A New Understanding of ADHD in Children and Adults: Executive Function Impairments

A New Understanding of ADHD in Children and Adults: Executive Function Impairments

by Thomas E. Brown, PhD. Routledge/Taylor & Francis, New York, NY, 2013, 192 pages, $44.95 (paper), $140.00 (hardcover).

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders, affecting between 3% and 7% of school-age children and about 4% of adults. Descriptions of the disorder that we now refer to as ADHD date back over 100 years and have focused primarily on the behavioral manifestations of the disorder. Over time, our understanding of ADHD has evolved to include problems with attention as a central feature of the disorder, in addition to hyperactivity and impulsivity. More recently, Brown and others have focused on the role of executive function impairments in ADHD. In A New Understanding of ADHD in Children and Adults, Brown integrates the work of multiple researchers and clinicians over the past 15 years into a new model of the disorder emphasizing the developmental impairment of executive function.

The book contains 6 chapters, and Brown captures the reader’s interest in the beginning by debunking multiple myths about ADHD using current scientific research findings. In the second chapter, Brown proposes a new working definition of ADHD, highlighting the developmental nature of the disorder and an expanded model of executive functions. He compares and contrasts his paradigm with the old definition of ADHD, and with more contemporary models such as that proposed by Russell Barkley.

Brown then adopts a lifespan perspective, summarizing research findings to describe the manifestations of impaired brain development, executive functioning, and self-management from early childhood through adulthood. The book goes on to delve into the challenges of diagnosing ADHD in children and adults utilizing the new model, critically examining various rating scales of executive function, appropriateness of neuropsychological tests, sensitivity of the clinical interview, and the limited usefulness of "objective" measures.

Next, Brown reviews the research on the treatment of ADHD, including the impact of approved medications and psychosocial treatments on brain function. Finally, an overview of the significant psychiatric comorbidities associated with ADHD is provided. Brown concludes that ADHD and the associated executive function impairment do not simply co-occur with other diagnoses such as learning disorders, mood disorders, oppositional defiant disorder, and conduct disorder, but rather that ADHD-associated executive function impairments underlie all these disorders, much in the way that a defect in the operating system of a computer will impact a wide range of software programs (pp 163-164).

For a paperback volume of less than 200 pages, this book is densely packed with current research on ADHD and executive function. Brown utilizes these recent findings to support an expanded view of ADHD that applies to patients of all ages, making this book a useful resource for adult and child psychiatrists, as well as neurologists, primary care physicians, clinicians, educators, parents, and patients.

Rebecca Klisz-Hulbert, MD

[email protected]

Author affiliation: Wayne State University School of Medicine, Detroit, Michigan.

Potential conflicts of interest: None reported.

J Clin Psychiatry 2014;75(11):e1332 (doi:10.4088/JCP.14bk09249).

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