ADD/ADHD and impaired executive function in clinical practice

Abstract

The disorder currently known as attention-deficit disorder (ADD) or attention-deficit/hyperactivity disorder (ADHD) is now recognized by most clinicians as a legitimate and widely prevalent disorder among children and adults. Yet there is still widespread misunderstanding as to the disorder’s nature. Many clinicians mistakenly continue to think of this as a behavior disorder characterized by hyperactivity in children and excessive restlessness or impulsivity in adults. In fact, ADD/ADHD is essentially a cognitive disorder, a developmental impairment of executive functions (EFs), the self-management system of the brain. Although EFs are complex, their impairment constitutes a syndrome that can be recognized readily in clinical practice; impaired EF involves a pattern of chronic difficulties in executing a wide variety of daily tasks. Once recognized, this disorder can be effectively treated in most cases. In this article, I describe the nature of EF impairments in ADD/ADHD and how the syndrome can be recognized and effectively treated in clinical practice. (Note: The term ADHD is used in the balance of this article to refer to both inattentive and combined subtypes.)

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References and Recommended Reading

  1. 1.

    Brown TE: Attention Deficit Disorder: The Unfocused Mind in Children and Adults. New Haven, CT: Yale University Press; 2005.

    Google Scholar 

  2. 2.

    Brown TE: Executive functions and attention deficit hyperactivity disorder: implications of two conflicting views. Int J Disabil Dev Educ 2006, 53:35–46.

    Article  Google Scholar 

  3. 3.

    Barkley RA: Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, edn 3. New York: Guilford Press; 2006.

    Google Scholar 

  4. 4.

    Barkley RA, Murphy KR, Fischer M: ADHD in Adults: What the Science Says. New York: Guilford Press; 2008.

    Google Scholar 

  5. 5.

    Kessler RC, Adler L, Barkley R, et al.: Prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006, 163:716–723.

    PubMed  Article  Google Scholar 

  6. 6.

    Baxter MG, Murray EA: The amygdala and reward. Nat Rev Neurosci 2002, 3:563–573.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Phelps E: The interaction of emotion and cognition: the relationship between the human amygdala and cognitive awareness. In The New Unconscious. Edited by Hassin R, Uleman J, Bargh JA. New York: Oxford University Press; 2005:61–76.

    Google Scholar 

  8. 8.

    Faraone SV, Biederman J, Spencer T, et al.: Diagnosing adult attention deficit hyperactivity disorder: are late onset and subthreshold diagnoses valid? Am J Psychiatry 2006, 163:1720–1729.

    PubMed  Article  Google Scholar 

  9. 9.

    Biederman J, Petty C, Fried R, et al.: Impact of psychometrically defined deficits of executive functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry 2006, 163:1730–1738.

    PubMed  Article  Google Scholar 

  10. 10.

    Burgess PW: Theory and methodology in executive function research. In Methodology of Frontal and Executive Function. Edited by Rabbitt P. East Sussex, United Kingdom: Psychology Press Publishers; 1997:81–116.

    Google Scholar 

  11. 11.

    Rabbitt P, ed: Methodology of Frontal and Executive Function. East Sussex, United Kingdom: Psychology Press Publishers; 1997.

    Google Scholar 

  12. 12.

    Barkley RA: ADHD and the Nature of Self-Control. New York: Guilford Press; 1997.

    Google Scholar 

  13. 13.

    Brown TE, ed: Attention Deficit Disorders and Comorbidities in Children, Adolescents and Adults. Washington, DC: American Psychiatric Press; 2000.

    Google Scholar 

  14. 14.

    Biederman J, Petty CR, Fried R, et al.: Can self-reported behavior scales assess executive function deficits? A controlled study of adults with ADHD. J Nerv Ment Disord 2007, 195:240–246.

    Article  Google Scholar 

  15. 15.

    Sandra Kooij JJ, Marije Boonstra A, Swinkels SH, et al.: Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients. J Atten Disord 2008, 11:445–458.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Brown TE: Brown Attention Deficit Disorder Scales for Adolescents and Adults. San Antonio, TX: The Psychological Corporation; 1996.

    Google Scholar 

  17. 17.

    Ramsay JR, Rostain AL: Cognitive-Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach. New York: Routledge; 2008.

    Google Scholar 

  18. 18.

    Kessler RC, Adler LA, Barkley R, et al.: Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the National Comorbidity Survey Replication. Biol Psychiatry 2005, 57:1442–1451.

    PubMed  Article  Google Scholar 

  19. 19.

    Brown TE: ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults. Washington, DC: American Psychiatric Press; 2009.

    Google Scholar 

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Correspondence to Thomas E. Brown.

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Brown, T.E. ADD/ADHD and impaired executive function in clinical practice. Curr Atten Disord Rep 1, 37–41 (2009). https://doi.org/10.1007/s12618-009-0006-3

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Keywords

  • Executive Function
  • ADHD Symptom
  • Atomoxetine
  • Stimulant Medication
  • Adult ADHD