasks, and prioritizing and planning complex sets of tasks or completing long-term projects at work or school. Poor self-regulation and control of emotional behaviors frequently are seen in patients with ADHD. This study assessed EF behaviors in adults with ADHD at baseline and after 4 weeks of treatment with lisdexamfetamine dimesylate (LDX). By Thomas E. Brown, Matthew Brams, Joseph Gao, Maria Gasior & Ann Childress Lisdexamfetamine Effects on Executive Activation and Neurochemistry in Menopausal Women with Executive Function Difficulties During the menopause transition, many women with no history of executive functioning deficits report cognitive difficulties in domains including working memory, organization,focus, and attention (Epperson et al, 2011). This midlife onset of executive difficulties may be a result of reduced estradiol modulation of the executive system (Shanmugan and Epperson, 2014). Lisdexamfetamine (LDX) has been suggested to be a safe and effective treatment option for these women. However, the mechanism by which LDX improves executive functioning in these women is not known. Here we investigated the effects of LDX on brain activation and neurochemistry, hypothesizing that LDX would be associated with increased activation and decreased glutamate in executive regions.

In 2019, Dr. Brown's ADHD Rating Scales have been fully updated and re-normed; replacing all previous versions and now include more clinically valid questions about Executive Functions and Emotions in ADHD BEFARS Click to Order Brown EF/A Scales Dr. Brown has developed and published assessment tools to help assess executive function impairments associated with ADD/ADHD and related problems. These tools are designed for easy use by psychologists, physicians, psychiatrists, school psychologists and other educational, medical or mental health professionals. His rating scales, normed for each age group across the lifespan, elicit valuable data about executive function impairments for persons aged 3 years through adult. The scales are useful for: screening individuals who might benefit from assessment for ADD/ADHD as one component of a comprehensive assessment of persons for possible ADD/ADHD for monitoring effectiveness of ongoing treatment for ADD/ADHD These scales are widely used by schools and clinicians in paper and pencil or clinical interview format; they have also been utilized in research for many clinical trials of ADHD medications. Scales are divided into Age Groups Young Children (3 to 7) Middle Childhood (8 to 12) Adolescents/Teens (13 to 18) Adults (19+) All Patients Will Receive Their Own Copy After their Initial Evaluation The Brown Scales help to assess a wide range of symptoms of executive function impairments associated with ADHD/ADD. These normed rating scales are available to elicit parent report and teacher report for children ages 3 to 7 yrs and 8 to 12 yrs. For 8 to 12 year olds, a normed self-report version is also available. For adolescents (12-18 yrs) and for adults, normed rating scales elicit self-report and collateral report on a single form. Dr. Brown's scale was first released in 1996 and focused on adolescents and adults. In 2001, it was revised to assess children. Both Brown Scales for Children and Adolescents and the Brown Scales for Adolescents and Adults provide age-based norms and detailed information about how to administer and interpret the Brown Scales. In 2018 the scales underwent another revision to better assess this complex impairment that impacts academic, social, emotional, and behavioral development for both children and adults. Now known as the Brown Executive Function/Attention Scales (Brown EF/A Scales), it goes beyond other measures to screen and assess a wider range of impairments of executive function and attention. What makes Brown EF/A Scales Different? Helps address situational variability: The clinical presentation of ADHD is generally variable, the symptoms are situational, and the degree to which a patient exhibits them may be observed and interpreted differently by various observers.1 The Brown EF/A scales will provide a comprehensive evaluation of an individual's ADHD symptoms by analyzing their behavior using multiple perspectives: the examinee's self-perspective, teacher's perspective and parents' perspective. Items are more specific and contextual: Patients with ADHD experience situational variability and have the ability to focus on certain activities which hold strong interest for them. The Brown EF/A scales will include items that are more specific and ask about difficulties they might encounter in a specific context, e.g. difficulty remembering what has been read (when reading is assigned, not self-selected texts). Focus on severity as opposed to frequency: The items on the Brown EF/A scales, unlike other instruments will focus on severity of specific behaviors as opposed to frequency. This will allow examinees to directly and more accurately report symptoms they perceive to be problems. Includes DSM-5 symptoms of ADHD and more: In addition to diagnostic criteria for ADHD defined in DSM-5, the Brown EF/A scales also assess other important aspects of executive function impairments found in persons with ADHD, but not yet included in DSM-5 diagnostic criteria for ADD/ADHD. Based on Dr. Brown's model of Executive Functions: The Brown EF/A scales are based on Dr. Brown's six cluster model of executive functions that has been well recognized and explained in books and articles for more than a decade.

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A collection of highly recommended articles from scientific research journals and respected sources for up-to-date information about topics in ADHD Top of Page ADHD Overview Executive Functions Comorbidities Assessments Medication Magazine Articles & Peer Reviewed Journals ADHD Overview Read More Read More Executive Functions Comorbidities Read More Assessments Read More Medications Read More ADHD Overview ADHD Overview The Marshmallow Test, "Willpower" and ADHD The most puzzling feature of ADHD is that it is situationally specific. Virtually all children and adults with ADHD have at least a few specific activities in which they are able to focus their attention very well for long periods of time, are able to keep several different things in mind simultaneously, are able to sustain their efforts for challenging tasks, and can prevent themselves from acting too impulsively—all this even though they have great difficulty in demonstrating those same skills for many other tasks that they recognize as important. Growing Up With ADHD: Clinical Care Issues “Growing Up With ADHD: Clinical Care Issues,” was published in the January 2016 issue of Psychiatric Times, a publication distributed to all psychiatrists in the U.S. It describes why young adults with ADHD often do not get the help they need when they are no longer being cared for by their pediatrician. It includes some suggestions for how they can be provided more adequate care. 10 Myths about ADHD This article, reprinted with permission from ATTENTION magazine (June, 2013 issue), is comprised of excerpts from the first chapter of Dr. Brown’s book, A New Understanding of ADHD in Children and Adults: Executive Function Impairments (Routledge, 2013). ADHD: From Stereotype to Science This article describes an updated understanding of ADHD. Published in Educational Leadership, a national magazine for teachers and school administrator, it describes how ADHD is not primarily a problem of behavior, but more a problem with the management system of the brain. The article explains how ADHD involves working memory problems which impact reading and writing. Parents may want to share this with teachers and read it for themselves. 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 The World Federation of ADHD Guide This 124 page ebook sponsored by the World Federation of ADHD was written by leading ADHD experts around the world. It provides accurate information about the causes of ADHD, assessment of ADHD over the lifespan, as well as medications and psychosocial treatments for children, teens, and adults with ADHD. Chapter 4 was contributed by Dr. Thomas E. Brown and Dr. Ryan J. Kennedy regarding Psychooscial Treatments for ADHD. 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. The Myths & Facts about ADD/ADHD 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. Executive Functions Executive Functions 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. 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 AD/HD Early Adulthood Challenges 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 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. Comparison of Two Measures of Working Memory Impairments in 220 Adolescents and Adults with ADHD Working memory is one of the most significant impairments of ADHD in adolescents and adults. This study demonstrated that a brief standardized story memory test is a more sensitive and relevant measure of working memory than is the digit span test often used for assessment of working memory in those with ADHD. Despite high IQ, most participants with ADHD scored significantly lower on the story memory test than do others in the general population. Ryan J. Kennedy, D. M. Quinlan, and T.E. Brown. Journal of Attention Disorders (2016) Executive Function Impairments in High IQ Children and Adolescents 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. 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. 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. 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. Comorbidities Comorbidities 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. Assessment and Management of Sleep Problems in Youths With Attention-Deficit/Hyperactivity Disorder A research work-group report. 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. Unrecognized Attention-Deficit/Hyperactivity Disorder in Adults Presenting with Other Psychiatric Disorders+ Many adults with a diagnosed psychiatric disorder also have attention-deficit/hyperactivity disorder (ADHD). In many cases, comorbid ADHD is unrecognized and/or undertreated. Differential diagnosis of adult ADHD can be challenging because ADHD symptoms may overlap with other psychiatric disorders and patients may lack insight into their ADHD-related symptoms. Current ADHD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision may prevent appropriate diagnosis of many patients with significant ADHD symptoms. Adults may not be able to provide a history of onset of symptoms during childhood, and it may be difficult to confirm that ADHD symptoms are not better accounted for by other comorbid psychiatric conditions. Comorbid ADHD is most prevalent among patients with mood, anxiety, substance use, and impulse-control disorders. ADHD can negatively affect outcomes of other comorbid psychiatric disorders, and ADHD symptoms may compromise compliance with treatment regimens. Furthermore, unrecognized ADHD symptoms may be mistaken for poor treatment response in these comorbid disorders. In these individuals, ADHD pharmacotherapy seems to be as effective in reducing core ADHD symptoms, as it is in patients who have no comorbidity. Limited evidence further suggests that ADHD therapy may help to improve symptoms of certain psychiatric comorbidities, such as depression. Therefore, management of ADHD may help to stabilize daily functioning and facilitate a fuller recovery. CNS Spectr CNS Spectr. 2008;13(11):977-984 . 2008;13(11):977-984 By Russell A. Barkley, PhD, and Thomas E. Brown, PhD 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 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. Assessments Assessments 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. 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. 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. Medication Medication 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. Clinical utility of ADHD symptom thresholds to assess normalization of executive function with lisdexamfetamine dimesylate treatment in adults This analysis assessed the relationship of various cutoff scores of the ADHD Rating Scale IV (ADHD-RS-IV) to levels of improvement in ADHD-related executive function (EF), measured by the Brown ADD Scale for Adults (BADDS), which may provide a measure of clinically meaningful EF improvement after ADHD treatment. Impact of atomoxetine on subjective attention and memory difficulties in perimenopausal and postmenopausal women Perimenopausal and postmenopausal women frequently report midlife onset of impairments of attention, organization, and short-term memory. We sought to determine whether these cognitive symptoms in healthy women in the menopause transition without a history of ADHD would respond to treatment with atomoxetine(ATX), a medication demonstrated to be effective in reducing similar cognitive impairments in adults with ADHD. New onset executive function difficulties at menopause: a possible role for lisdexamphetamine Reports of cognitive decline, particularly in the domains of executive functions (EFs), are common among menopausal women. This study aims to detertime the impact of the psychostimulant lisdexamfetamine (LDX) on subjective and objective cognitive function among menopausal women who report new-onset EF complaints. Open-label administration of lisdexamfetamine dimesylate improves executive function impairments and symptoms of attention-deficit/hyperactivity disorder in adults. Executive function (EF) impairment in attention-defi cit/hyperactivity disorder (ADHD) may account for behavioral symptoms such as poor concentration, impaired working memory, problems in shifting among tasks, and prioritizing and planning complex sets of tasks or completing long-term projects at work or school. Poor self-regulation and control of emotional behaviors frequently are seen in patients with ADHD. This study assessed EF behaviors in adults with ADHD at baseline and after 4 weeks of treatment with lisdexamfetamine dimesylate (LDX). By Thomas E. Brown, Matthew Brams, Joseph Gao, Maria Gasior & Ann Childress Lisdexamfetamine Effects on Executive Activation and Neurochemistry in Menopausal Women with Executive Function Difficulties During the menopause transition, many women with no history of executive functioning deficits report cognitive difficulties in domains including working memory, organization,focus, and attention (Epperson et al, 2011). This midlife onset of executive difficulties may be a result of reduced estradiol modulation of the executive system (Shanmugan and Epperson, 2014). Lisdexamfetamine (LDX) has been suggested to be a safe and effective treatment option for these women. However, the mechanism by which LDX improves executive functioning in these women is not known. Here we investigated the effects of LDX on brain activation and neurochemistry, hypothesizing that LDX would be associated with increased activation and decreased glutamate in executive regions.

Biographical Summary of Dr. Thomas E. Brown About Thomas E. Brown, PhD Thomas E. Brown, PhD is a clinical psychologist who received his Ph.D. from Yale University. He specializes in assessment & treatment of high-IQ children, adolescents & adults with ADHD & related problems. For over 30 years, Dr. Brown maintained an independent clinical practice in Hamden, CT. He also served as Associate Director of the Yale Clinic for Attention & Related Disorders from its inception, until 2017, when he re-located to California and opened the Brown Clinic for Attention and Related Disorders . After serving on the clinical faculty of the Yale Medical School for 20 years, Dr. Brown resigned to accept an appointment as Adjunct Clinical Associate Professor of Psychiatry and Behavioral Sciences at the Keck School of Medicine of the University of Southern California. He has resigned from this position and currently is Clinical Professor of Psychiatry & Neuroscience, at the University of California, Riverside School of Medicine In response to invitations, Dr. Brown has given lectures, workshops or grand rounds at hospitals, medical schools, colleges and universities, independent schools, public school systems, and at advocacy, business and professional groups throughout the United States. He has also presented workshops at international meetings of professionals in over 40 countries. Dr. Brown’s research interests and publications include assessment and treatment of ADD/ADHD, especially in persons with high IQ; executive function and memory impairments in ADD; overlap of ADD and learning disorders, use of combined medications for ADD comorbidities, and problems of sleep and awakening in ADD. For his research and teaching about ADHD Dr. Brown received an award of honor by the National Attention Deficit Disorder Association and a Distinguished Professional award from the HELP Group in Los Angeles. He has been inducted into the CHADD Hall of Fame for outstanding contributions to research and professional education about ADHD in children and adults. He has also been elected a Fellow of the American Psychological Association. He has published more than 30 scientific articles in professional journals and is author of the Brown Executive Function/Attention Rating Scales (formerly: The Brown Attention Deficit Disorder Scales) published by The Psychological Corporation/Pearson. He is the author of 6 books and the editor for ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults , a major text and reference work published by American Psychiatric Publishing. Anchor 1 Publications Books by TEB ADHD and Asperger Syndrome in Smart Kids and Adults: 12 Stories of Struggle, Support and Treatment. ADHD and Asperger Syndrome in Smart Kids and Adults offers detailed examples of 12 individuals who have above-average cognitive intelligence, but struggle with executive function impairments of ADHD and significant social-emotional impairments of Asperger syndrome. Case examples are followed by updated, science-based descriptions of these disorders. Read More Outside the Box: Rethinking ADHD in Children & Adults - A Practical Guide Identifies assumptions about ADD/ADHD that demand reevaluation in light of recent research. Building upon a current, science-based foundation, the book describes in practical terms how ADHD can be recognized at various ages; how it differs from more typical brain development; how it can significantly impair those affected; and how it can safely, and in most cases effectively, be treated in children and adults. Read More Smart but Stuck: Emotions in Teens & Adults with ADHD Explains how and why many with ADHD get stuck in their schooling, employment and relationships due to emotional problems they did not know they have. It describes how emotions –positive and negative, often unconsciously–play a critical role in prioritizing tasks, sustaining or shifting interest and effort, holding thoughts in working memory, and choosing to engage in or avoid tasks and situations. True stories of teens and adults illustrate how those with ADHD can get “unstuck” from emotional problems that are holding them back (Jossey-Bass/Wiley, 2014) Read More Attention Deficit Disorder: The Unfocused Mind in Children and Adults Introduces and describes the six clusters of Brown’s model of ADHD as impaired executive functions and illustrates these with many examples of how these difficulties appear in daily life during childhood, adolescence and adulthood. It explains how the brain works in managing executive functions and how these change during development. It also explains how ADD/ADHD differs from normal inattention, other disorders that often accompany ADHD, and what treatments are effective. (Yale University Press, 2005). Also available in Chinese, Dutch, Japanese, Portuguese, Turkish and Spanish. Read More Brown Executive Function/ Attention Rating Scales (BEFARS) 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. (Pearson, 2019) Read More A New Understanding of ADHD in Children and Adults: Executive Function Impairments Offers and explains a new working definition of ADHD. It also describes 35 myths about ADHD and why they are wrong. Chapters explain recent research that supports the new model of ADHD, implications of that research for assessment and effective treatment, and why so many of those with ADHD also suffer from other disorders of learning, emotion or behavior (Routledge, 2013). Read More ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults An edited textbook in which Dr. Brown and 33 expert contributors offer describe how ADHD is different when accompanied by various co-occurring disorder. (American Psychiatric Publishing, 2009). Read More