Smart, but Stuck: Emotions in Teens & Adults with ADHD
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1 Smart, but Stuck: Emotions in Teens & Adults with ADHD Thomas E. Brown, PhD Associate Director, Yale Clinic for Attention and Related Disorders Department of Psychiatry Yale Medical School
2 Consultant: Thomas E. Brown, Ph.D. Disclosure Statement Eli Lilly,Shire Speaker: Eli Lilly, Shire Publication royalties: PsychCorp/Pearson, Yale University Press, American Psychiatric Press, Routledge, Wiley Research Support: Eli Lilly, Shire TEBrown, Yale Medical
3 Overview For Those with ADHD: 1. What emotions motivate avoidance of important tasks? 2. Why do emotions often disrupt social interactions? 3. How do family dynamics impact emotions? 4. How can teens/adults get unstuck? TEBrown, Yale Medical School, 2013
4 Old & New Understandings of ADHD? Old: behavior problems & not listening New: developmental impairment of 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 and 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 Brown s Model of Executive Functions Impaired in ADHD Symptom Characteristics Dimensional, not all-or-nothing Everyone sometimes has some impairments in these functions; in ADHD, it is a chronic, severe impairment Situational variability: If I m interested Most persons with ADHD have a few activities where ADHD impairments are absent ADHD looks like a willpower problem, but it isn t! TE Brown, Yale Medical School, 2013
8 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 Activation Focus Effort Emotion Memory Action Brown TE. Manual for Attention Deficit Disorder Scales for Children and Adolescents; 2001.
9 A Working Definition of ADHD (TEBrown, 2013) 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-specific, chronic, and significantly interfere with functioning in many aspects of daily life.
10 Executive Functions are complex and operate in dynamic, integrated ways For example, EF of focus Does not mean as in holding the camera still to take a photo of an unmoving object Does mean as in focusing on the task of driving a car TEBrown, Yale Medical School, 2013
11 Assessment for ADHD should consider possible problems with emotion DSM diagnostic criteria for ADHD do not include any symptoms of problems in regulating emotions But, researchers and clinicians report chronic problems in emotional regulation are characteristic of many with ADHD Regulating emotion is a core aspect of ADHD! TE Brown, Yale Medical School, 2013
12 Brown ADD Scale-Cluster 4 Managing Frustration and Modulating Emotions TE Brown, Yale Medical School, 2013 Emotion takes over too much of thinking or feeling Like a computer virus in the mind. Can t push emotion to back of mind and get on with what needs to be done. -frustration -anger -hurt feelings ---worry -wanting -discouragement ---sadness
13 Problems with Emotions in ADHD not only with brakes: controlling negative emotions, e.g. anger, frustration also with ignition: activating positive emotions, e.g. interest, motivation TE Brown, Yale Medical School, 2013
14 Eric 20 year-old university student I m in a great university where I want to do well, but I just can t get myself motivated to do the work. I did really well in high school; now my grades have tanked. I ve been spending too much time hanging out with my girlfriend and smoking weed. I ve tried some ADHD meds, but they make me too jittery. TEBrown, Yale Medical School, 2013
15 Eric Loss of structure Does she really want me? Weed: abstinence vs harmreduction Immediate vs Delayed Rewards
16 Lisa 16 year-old high school student Other kids don t seem to get my jokes and aren t interested in what I am. I try to make friends, but no one ever calls me back when I call them. I try to talk with my parents about it, but my dad doesn t understand kids and my mom is always yelling at me. ADHD meds help me do schoolwork, but they don t help with social stuff. TEBrown, Yale Medical School, 2013
17 Lisa Triangles and Polarization Rebound Learning social cues New context Cutting and rejection
18 Mike 21 year-old university student My Dad always said I m smart, but just lazy; maybe he s right. I got put on academic probation, now I have to drop out. I m always spacing out and can t get started on anything until the last minute. I tried my friend s ADHD med; it helped a lot, but my dad doesn t want me evaluated for ADHD; he says meds are like steroids. TEBrown, Yale Medical School, 2013
19 Mike Social anxiety Family skepticism Possible Selves Hidden concerns Sexuality Unacknowledged burdens
20 Sarah 50 year-old homemaker & mother I ve been married 25 years, have 3 great kids, and had a decent career as a journalist, but I just got fired because I couldn t prioritize and keep up with my work. Since menopause I ve had trouble keeping track of things and getting work done. It s been getting worse. I m scared I may be getting Alzheimers. TEBrown, Yale Medical School, 2013
21 Sarah Empty nest & re-entry Fears of dementia Estrogen and executive functions Demoralization Medications
22 Sue 14 year-old high school student Until I got into middle school I always got good grades and never got into trouble. Now everybody thinks I m hopeless because I dress Goth and don t do much homework. My parents and teachers look down on me just because of the friends I hang out with. They don t really know me or my friends! TEBrown, Yale Medical School, 2013
23 Sue Reciprocal confrontations Documenting abilities Validating for accommodations Frustrations, hope and reassurance Risks of micro-managing
24 James 20 year-old college student If I don t finish four papers this month, I m going to be put on probation at school. I just can t get myself to finish. I ve had this problem a long time, now it s worse than ever. I ve done the research for most of my papers, but I can t get past the 1 st paragraph in any one of them. I m stuck! TEBrown, Yale Medical School, 2013
25 James Reassurance and denial Writing papers and EF Immobilization by perfectionism Functions of Internet gaming addiction Becoming a licensed driver
26 Books by Thomas E. Brown, Ph.D
27 Smart but Stuck: Emotions in Teens & Adults with ADHD by Thomas E. Brown New book to be released March,2014 Jossey-Bass/Wiley
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