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.)
This is a preview of subscription content, access via your institution.
References and Recommended Reading
Brown TE: Attention Deficit Disorder: The Unfocused Mind in Children and Adults. New Haven, CT: Yale University Press; 2005.
Brown TE: Executive functions and attention deficit hyperactivity disorder: implications of two conflicting views. Int J Disabil Dev Educ 2006, 53:35–46.
Barkley RA: Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, edn 3. New York: Guilford Press; 2006.
Barkley RA, Murphy KR, Fischer M: ADHD in Adults: What the Science Says. New York: Guilford Press; 2008.
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.
Baxter MG, Murray EA: The amygdala and reward. Nat Rev Neurosci 2002, 3:563–573.
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.
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.
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.
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.
Rabbitt P, ed: Methodology of Frontal and Executive Function. East Sussex, United Kingdom: Psychology Press Publishers; 1997.
Barkley RA: ADHD and the Nature of Self-Control. New York: Guilford Press; 1997.
Brown TE, ed: Attention Deficit Disorders and Comorbidities in Children, Adolescents and Adults. Washington, DC: American Psychiatric Press; 2000.
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.
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.
Brown TE: Brown Attention Deficit Disorder Scales for Adolescents and Adults. San Antonio, TX: The Psychological Corporation; 1996.
Ramsay JR, Rostain AL: Cognitive-Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach. New York: Routledge; 2008.
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.
Brown TE: ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults. Washington, DC: American Psychiatric Press; 2009.
About this article
Cite this article
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
- Executive Function
- ADHD Symptom
- Stimulant Medication
- Adult ADHD