Attention Deficit Disorder: The Unfocused Mind in Children and Adults

by Thomas E Brown, Ph.D.
Yale University Press © 2005
$27.50 384 pp

For years Thomas E. Brown, Ph.D. has been paying attention to the stories of patients with AD/HD. As associate director of the Yale Clinic for Attention and Related Disorders and assistant clinical professor of psychiatry at Yale University School of Medicine, he also knows the science behind the diagnosis. The result is a new book, Attention Deficit Disorder: The Unfocused Mind in Children and Adults. Like Dr. Brown’s very popular talks at annual ADDA conferences, it presents the stories he’s collected during his clinical experience and pairs them with recent research to draw a clear picture of ADHD.

Dr. Brown’s model of ADD groups significant chronic difficulties which tend to show up together and improve together into six clusters of symptoms which he calls the ADD Syndrome: “a complex disorder that involves impairment in focus, organization, motivation, emotional modulation, memory and other functions of the brain’s management system.”

These executive function impairments are often described as being like a slightly off maestro lacking control of an orchestra. He has trouble managing the starting and stopping of thoughts and actions; his memory and focus are disorganized and undependable.

Executive functions impaired in the ADD syndrome are not simply skills to be learned. ADD Syndrome is not about a lack of will power. Trying harder will not fix it. And medication is not magic — Pills can’t teach skills.

As for any disorder, the most important thing in successful treatment of ADD is education about what it is, what it does, and how it affects the person and his family. The education in this book is clear and comprehensive in its offering. Brown’s references to the problem of emotional modulation for people with ADD is not reflected in the DSM-IV* but it makes sense in my limited experience. I also found some interesting explanations for other problems that I didn’t know were related to ADHD. For example, I learned that while I may understand all the words my children use to describe their day, my ability to repeat them – word for word — it is out of scale with my understanding of the story. An obscure fact? Perhaps. But I believe knowing that’s common for people with ADD will help me appreciate why a verbal grocery list is less effective than a written one.

The book is heavily cited for clinicians but never in a way that made me feel inferior. In addition, the book includes the clearest explanation I have ever seen of how the brain uses its special proteins to move thoughts around and how different medications affect that process. I particularly appreciate Dr. Brown’s gentle humor and compassion in the construction of metaphors to explain complicated concepts and then his further explanation about why they are not quite the full story. He’d regularly speaks at ADDA conferences. If you have the opportunity, do not miss him!@

ADD is, if anything, a collection of symptoms – widely varied in those diagnosed with it. For clinicians, this book has the studies to back the premise that ADD Syndrome includes a more complex collection of markers. For parents or adults with ADD, this book lays out the intricacies of the bits and pieces of behaviors that have just not made sense before.

* For a refresher on what the DSM-IV says about ADHD, check out the very useful website of David Rabiner, Ph.D. Associate Research Professor, Duke University