Vol. 12, No. 3, 2006 Page 5
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.
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.