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ATTENTION DEFICIT DISORDER: THE UNFOCUSED MIND IN CHILDREN AND ADULTS
by THOMAS E. BROWN, Ph.D.
Yale University Press
September 2005
Parents and professionals dealing with children or adults
with attention deficit disorder (ADD) will find valuable
information in this book that is not readily available in books
pertaining to learning and behavioral disorders.
Explaining that "the core problem in ADHD is not lack
of willpower, but chronic, often lifelong impairment of the
'executive' or management functions of the brain," Brown
describes how this impairment can make the responsibilities
of adult life-holding down a job, raising a family, handling
finances, and developing relationships-a constant struggle.
He also discusses the variety of behavioral, learning, and
psychiatric disorders that overlap with ADD, including
conduct disorder, oppositional defiant disorder, bipolar
disorder, and Asperger syndrome.
Brown offers an extensive dissertation on the six areas of
functioning-activation, focus, effort, emotion, memory, and
action-affected by impairments in executive function
(which he defines as brain circuits that prioritize, integrate,
and regulate other cognitive functions). In addition, he
provides a highly informed discussion of ADD treatment
options at different ages, although the important role of
nutrition and toxins receives little attention.
Overall, this work by Brown-who is an assistant clinical
professor of psychiatry at Yale University School of
Medicine, and Associate Director of the Yale Clinic for
Attention and Related Disorders-is an excellent resource
for parents and professionals interested in the neurological
roots of ADD. Dr. Brown's website, at
www.drthomasebrown.com, contains additional articles and
information.
QUOTES FROM ATTENTION DEFICIT DISORDER:
THE UNFOCUSED MIND, by THOMAS E. BROWN, Ph.D.
(A)DD syndrome is essentially a chemical problem,
specifically an impairment in the chemical system that
supports rapid and efficient communication in the brain's
management system.
Even today many educators and clinicians do not realize
that those executive functions crucial to effective
performance as a student can be severely impaired even in
individuals who are very bright and talented. In many
schools and families, bright but disorganized and poorly
performing students with ADHD are still seen as stubbornly
lazy, unmotivated, or defiant. Well-intentioned but
uninformed teachers and parents often punish these bright,
extremely inconsistent students for what appears to be a lack
of motivation or a refusal to do what they need to do.
(T)here are many parents of children with ADD
syndrome, some of whom have successfully raised other
children, who have worked very hard with multiple strategies
to elicit cooperation from their child, only to find that even
carefully executed advice from experts fails to help.
(F)or many adolescents there is not a good fit between
their developing capacities and the demands of their
environment. Their ability to negotiate the increasingly
complex demands of adolescence is inconsistent and
sometimes wildly erratic. For most adolescents who suffer
from ADD syndrome, this process of major transitions is
even more difficult: for some, it is overwhelming.
Many mental health workers assume that interpersonal
problems are always caused by unrecognized emotional
conflicts. For some individuals, however, interpersonal
difficulties are more fundamentally rooted in an inability
clearly to say what one is thinking or to understand correctly
what others are trying to say.
(E)xecutive functions are basic and essential to the
integrated operation of many diverse activities of the mind;
consequently, individuals with weaknesses in the
development of their executive functions are likely to be
more vulnerable to many other types of psychiatric
impairments, just as anyone with weak bones is more
vulnerable to fractures and one with a weak immune system
is more vulnerable to a wide variety of infections.
A substantial body of research has demonstrated that
genetic factors play a very large role in the etiology of
ADHD. Steven Faraone and colleagues (1998) and
Rosemary Tannock (1998) have summarized findings of
multiple twin and adoption studies that indicate high
heritability rates for ADHD and components of ADHD: from
.75 to .98, with an average of about .80.
Their capacity to tolerate frustration and change their
behavior may not be sufficiently developed, and unlike most
other children, they seem unable to respond to anticipated
rewards or even to harsh punishments.
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