From Stuck to Unstuck: An Interview with Dr. Thomas E. Brown

By Judy Brenis

Dr. Thomas Brown, one of the keynote speakers at this year’s ADDA Conference, being held July 24-27 in Orlando, Florida, will be asking attendees to think about the role emotions play in the experience of people with ADHD.

“This is an area that has been neglected in the study and treatment of ADHD,” says Brown, a clinical psychologist specializing in the assessment and treatment of high-IQ children, adolescents and adults with ADD and related problems.

“Both children and adults with ADHD often have trouble putting a lid on it when they are frustrated or irritated. They tend to over-react. For many persons with ADHD, when an emotion hits them, whether it is worry, or they are annoyed about something or their feelings are hurt, that emotion often hits them in the same way a computer virus invades a hard drive; it just gobbles up all of the space inside them, it takes over and it is really difficult to put the emotion into perspective and to put it to the back of their minds and get on with what they have to do,” explains Brown, who is also an assistant clinical professor of psychiatry at Yale University School of Medicine, and associate director of the Yale Clinic for Attention and Related Disorders.

“Many persons with ADHD have great difficulty managing these emotions,” Brown says. “These are aspects of emotional intelligence, being able to read one’s own feelings and the feelings of others, then being able to modulate and deal with those emotions and also using them to guide one’s actions.”

Brown believes that the biggest missing piece in the current understanding of ADHD is the importance of emotions, which he writes about in his newest book, “Smart but Stuck: Emotions in Teens and Adults with ADHD.”

According to Brown, the simple fact is that while most people with ADHD have a lot of difficulty around executive functions, follow through, motivation, etc. they often have trouble in the area of emotional intelligence as well. To fully understand the role of emotions in ADHD, “…we must not only recognize that those with the disorder often have a hard time managing how they express their emotions but also acknowledge the critical role that emotions, both positive and negative, play in the executive functions: initiating and prioritizing tasks, sustaining or shifting interest and effort, holding thoughts in active memory, choosing to engage in or avoid a task or situation.”

“ADHD really impacts almost all areas of one’s life,” Brown says. “ADHD is now recognized as a cluster of difficulties, not just considered a problem of behavior like Dennis The Menace, someone always getting into trouble and doing the wrong things.”

ADHD used to be classified as a disruptive behavior disorder, Brown points out, but it is now recognized that there are many people who have ADD or ADHD, who have never had any significant behavior problems. And even for those who have had behavior problems, often those behaviors are the least of it. The difficulty over the long haul, particularly during the adult years, is far more with problems of attention.

“There has been a major change in the understanding of the nature of the disorder and we are now seeing it as a much more complicated thing than before,” Brown says emphatically. “What we have begun to recognize more and more in recent years is that this whole notion of inattention symptoms includes a much broader range than was defined in the past.”

“ADHD is really best conceptualized as an impairment of executive function, the management system of the brain.”

Brown continues, “ADHD impacts how a person drives their car, manages their money, goes about finding and holding a job or progresses within their job, relationships with members of their family, how parents relate to their kids or kids relate to their parents.”

“Gradually it is also becoming clearer that most of the functions that are impaired are unconscious,” Brown says. “Not as in ‘repressed,’ but in that they happen so fast. It’s not something the person stops to think about, but how the person is wired.”

In the past, ADHD was also thought to cause the most problems while a child was in school, Brown points out, “but the hardest years we now know are in late adolescence and adulthood when the person with ADHD has to take on greater responsibilities.”

One of the most interesting aspects of ADHD is that while the person with ADHD has difficulty paying attention in many areas of their life, there are always a few activities where they have absolutely no problem at all. “It’s a mystery,” Brown says. “It’s different for different people, but for some it may be playing a sport, or while drawing or making art, reading certain kinds of books, video games, preparing gourmet meals.”

“Every patient I have ever seen who as ADHD can tell me about one or several different areas of activity in which they are able to function perfectly well and don’t have trouble paying attention, don’t have trouble remembering what is going on. And yet they will have massive difficulties in other areas of their lives. They begin to ask themselves, ‘If I can do it here, if I can focus here, why can’t I do it here and here and here.’ But when asked why, they always say that either, ‘It is something that I am really interested in,’ or ‘It is a situation where I feel I have a gun to my head.’ And what many people don’t realize is that although this may look like a problem of willpower, it is not. It results from the chemistry of the brain changing instantly when we are faced with something that really interests us or with something that scares us.”

Brown credits his diverse background in many areas of psychology for his ability to be an active listener and really pay attention to what his patients are trying to tell him. He says in his early practice he soon realized that the impacts of ADHD were a lot more complex than the books were saying. Brown began his training at Yale in dominant theory in psychoanalysis, but went on to study family therapy, cognitive behavior therapy, and psychopharmacology.

When working with high IQ patients, Brown could see his clients suffering as a result of not being able to use their smarts as effectively as most people because of all of these other issues. He said he listened to what they were describing they were going through each and every day. He learned that when most people with ADHD read things they aren’t interested in, while they read and understand it, as soon as they move on and stop, they realize their eyes have gone over every word but it doesn’t stick inside their head.

Brown started asking questions. What is the level of motivation for this person? What is it that allows the person to get engaged in a task? What helps this person focus on some things, but not others? “It has helped me to get a much broader picture of what ADHD is and how it impacts people in different cycles.” Brown works with three-year-olds to those in their 70’s and he says he enjoys the mix and getting to see how (ADHD) looks at different points of the life cycle.

During Brown’s talk at the ADDA Conference, he will be using specific true stories about intelligent, capable teens and adults who have gotten “stuck” at school or work, or in social relationships because of their ADHD. These moving case histories will illustrate the many facets of the disorder, as well as provide detailed strategies and treatments those with ADHD can use to get “unstuck.”

Judy Brenis is an ADHD coach in Santa Cruz, California, and the author of the book, ADHD Heroes. ADHD touched her life when her now-adult daughter was diagnosed with ADHD at age five. Judy is passionate about helping those with ADHD create successful, happy healthy lives. Reach her at www.adhdcoachingjudy.com.