The ADHD-Executive Function Connection

Transcription

1 ADHD Webinar The ADHD-Executive Function Connection (Type your questions in the box to the. right) ADDitude Magazine ADHD Expert Webinars -

2 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. ADDitude Magazine ADHD Expert Webinars -

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

4 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

5 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

6 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

7 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.

8 What Requires Executive Functions? Tasks that involve managing oneself To prioritize, start, sustain, shift, stop, and integrate cognitive functions Using memory without momentby-moment guidance from others Brown TE. In press.

9 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.

10 1. Organize, Prioritize, and Activate Difficulty organizing tasks, materials Difficulty estimating time, prioritizing tasks Trouble getting started on work.

11 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)

12 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.

13 . 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

14 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

15 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!

16 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.

17 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)

18 Books by Thomas E. Brown, Ph.D. ( 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

19 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. ADDitude Magazine ADHD Awareness Expert Webinars

20 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 for announcements for upcoming webcasts.

21 Thank You! If you missed any part of today s webcast, a recording is available for playback at To continue the conversation, we invite you to join us at ADDConnect ADDitude s online community for attention deficit support and solutions where you can join our ongoing ADHD discussion groups. ADDitude Magazine ADHD Awareness Expert Webinars