ADHD Webinar

The ADHD-Executive Function Connection (Type your questions in the box to the. right) ADDitude Magazine ADHD Expert Webinars www.additudemag.com/webinars

Thomas E. Brown, Ph.D. Dr. Brown is an assistant clinical professor of psychiatry at the Yale University School of Medicine, and associate director of the Yale Clinic for Attention and Related Disorders. He is author of the book Smart but Stuck: Emotions in Teens and Adults with ADHD.

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The ADHD-Executive Function Connection Thomas E. Brown, PhD Associate Director, Yale Clinic for Attention and Related Disorders Department of Psychiatry Yale Medical School

What is essential problem in ADHD?  Old: behavior problems & not listening  New: developmental impairment of the

brain’s management system: EF

 Aspects of brain’s EF don’t come online

in usual time frame.  And don’t work consistently TE Brown, Yale Medical School, 2013

Executive Functions  Wide range of central control processes

of the brain  Connect, prioritize, and integrate

cognitive functions–moment by moment  Like conductor of a symphony orchestra

TE Brown, Yale Medical School, 2013

“Will you do it and, if so, how &when?” (Lezak, 2004)

Will you do it?

Motivation/Activation

How will you do it? Planning/Organizing When?

Timing/Remembering

TE Brown, Yale Medical School, 2013

“Focus” and Executive Function Impairments of ADHD  “inattention” symptoms of ADHD • Do not mean • Unable to focus as in holding the camera still to take a photo of an unmoving object

• Do mean • Unable to focus as in focusing on the task of driving a car

Brown TE. 2005, 2013, 2014.

What Requires Executive Functions?  Tasks that involve managing

oneself  To prioritize, start, sustain, shift,

stop, and integrate cognitive functions  Using memory without moment-

by-moment guidance from others Brown TE. In press.

Brown’s Model of Executive Functions Impaired in ADHD Executive Functions

Organizing, prioritizing, and activating to work

Focusing, sustaining focus, and shifting focus to tasks

Regulating alertness, sustaining effort, and processing speed

Managing frustration and modulating emotions

Utilizing working memory and accessing recall

Monitoring and selfregulating action

1. Activation

2. Focus

3.Effort

4. Emotion

5.Memory

6.Action

Brown TE. Manual for Attention Deficit Disorder Scales for Children and Adolescents; 2001.

1. Organize, Prioritize, and Activate  Difficulty organizing tasks,

materials  Difficulty estimating time,

prioritizing tasks  Trouble getting started on work .

2. Focus, Shift, and Sustain Attention  Loses focus when trying to listen

or plan  Easily distracted–internal/external  Forgets what was read, needs to re-read (if not self-selected)

3. Regulating Alertness, Effort, and Processing Speed  Difficulty regulating sleep and

alertness  Quickly loses interest in task, especially longer projects; doesn’t sustain effort  Difficult to complete task on time, especially in writing–“slow modem” .

4. Manage Frustration, Modulate Emotion (Not included in DSM-IV criteria)  Emotions impact thoughts, actions too much  Frustration, irritations, hurts, desires, worries, etc., experienced “like computer virus”  “Can’t put it to the back of my mind” .

6. Monitor and Self-Regulate Action (Not just hyperactive behavior)  Difficulty controlling actions, slowing

self and/or speeding up as needed for tasks  Impulsive, acts without thinking of likely consequences  Hard to monitor and modify own actions to fit situation/aims

Executive Functions: Development and Demands  EF capacity develops through

childhood, into adolescence, and beyond; it is not fully present in early childhood  Environmental demands for EF

increase with age, from preschool through adulthood  EF impairments often are not

noticeable by age 12!

2 Conflicting Views of ADHD & EF 1. EF is measured by “tests of EF” in psychologist’s office. 30% of those with ADHD impaired on those tests 2. EF can’t be measured by “tests of

EF”. Should be measured with normed rating scales & interviews about daily life requiring EF. 100% of those with ADHD are impaired on these measures.

What is ADHD? (A Controversial Viewpoint)

ADHD = Developmental Impairment of Executive Functions

Developmental Impairment = Not developing as expected for age Brown, T.E. (2013) A New Understanding of ADHD; (2006) Executive Functions & ADHD: Two Conflicting Views (on website)

Books by Thomas E. Brown, Ph.D. (www.DrThomasEBrown.com)

•

“Smart but Stuck: Emotions in Teens and Adults with ADHD ” – 2014

•

“A New Understanding of ADHD in Children and Adults: Executive Function Impairments” – 2013

•

“ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults” – 2009

•

“Attention Deficit Disorder: The Unfocused Mind in Children and Adults” - 2005

Questions? Please enter questions in the box to your right. Please note: Attendance and all questions are confidential. None of the attendees of today’s webinar can see the names of other attendees nor can they see the questions being submitted. Only the moderator of the webinar will see your questions. ADDitude does not provide medical advice, diagnosis, or treatment. The material in this webinar is provided for educational purposes only.

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ADHD Webcast Series Upcoming Webinars • February 18- How Mindset Impacts Learning with Cindy Goldrich, a board-certified ADHD coach. • February 25- Just Diagnosed: A Step-by-Step Guide to Adult ADHD Diagnosis and Treatment with Dr. Edward M. Hallowell • March 10- A Parent’s Guide to Executive Function Skills: Strategies for Tweens and Teens with Sarah Ward, M.S., CCC/SLP and Kristen Jacobsen, M.S., CCC/SLP • Visit http://www.additudemag.com/webinars for announcements for upcoming webcasts.

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