Dr. Thomas E. Brown, clinical psychologist, Yale University professor of psychiatry, and associate director of the Yale Clinic for Attention and Related Disorders, offers a clinician’s perspective on the manifestations and treatment of ADHD in his 2014 book, Smart but Stuck: Emotions in Teens and Adults with ADHD. He focuses particularly on the often overlooked social and emotional components of Attention Deficit Hyperactive Disorder (ADHD).
Brown begins with an explanation of ADHD in terms of its behavioral manifestations. He explains that ADHD is defined as a chronic impairment in executive function and self-management. It interferes with a person’s daily life. Brown shows that people with ADHD can be intensely focused on highly enjoyable activities, while neglecting to initiate focus on material and on deadlines that they know are important. They often have diminished working memory and thus struggle to maintain multiple ideas in their mind at once. People with ADHD are less able to resist immediate rewards in favor of long-term payoffs. They may avoid their commitments or cope with the stress they experience as a result of their disorder by engaging in such activities as heavy marijuana use or extended video game play. They may struggle with anxiety, irritability, boredom, shame about their attentional issues, or have trouble ratcheting down their emotions in charged situations.
Brown also explains the neurochemical and neuroanatomical differences that characterize the brains of people with ADHD. Brain imaging has demonstrated that people with ADHD have more trouble shifting between their default mode and their more active attention network. Areas of the brain associated with executive function mature three to five years later than is typical. People with ADHD have a different pattern of release and reception of two critical neurochemicals.
In eleven chapters, each named for one of his patients, Brown vividly recounts stories about bright and talented teenagers and adults who are severely affected by ADHD—people who are “smart but stuck.” His patients often score in the top ten percent or higher on IQ tests and yet, because of their ADHD, have endured serious setbacks, including delayed college graduation, lost tuition, strained social and familial relations, and divorce. He describes his initial patient consultation, the course of treatment, and the circuitous route to improvement. Brown pays special attention to life circumstances and co-morbidities that must be considered in treatment, as patients often come to him shortly after a major life change (e.g., transitioning to college, illness of a family member, death of a loved one) and have other issues present (e.g., obsessive compulsive disorder, social anxiety). Seamlessly interspersed among the stories are epidemiological statistics and clinical explanations about how an aspect of a patient’s story manifests in the ADHD population at-large. He ends each story with a summary of factors that helped the patient get “unstuck.”
Brown concludes with recommendations for understanding the emotional component of ADHD in order to help people with the disorder. People with ADHD or who suspect they might have it benefit from having a proper clinical evaluation of their strengths and weakness and a detailed explanation of what the disorder is and is not. Loved ones of people with ADHD must understand that people with ADHD are not simply lacking in willpower and that it is possible for someone with ADHD to be highly intelligent. Counseling (e.g., psychotherapy), medication, (e.g., Methylphenidate), and school or workplace accommodations (e.g., extended time for test taking) may help a person manage ADHD. Most critically, a person with ADHD and those who support him or her need hope that is realistic. They need neither a naïve belief that if they try hard enough they can accomplish anything, nor a fatalistic belief that they are doomed to fail. Rather, they need to understand that there are ways to help people with ADHD cope with inevitable obstacles such that they can improve their situation and be content and productive.
Although Brown illustrates that the manifestation and treatment of ADHD is unique to each individual, he provides simultaneously such a rich representation of the disorder that anyone who is managing ADHD or who has a loved one or colleague with ADHD will find bits of these stories that are uncannily resonant with his or her own experience.
Brown, T. E. (2014). Smart But Stuck: Emotions in Teens and Adults with ADHD. John Wiley & Sons.