Dr. Brown’s New Book

by barbaraluther on June 13, 2013

Dr. Thomas E. Brown has a new book out, A New Understanding of ADHD in Children and Adults: Executive Function Impairments. I was eagerly awaiting this book, and I’m happy it’s now out. But I should caution that while it’s not a long book, it is dense and not really for a lay audience.

I was very excited that Dr. Brown started this book with “35 Myths About ADHD and Why They Are Wrong.” His answers are very clear and succinct. If you are someone who deals with an uneducated public (and who among us doesn’t?), then this chapter is fantastic by itself.

Dr. Brown uses the metaphor of ADHD being like a problem with the operating system of a computer — it affects the entire system. He puts forth a new working definition of ADHD and explains each of the six elements of the definition in chapter 2. His definition of ADHD is:

ADHD =
* a complex syndrome of
* developmental impairments of executive functions,
* the self-management system of the brain,
* a system of mostly unconscious operations.
* These impairments are situationally variable,
* chronic, and significantly interfere with functioning in many aspects of the person’s daily life.

Dr. Brown distinguishes his new definition and model of ADHD from Dr. Barkley’s model, saying it’s quite similar to Barkley’s except for three key aspects:

1. Dr. Barkley’s model applies only to the combined type of ADHD while Brown’s model includes all types of ADHD as well as the sluggish cognitive tempo (SCT) group which Barkley breaks out from ADHD.
2. Dr. Barkley’s model emphasizes the capacity to inhibit as the most important aspect of ADHD while Dr. Brown’s model treats all six clusters of symptoms as equal.
3. Dr. Barkley’s model holds that executive functions are essentially conscious, effortful actions with less conscious functions like alertness, attention, and memory as “pre-executive”. Dr. Brown’s new model presents all executive functions as situationally variable and operating mostly in unconscious ways. He uses the word “automaticity” to refer to the “capacity of humans to initiate, execute and modify complex behaviors instantaneously, without having to deliberate consciously about what to do.” (p.34)

It seems to me that Dr. Brown’s most important distinction is the last one — that executive functions are carried on without much conscious effort or thought. He believes this aspect of executive functioning is a major reason why ADHD challenges persist, despite the strong wishes and efforts of individuals to change their problematic patterns of behavior.

His new model expands the range, complexity, and duration of ADHD, and his model applies to all ages. The model includes a wide range of self-management functions beyond those that affect readily observable behaviors. This model includes issues with modulation of emotions, motivation, sleep and alertness, and multiple aspects of working memory.

Having laid out his new model and definition, Dr. Brown then gives us a chapter on “What Research Reveals About the Causes and Unfolding Nature of ADHD.” This chapter does a fabulous job of summarizing the extensive recent research into the various aspects of ADHD.

From there, Dr. Brown moves into discussing differences the new model makes in assessment and treatments of ADHD. His final chapter discusses “Why Many Learning and Psychiatric Disorders So Often Co-Occur with ADHD.” These last three chapters are much more for the mental health professional.

When I finished the chapter on co-occurring disorders, I was anticipating that Dr. Brown would bring all these findings together and propose some ideas on working from his new model. Instead, the book just stops. I actually thought there had been a mistake in printing; I mean, there was no conclusion whatsoever! But the page numbers of the notes which followed told me that this was indeed the end of the book. After such a thorough presentation of his model and the research to support it, I was left rather frustrated and wanting more.

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