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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 ​

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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. Activación : 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. Foco : 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. Esfuerzo : 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. Emoción : 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. Memoria : 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. Acción : 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. 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

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

O ffi ce Po lic ies Appointments Payment & Fees Superbills Appointments & Fees Appointments can be scheduled online using our website, email or by call during normal business hours: ​ ​ Business Hours: We are open Mon-Fri , 9am to 5pm PST. Closed on weekends and most Federal Holidays. ​ ​​ Cancellations ​ If necessary, please contact our office to cancel or reschedule your appointment if less than 24 hours prior to the scheduled time. ​ ​ Charges may apply for no-show/no-call, late cancellations within 1-2 business day's notice. ​ Late cancellation fees are no greater than the fee of your scheduled visit & is not reimbursable by insurance. Frequently cancelled or missed appointments are subject to dismissal from the Brown Clinic. ​ ​ Payment for Services ** We do not accept insurance. ** ​ Payment in full is due on the day service is rendered, unless other written arrangements are made in advance and agreed upon. ​ ​ To secure appointments, all patients must provide a form of payment information which is stored & protected electronically on our secure gateway system Authorize.net ​ ​ We are able to process payments using the following credit or debit cards, including HSA and FSA cards. ​ ​ ​ Our office is trained to follow HIPAA protocol & is compliant with all patient data- financial, medical and personal health information. ​ Contact us for forms needed to release medical records to/from other professionals from our office. SUPERBILLS We are considered “out-of-network” & our providers do not take any commercial insurance, Medicare or Medicaid plans. If you plan to submit your own SUPERBILL form to your insurance provider for reimbursement, 1st contact your insurance provider prior to your appointments to understand the details of your mental health benefits. ​ If you are eligible to use your out-of-network benefits, we can provide the form or what is commonly referred to as a SUPERBILL as noted above that you may be able to use to submit a claim with your insurance. These plans vary widely and may reimburse patients; the total cost of each of our sessions depends on your individual plan & deductibles. ​ SEE SUPERBILL INFORMATION BELOW Commonly Used CPT Codes & Descriptions for Out-of-Network Providers & Services ​ Contact us to inquire about fees for specific codes The total charge for appointments varies according to your individual provider, time, complexity, appointment types & fee (rate per hour ) Group Practice NPI (Type 2) # 1700394970 EIN # 824910459 Location Code : "2" (Tele-health) or "11" (in-office) 90792 initial psychiatric and diagnostic evaluation @ 3 hours 99205, 99354, or 99355 (New Patient Office Visit = 1 hr + (1 hr) + (1/2 hr. x 2) 90834, 90837 (45 - 60 minutes of individual psychotherapy) 90846 ​ 45-60 minutes of family therapy... without patient present Anchor 1

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.

Testing for Academic Accommodations (PDF) Report Policy & Fees An optional service that we offer to patients after the evaluation is an assessment of their cognitive abilities, such as the gold-standard IQ tests (WAIS & WISC). ​ Psycho-educational testing is not usually required for the standard ADHD accommodations in schools, however such testing is often a prerequisite before determining eligibility for specific learning disorder accommodations, for an I.E.P. and for many national or professional board certification exams & other standardized exams like the SAT. ​ Generally, accommodations can be used for all grade levels in schools, colleges or universities, as well as professional board exams, standardized testing, and workplace. ​ ​ After the completion of each testing session, your doctor will review your results and can provide a letter to request support for accommodations or recommendations based on the findings. You will receive a copy of your test results to take home. ​ Comprehensive Reports (PDF) Report Policy & Fees If you are required to provide a more analytical analysis and written report, this can be provided as an additional service with applicable fees based on time. Written reports of consultations and/or psychological testing can be prepared by to individually fit the needs of each patient. Accommodation can apply to all grade levels in school, universities, and for SAT, ACT, GRE, MCAT, LSAT, GMAT, or professional credentialing tests are usually required to submit narrative reports according to specifications of the established guidelines.