Childhood Disorders
Resources

 email page    print page

All Topic Reviews
12 and HoldingA Guide to Asperger SyndromeA Lethal InheritanceA Mother's Courage: Talking Back to AutismA Parent's Guide to Asperger Syndrome and High-Functioning AutismA Special EducationA Toss Of The DiceA Tribe ApartA User Guide to the GF/CF Diet for Autism, Asperger Syndrome and AD/HDA Walk in the Rain With a BrainABC of Eating DisordersADD-Friendly Ways to Organize Your LifeADHD Grown UpADHD in the Schools: Assessment and Intervention StrategiesAdolescence and Body ImageAdolescent DepressionAggression and Antisocial Behavior in Children and AdolescentsAll Alone in the UniverseAlpha GirlsAmericaAnother PlanetAntisocial Behavior in Children and AdolescentsAsperger Syndrome and Your ChildAsperger Syndrome, Adolescence, and IdentityAsperger's and GirlsAssessment of Childhood DisordersAttention Deficit DisorderAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderAutism - The Eighth Colour of the RainbowAutism and MeAutism's False ProphetsAutistic Spectrum DisordersBad GirlBeen There, Done That? DO THIS!Before I DieBetween Two WorldsBeyond AppearanceBig Mouth & Ugly GirlBipolar ChildrenBipolar Disorder in Childhood and Early AdolescenceBipolar DisordersBipolar KidsBlackwell Handbook of Childhood Cognitive DevelopmentBody Image, Eating Disorders, and ObesityBody Image, Eating Disorders, and Obesity in YouthBoy AloneBrain-Based Therapy with Children and AdolescentsBreaking PointBreathing UnderwaterBringing Up ParentsBullying and TeasingBullying PreventionBut I Love HimCan't Eat, Won't EatCaring for a Child with AutismCatalystChild and Adolescent PsychiatryChild and Adolescent Psychological DisordersChild and Adolescent PsychopathologyChild NeuropsychologyChild Well-BeingChildren and SexualityChildren Changed by TraumaChildren with Emerald EyesChildren with Sexual Behavior ProblemsChildren, Sexuality and SexualizationChildren’s Dreaming and the Development of Consciousness City of OneCommunication Issues In Autism And Asperger SyndromeConcepts of NormalityConcise Guide to Child and Adolescent PsychiatryConquering the Beast WithinConsuming KidsContesting ChildhoodCount Us InCrackedCrossesCutCyber-Safe Kids, Cyber-Savvy TeensDamageDemystifying the Autistic ExperienceDescartes' BabyDilemmas of DesireDirtyDisconnected KidsDoing SchoolDon't Bother Me Mom--I'm Learning!Don't Pick On MeDying to Be ThinEarly Intervention Programs and PoliciesEating an ArtichokeEducating Children With AutismEight Stories UpElijah's CupEmerald City BluesEmotional and Behavioral Problems of Young ChildrenEpilepticEthical Dilemmas in PediatricsEvery Girl Tells a StoryExiting NirvanaExploiting ChildhoodEye ContactFacing BipolarFamily HistoryFast GirlsForever YoungFreaks, Geeks and Asperger SyndromeFreewillFrictionGirl CultureGirl in the MirrorGirlfightingGirlhoodGirlWiseHandbook of Evidence-Based Therapies for Children and AdolescentsHandbook of Preschool Mental HealthHealing ADDHelping Children Cope With Disasters and TerrorismHelping Hyperactive KidsHelping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional ProblemsHelping Students Overcome Depression and AnxietyHelping Teens Who CutHollow KidsHope's BoyHow Infants Know MindsHow to Keep Your Teenager Out of Trouble and What to Do If You Can'tHurry Down SunshineI Am Not Joey PigzaIdentifying Hyperactive ChildrenIf Your Adolescent Has an Eating DisorderIn the Company of CraziesIncorporating Social Goals in the ClassroomIntegrated YogaIntrusive ParentingIssues for Families, Schools and CommunitiesJake RileyJoey Pigza Loses ControlJoey Pigza Swallowed the KeyJuvenile-Onset SchizophreniaKim: Empty InsideLearning and Behavior Problems in Asperger SyndromeLearning Disorders and Disorders of the Self in Children and AdolescentsLearning Outside the Lines Let Kids Be KidsLiberation's ChildrenLife As We Know ItLisa, Bright and DarkLook Me in the EyeLoserLove and SexLove That DogMad at SchoolMaking ADD WorkMaking American BoysManicMastering Anger and AggressionMaverick MindMedicating ChildrenMind FieldsMind to MindMommy I'm Still in HereMore Than a LabelMy Flesh and BloodMyths of ChildhoodNew Hope for Children and Teens with Bipolar DisorderNew Look at ADHD: Inhibition, Time, and Self-ControlNo Child Left DifferentNo Two AlikeNon-Drug Treatments for ADHDNot Much Just Chillin'NurtureShockOdd Girl OutOdd Girl Speaks OutOne Hot SecondOne in ThirteenOphelia SpeaksOphelia's MomOur Journey Through High Functioning Autism and Asperger SyndromeOut of the WoodsOvercoming ADHDOvercoming School AnxietyParenting a Child Who Has Intense EmotionsParenting Children With ADHDParenting Your Out-Of-Control TeenagerPediatric PsychopharmacologyPediatric PsychopharmacologyPediatric PsychopharmacologyPeople with HyperactivityPhobic and Anxiety Disorders in Children and AdolescentsPINSPlease Don't Label My ChildPraising Boys WellPraising Girls WellProblem Child or Quirky Kid?Problem GirlsPsychotherapy for Children and AdolescentsPsychotherapy with Children and AdolescentsPurgeRaising a Moody ChildRaising BlazeRaising Generation RxRaising Resilient ChildrenReady or Not, Here Life ComesReclaiming Our ChildrenRedressing the EmperorReducing Adolescent RiskRemembering Our ChildhoodResilience in ChildrenRethinking ADHDReweaving the Autistic TapestryRitalin is Not the Answer Action GuideRitalin NationRunning on RitalinRunning with ScissorsRutter's Child and Adolescent PsychiatrySeeing EzraSex and the American TeenagerSex, Therapy, and KidsSexting and Young PeopleSexual Teens, Sexual MediaShort Term 12Should I Medicate My Child?SmashedSnapshots of AutismSongs Without WordsSophie Spikey Has a Very Big ProblemSpeakStaying Connected to Your TeenagerStick FigureStraight Talk about Psychiatric Medications for KidsStraight Talk about Psychological Testing for KidsStraight Talk about Your Child's Mental HealthStrange SonStudent DepressionSuicidal Behavior in Children and AdolescentsSurvival Strategies for Parenting Children with Bipolar DisorderSurviving OpheliaTaking Charge of ADHD, Revised EditionTaming the Troublesome ChildTemple GrandinThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anti-Romantic ChildThe Bipolar ChildThe Boy Who Loved WindowsThe Boy Who Was Raised as a DogThe Buffalo TreeThe Bully Action GuideThe Bully, the Bullied, and the BystanderThe Burn JournalsThe Color of AbsenceThe Curious Incident of the Dog in the Night-TimeThe Depressed ChildThe Developing MindThe Dragons of AutismThe Einstein SyndromeThe EpidemicThe Evolution of ChildhoodThe Explosive ChildThe Eyes of van GoghThe Fasting GirlThe Field of the DogsThe Flight of a DoveThe Hidden Gifts of the Introverted ChildThe Horse BoyThe Identity TrapThe Inner World of a Suicidal YouthThe Inside Story on Teen GirlsThe Kindness of StrangersThe Last Normal ChildThe Little MonsterThe Medicated ChildThe Myth of LazinessThe New Gay TeenagerThe Nurture AssumptionThe OASIS Guide to Asperger SyndromeThe Other ParentThe Perversion of YouthThe Philosophy of AutismThe Psychoanalytic Study of the ChildThe Real Truth About Teens and SexThe Ride TogetherThe Rise and Fall of the American TeenagerThe Science of ADHDThe Sex Lives of TeenagersThe Survival Guide for Kids With LD*The Unhappy ChildThen Again, Maybe I Won'tTherapy with ChildrenThings I Have to Tell YouThings Tom LikesThrough the Glass WallThumbsuckerTotally WiredTouching Spirit BearTrauma in the Lives of ChildrenTreating ADHD and Comorbid DisordersTreatment of Childhood DisordersTwistedUnder the Wolf, Under the DogUnhappy TeenagersUnstrange MindsWastedWe've Got IssuesWeather Reports from the Autism FrontWhat about the KidsWhat in the World Are Your Kids Doing Online?What Works for Whom?What Would Joey Do?What's Happening to My Body? Book for BoysWhat's Happening to My Body? Book for GirlsWhat's Happening to Tom?When Nothing Matters AnymoreWhen Your Child Has an Eating DisorderWhose America?Why Don't Students Like SchoolWill's ChoiceWinnicott On the ChildWorried All the TimeYou Hear MeYoung Minds in Social WorldsYoung People and Mental HealthYour Child, Bully or Victim?

Related Topics
Attention Deficit DisorderReview - Attention Deficit Disorder
The Unfocused Mind in Children and Adults
by Thomas E. Brown
Yale University Press, 2005
Review by Ben Lovett
Aug 22nd 2006 (Volume 10, Issue 34)

Thomas Brown is already known in the Attention Deficit Hyperactivity Disorder (ADHD) world for his standardized questionnaires that people fill out to determine if they or their children have the symptoms of ADHD. In this book, Brown shows off his theoretical side, integrating research from neuroscience, pharmacology, clinical psychiatry and cognitive neuropsychology to develop a model of what he calls ''the Attention Deficit Disorder (ADD) syndrome'', a constellation of deficits in such areas as initiating tasks, persisting over time, regulating alertness and managing emotions.

If this thumbnail description of Brown's ADD syndrome does not square with what you had thought ADHD to be, you are not alone. A brief primer on official terminology: in the most recent (1994) listing of psychiatric disorders, found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), only ''ADHD'' is present. However, the symptoms required for diagnosis are divided into two areas: inattention and impulsivity/hyperactivity. If an individual only has a significant number of symptoms from the inattention list, they may be diagnosed with ''ADHD, primarily inattentive type,'' which is still referred to by many clinicians as ADD.

The inattentive subtype of ADHD, however, is not quite the syndrome that Brown discusses. He begins not with DSM-IV descriptions, but with the neuropsychological concept of ''executive functioning''. Just as an executive in a corporation plans, delegates, supervises and otherwise coordinates different tasks, certain systems in the brain do the same thing. Brown divides the various executive functions into six groups (e.g., focus, memory) and gives an overview of the research on each one. To understand Brown's ADD syndrome, think of the executive functions as a single brain system. People vary along a continuum of how effective their executive functioning system is at coordinating and monitoring tasks, and those who are at the low end of this continuum can be said to have ADD.

The first half of Brown's book is devoted to exploring the executive functions, their neural bases, and how deficits in executive functions can cause impairment in childhood, adolescence and adulthood. His points in these chapters should not be controversial, and his straightforward prose communicates complex ideas in an accessible way. More problematic is the second half of the book, which focuses on diagnosis and treatment. Since the ADD syndrome is not recognized as an official disorder, recommendations for diagnosis and treatment must either be somewhat ad hoc, or else borrowed from currently recognized psychiatric conditions, such as ADHD.

Brown chooses the latter strategy, first reviewing the typical diagnostic tools for ADHD. He points out that the clinical interview is the most important part of an ADHD assessment, and he discusses the differences between interviewing adults and children. He describes the standardized tasks and tests that can provide helpful supplementary information, and notes the advantages and disadvantages of each. Brown integrates his new ADD syndrome into clinical practice by broadening the category of ADHD, attacking purported exclusionary criteria for the disorder. For instance, the DSM-IV states that symptoms must begin before age 7, but Brown notes that children are sometimes given enough environmental support that deficits are not evident at early ages. Similarly, the DSM requires that individuals must show at least 6 of the listed symptoms, but Brown points to a study in which only 1% of adults in the general population reported experiencing 6 or more symptoms. Many would interpret this study as showing that the prevalence of ADHD is lower in adults than in children, but Brown relies on the study to argue that we should lower our symptom thresholds when diagnosing adults.

After discussing diagnostic strategies, Brown devotes an entire chapter to disorders than may accompany his ADD syndrome. It is generally agreed that individuals with ADHD experience a higher risk of developing such problems as depression, anxiety and learning disabilities, but Brown goes further, arguing that executive functioning deficits are a component of these other disorders. The chapter concludes by claiming that the ADD syndrome, as Brown describes it, is not specific to individuals who meet the criteria for ADHD; instead, ''this syndrome might be seen as a cluster of impairments that cuts across other diagnostic categories''. Brown does not shy away from the treatment implications, suggesting that ''some treatments demonstrated useful for ADHD might also be helpful for some cases of other disorders, such as depression or traumatic brain injury''.

In the last two chapters, Brown details those treatments, along with their efficacy, and the degree to which individuals with the ADD syndrome can reasonably expect their symptoms to remit. Brown's discussion of treatment options is evenhanded, relying on the now-famous MTA study (which found medication to be superior to behavioral treatment for ADHD) but also acknowledging that behavioral therapies can be useful in certain settings (e.g., schools).

Given the book's broadening of diagnostic categories, its admittance that clinically significant inattention is not specific to ADHD, and its uncritical endorsement of pharmacological treatments, the message appears to be this: some people aren't as good as the rest of us at getting things done, and if there's a big gap between what they're getting done and what they could be getting done, they have ADD syndrome, so give them medications, which will offer a good chance for symptom improvement. Given the current state of the ADHD diagnosis, filled with more contention than consensus, this may seem to be a pragmatic response. However, Brown doesn't adequately consider the downsides of this arrangement. Couldn't any apparently normal, healthy person find a life setting where they found it difficult to get things done? Is medication -- or, for that matter, behavioral therapy -- the answer, any time that someone happens to be experiencing inattention and isn't reaching what they consider to be their potential?

Brown's ''new, somewhat controversial understanding'' of these ADHD symptoms, then, should be viewed as a provocative proposal, not a careful argument that considers and deals with potential objections. For professionals and interested non-professionals, the book should contribute to a vigorous debate about foundational issues in psychopathology. The author's style and some of the information presented are clearly meant for a wider audience, but general readers should be aware that Brown's primary topic is the ADD syndrome as he describes it, not ADHD; for those seeking a general introduction to the latter condition, other volumes are available and superior.

 

© 2006 Ben Lovett

 

Ben Lovett is currently a doctoral candidate in the psychology department at Syracuse University, where his research interests include learning disabilities and ADHD. For more information, see his website: http://web.syr.edu/~bjlovett/


Share

Welcome to MHN's unique book review site Metapsychology. We feature over 7700 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than thirty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Can't remember our URL? Access our reviews directly via 'metapsychology.net'


Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from Amazon.com for purchases through this site, which helps us send review copies to reviewers. Please support us by making your Amazon.com purchases through our Amazon links. We thank you for your support!


Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? Currently, we especially need thoughtful reviewers for books in fiction, self-help and popular psychology. To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716