2016/2/4 A 

New Understanding of Attention Deficit Disorder (ADD/ADHD) from Thomas E. Brown

A New Understanding of Attention Deficit

Disorder (ADD/ADHD) from Thomas E. Brown

Magazine Articles & Articles from Peer-Reviewed Journals

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. Click here to download a PDF[1] of the
article.

Ten Myths About ADHD and Why They Are Wrong

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). Download a PDF of the article here[2]. 

Executive Functions: Six Aspects of a Complex Syndrome

This article, published in ATTENTION magazine, provides many examples from

everyday life to illustrate the various types of cognitive impairments typical of
children and adults with ADD/ADHD. Descriptions and explanations of these
“executive functions” are edited excerpts from the 2nd chapter of Dr. Brown’s book,
Attention Deficit Disorders: The Unfocused Mind in Children and Adults. Download a PDF
of the article by clicking here[3].

Inside the ADD Mind

http://www.drthomasebrown.com/articles/ 1/8
2016/2/4 A New Understanding of Attention Deficit Disorder (ADD/ADHD) from Thomas E. Brown

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

Reprinted with permission from the April/May issue of ADDITUDE magazine. Click
here to download a PDF of the article[4].

AD/HD and Co-Occurring Conditions

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

Download a PDF of AD/HD and Co-Occurring Conditions by clicking here.[5]

A New Approach to Attention Deficit Disorder

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

Reprinted with permission from the February, 2007 issue of Educational Leadership, a
magazine for leaders in education. Click here to download a PDF of this article[6].

Attention Deficit Disorders: The Myths, the Facts

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

http://www.drthomasebrown.com/articles/ 2/8
2016/2/4 A New Understanding of Attention Deficit Disorder (ADD/ADHD) from Thomas E. Brown

Reprinted with permission from the February, 2007 issue of Educational Leadership, a
magazine for leaders in education. Click here to download a PDF of this article.[7]

AD/HD and Challenges of Early Adulthood

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

Reprinted from the February, 2006 issue of ATTENTION! Magazine, with permission
from CHADD. Click here to download a PDF of the full article[8].

Articles from Peer-Reviewed Journals

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. Click here to download a PDF of the full article.[9]

Executive Function Impairments in High IQ Children and Adolescents with

ADHD

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,

http://www.drthomasebrown.com/articles/ 3/8
2016/2/4 A New Understanding of Attention Deficit Disorder (ADD/ADHD) from Thomas E. Brown

and Donald M. Quinlan in the Open Journal of Psychiatry. (July, 2011) .1: 56-65. Click
here to download a PDF of the full article. [10]

Executive Function Impairments in High IQ Adults with ADHD

This article reports a study of 157 adults aged 18 to 55 yrs 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. Click here to download a PDF of
the full article. [11]

ADD/ADHD and Impaired Executive Function in Clinical Practice

This article, intended for physicians or psychologists who are evaluating adults for
ADHD, describes how executive function impairments associated with ADHD can be
recognized in clinical practice. It emphasizes that diagnosis of ADHD does not require
esoteric neuropsychological tests; it describes chronic difficulties in daily life that are
characteristic of adults with ADHD. The article also notes that the DSM-IV
requirement for age of onset “before 7 years has been shown to be invalid. Practical
suggestions about initiating and monitoring medication treatment is also included.”
Thomas E. Brown in Current Attention Deficit Disorder Reports, 1: 37-41, 2009. Click
here to download a PDF of the full article[12].

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

http://www.drthomasebrown.com/articles/ 4/8
2016/2/4 A New Understanding of Attention Deficit Disorder (ADD/ADHD) from Thomas E. Brown

rests upon how executive functions are to be measured. This article describes the
differing viewpoints and argues that the “ADHD = developmental impairment of
executive functions” view is a more adequate way to understand what this disorder
really involves.

Reprinted with permission from the March, 2006 issue of the International Journal
of Disability, Development and Education. Click here to download a PDF of the full
article[13].

Circles Inside Squares: A Graphic Organizer to Focus Diagnostic Formulations

This article describes a simple graphic organizer that can be used to help focus
discussion between a clinician, patient and family about specific strengths, stresses
and problems that are identified in a clinical evaluation. It is particularly useful for
illustrating overlapping disorders and representing how much each contributes to the
patient’s current difficulties. The diagram can be used to elicit reactions from the
patient and family about how current problems should be understood and prioritized
for treatment. It can also be utilized on an ongoing basis to evaluate responses to
treatment. Thomas E. Brown, Ph.D. in Journal of the American Academy of Child and
Adolescent Psychiatry (2005) 44:1309-1312. Click here to download a PDF of the full
article[14].

Attention-Deficit/Hyperactivity Disorder Among Adolescents: A Review of the

Diagnosis, Treatment and Clinical Implications

Much of the literature about ADHD is still focused exclusively on children. At the
invitation of the American Academy of Pediatrics (AAP), a team of ten specialists in
ADHD reviewed research and standards of clinical practice to develop a summary of
current information about how ADHD can be recognized and effectively treated in
adolescents. M.L. Wolraich, C.J. Wibbelsman, T.E.Brown, S.W. Evans, E.M. Gotlieb, J.R.
Knight, E.C.Ross, H.H. Schubiner, E.H. Wender, and T.Wilens. Pediatrics (2005) 115:
1734-1746. Click here to download a PDF of the full article[15].

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

http://www.drthomasebrown.com/articles/ 5/8
2016/2/4 A New Understanding of Attention Deficit Disorder (ADD/ADHD) from Thomas E. Brown

which is presumed to impact dopaminergic and noradrenergic networks by alternative

mechanisms in different ratios. Four cases are presented to illustrate how
atomoxetine and stimulants can be utilized effectively in combination to extend
duration of symptom relief without intolerable side effects or to alleviate a wider
range of impairing symptoms than either agent alone. This combined
pharmacotherapy appears effective for some patients who do not respond adequately
to monotherapy, but because there is virtually no research to establish safety or
efficacy of such strategies, careful monitoring in needed. Thomas E. Brown, Ph.D. in
Journal of Child and Adolescent Psychopharmacology, (2004) Vol. 14: pp. 129-136. Click
here to download a PDF of full article[16].

Fluoxetine and Methylphenidate in Combination for Treatment of Attention

Deficit Disorder and Comorbid Depressive Disorder

Children and adolescents with attention deficit disorders and comorbid conditions
who had shown inadequate treatment responses to methylphenidate (MPH) alone,
were treated by addition of fluoxetine to the MPH. After 8 weeks in open trial, all 32
patients showed positive therapeutic responses in attention, behavior and affect.
Thirty of the 32 children showed clinically significant responses and the other two had
statistically, but not clinically significant responses. After 12 weeks of treatment one
patient showed deterioration in clinical status. The children had improved report card
grades in major subjects (p < .0001), and showed significant improvements (p < .0001)
on the Children’s Global Assessment Scale (C-GAS), Conners Parent Rating Scale
(CPRS) and Children’s Depression Inventory (CDI). No significant adverse effects were
observed. These preliminary results suggest that fluoxetine and methylphenidate in
combination may be safe and effective for some children with ADHD and with
comorbid anxiety or depressive symptoms who do not show adequate responses to
MPH or fluoxetine alone. G. Davis Gammon, M.D. and Thomas E. Brown, Ph.D. in
Journal of Child and Adolescent Psychopharmacology (1993) Vol. 3, pp. 1-10. Click here
to download a PDF of full article[17].

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

http://www.drthomasebrown.com/articles/ 6/8
2016/2/4 A New Understanding of Attention Deficit Disorder (ADD/ADHD) from Thomas E. Brown

William J. McMullen in Annals of the New York Academy of Sciences (2001) Vol. 931, pp.
271-286. Click here to download a PDF of full article[18].

Assessment of Short-Term Verbal Memory Impairments in Adolescents and

Adults with ADHD

One hundred seventy-six adolescents and adults diagnosed with ADHD (DSM-IV
criteria) were assessed with a measure of short-term verbal memory. The short-term
verbal memory score of each subject was compared with their verbal abilities on two
measures. Percentages of ADHD subjects with significant discrepancy between verbal
IQ and short-term verbal memory were compared with the standardization sample for
the verbal memory measure. Results: A majority of adolescents and adults diagnosed
with ADHD demonstrated significant discrepancy between performance on the short-
term verbal memory measure and verbal IQ. The percentage of ADHD subjects with a
significant discrepancy between these two measures greatly exceeded the percentage
of persons in the general population showing such a discrepancy. This brief measure
of short-term verbal memory may be a useful measure to include in a comprehensive
assessment for ADHD symptoms in adolescents and adults. Donald M. Quinlan, Ph.D.
and Thomas E. Brown, Ph.D. in Journal of Attention Disorders, (2003) Vol. 6: pp 143-
152. Click here to download a PDF of full article[19].

Links

1. http://www.drthomasebrown.com/wp-
content/uploads/2016/02/ADHD_From_Stereotype_article1.pdf
2. http://www.drthomasebrown.com/wp-
content/uploads/2013/07/BROWN_ADHD_MYTHS.pdf
3. http://www.drthomasebrown.com/pdfs/Executive_Functions_by_Thomas_Brown.pdf
4. http://www.drthomasebrown.com/wp-content/uploads/2013/05/additude.pdf

5. http://www.drthomasebrown.com/wp-
content/uploads/2013/05/Feb09_CooccurringConditions.pdf
6. http://www.drthomasebrown.com/wp-
content/uploads/2013/05/drbrown_ADD_anewapproach.pdf

7. http://www.drthomasebrown.com/wp-
content/uploads/2013/05/myths_and_facts.pdf
8. http://www.drthomasebrown.com/wp-
content/uploads/2013/05/EarlyAdulthoodChallenges1.pdf

http://www.drthomasebrown.com/articles/ 7/8