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Outside the Box: Rethinking ADD/ADHD in Children and Adults

A Practical Guide

Thomas E. Brown, Ph.D.

  • ISBN 978-1-58562-427-0
  • Item #62427

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Outside the Box: Rethinking ADD/ADHD in Children and Adults—A Practical Guide identifies assumptions about ADD/ADHD that demand reevaluation in light of recent research. Building upon a current, science-based foundation, the book describes in practical terms how ADHD can be recognized at various ages; how it differs from more typical brain development; how it can significantly impair those affected; and how it can safely, and in most cases effectively, be treated in children and adults. The book is based upon current scientific research but also on the experience and perspective of the author, a clinician who has devoted more than 35 years to studying this disorder formally and countless hours to engaging with and providing treatment for a diversity of children, teenagers, and adults with ADHD and related problems. The book's audience is the wide variety of clinicians involved in assessing, treating, and/or monitoring the care of children and adults with this disorder (e.g., pediatricians, primary care physicians, psychologists, psychiatrists, neurologists, physician assistants, advanced practice nurses, and clinical social workers) and also educators, disability service providers, human resource specialists, and the adolescents and adults who seek more information about ADHD assessment and treatment for themselves or for family or friends.

The book offers practical, accessible information that is grounded in the latest research:

  • The book is focused not primarily on details of academic arguments but on practical aspects of ADHD—how it varies from one person to another, how it changes over the life span, how treatments need to be adjusted for different individuals, and how it sometimes gets worse and sometimes gets better.
  • Emphasizing that ADHD is not a simple problem of failing to listen or staying focused on a task, the author examines research demonstrating that ADHD results from impairment of a complex syndrome of brain functions essential for self-management, the executive functions.
  • While DSM-5 is acknowledged as a valuable source of information about ADHD, this book draws upon a wider range of scientific research and perspectives not yet incorporated into DSM.
  • Although accessible to the general reader, the text includes citations to sources that can be used to obtain additional, more technical information.

Utterly current and scientifically based, Outside the Box: Rethinking ADD/ADHD in Children and Adults—A Practical Guide challenges old thinking and provides much-needed information and support to clinicians, educators, patients, and families.


  • Preface
  • About the Author
  • Introduction
  • Chapter 1. Basic Facts and the Central Mystery of ADHD
  • Chapter 2. A New Model of ADHD: Executive Function Impairments
  • Chapter 3. Differences Among Persons With ADHD
  • Chapter 4. Ways ADHD Can Impair Functioning at Various Age Levels
  • Chapter 5. How ADHD Impacts Brain Googling for Motivations
  • Chapter 6. How ADHD Develops, Sometimes Gets Worse, and Sometimes Improves
  • Chapter 7. How and Why Other Disorders Often Co-Occur With ADHD
  • Chapter 8. Assessing Children, Teenagers, and Adults for ADHD
  • Chapter 9. Emotional Dynamics in Individuals, Couples, and Families Coping With ADHD
  • Chapter 10. Practical Aspects of Medication Treatments for ADHD
  • Chapter 11. Practical Aspects of Nonmedication Interventions for ADHD
  • Chapter 12. Treatment Adaptations for ADHD With Various Complications
  • References
  • Index


    F. Xavier Castellanos, M.D.
    David C. Rettew, M.D.
    James J. Hudziak, M.D.
    Kelly Posner, Ph.D.
    Aliza W. Pressman
    Laurence L. Greenhill, M.D.
    George J. DuPaul, Ph.D.
    Thomas J. Power, Ph.D.
    Arthur L. Robin, Ph.D.
    Lily Hechtman, M.D., F.R.C.P.
    Gabrielle A. Carlson, M.D.
    Stephanie E. Meyer, PhD
    Rosemary Tannock, Ph.D.
    Jeffrey H. Newcorn, M.D.
    Jeffrey M. Halperin, Ph.D.
    Carlin J. Miller, Ph.D.
    Daniel A. Geller, M.B.B.S., F.R.A.C.P.
    Jeanette Wasserstein, Ph.D.
    Martha Bridge Denckla, M.D.
    Timothy E. Wilens, M.D.
    Paramala J. Santosh, MBBS, DipNB (Psych), MRCPsych, M.D.
    Judith A. Owens, M.D. M.P.H.
    Edward J. Modestino, A.L.B., M.L.A.
    Denis G. Sukhodolsky, Ph.D.
    Lawrence Scahill, M.S.N., Ph.D.
    James F. Leckman, M.D.
    Bjorn Kadesjo, M.D., Ph.D.
    Donald M. Quinlan, Ph.D.
    Jefferson B. Prince, M.D.
    Stephen P. Hinshaw, Ph.D.
    Peter S. Jensen, M.D.
    Howard Abikoff, Ph.D.
    Greg Kuny
    Alisa Guerzon
    Deb Tourtlotte

About the Authors

Thomas E. Brown, Ph.D., is a clinical psychologist who received his Ph.D. from Yale University and is Director of the Brown Clinic for Attention and Related Disorders in Manhattan Beach, California.

This brilliant book by a superb clinician-researcher compresses a wealth of vital, practical information into a marvelously user-friendly and engaging format. It's chock-full of everything anyone interested in ADHD wants to know, arranged in such a way that you can find what you want and will never be bored.—Edward Hallowell, M.D., author of Driven to Distraction and other books

Out of the Box is arguably the best practical book ever written on ADHD. Brown persuasively conveys that ADHD appears in many forms across the lifespan—and sets the record straight in terms of its linkage with core problems in working memory, emotion regulation, activation, and motivation. Laden with compelling case examples that humanize this condition, the writing is both authoritative and readable. Overall, the book masterfully blends the underlying science related to ADHD with extremely helpful guidance for assessment and treatment. It is a must-read for anyone dealing with ADHD.—Stephen P. Hinshaw, Phvsaa.D., Professor, Department of Psychology, University of California, Berkeley

Outside the Box offers an accessible update on the latest research about ADHD and answers questions and doubts that many struggle with about this disorder which is very prevalent in children and adults all over the world.—Sandra Kooij, M.D., Ph.D., Chair, European Network Adult ADHD

Professor Brown has written with his usual insightful understanding and communicates in an understandable way that will be a most valuable asset for professionals, patients, and parents alike. A brilliant read and one I will come back to many times. As a patient advocate this is an invaluable resource for me.—Andrea Bilbow, OBE, Founder of Attention Deficit Information and Support Service (ADDISS) in U.K.

This book is yet another example of Dr. Brown's exceptional ability to convey complex information about ADHD to a broad audience in easily understandable terms yet based on the scientific evidence and current scientific theories about ADHD. He has long championed the idea that ADHD is far more than a disorder of attention, but one of the brain's executive functions - mental abilities that are crucial to self-control and future-directed behavior. It is a view of ADHD I share. This book continues that theme, providing not only a fine understanding of the disorder, is complexity, and its causes, but also a number of insightful cases as well as numerous evidence-based recommendations concerning its management.—Russell A. Barkley, Ph.D., Clinical Professor of Psychiatry, Medical University of South Carolina

Professor Brown translates complex science into everyday language. This is THE guide for anyone having questions or doubts about ADHD. Case descriptions are delivered in an empathic tone that only one who has dedicated a lifetime to caring for patients and families with ADHD could provide. Highly recommended for patients, their families and professionals interested in ADHD.—Luis Augusto Rohde, M.D., Professor of Psychiatry, Federal University of Rio Grande do Sul, Brazil & President of the World Federation of ADHD

This down-to-earth book shows what ADHD really is and what it isn't. Brown gives us a true feel for ADHD and the impact of symptoms on people's lives. He defines executive functions in clear examples just as his patients described to him. For those who want an in-depth understanding of ADHD as it occurs in children, youth and adults, this book is a must read.—Michael J. Manos, Ph.D., Head of Pediatric Behavioral Health, Cleveland Clinic

This book is essential reading for anyone who wants to better understand ADHD across the life span. Brown gathers together some of the best thinking and research from a variety of fields to answer some of the most crucial questions about this still vexing and all-too-common condition. He has delivered a clear, comprehensive work that is both engaging and original. A rewarding, useful and accessible read.—F. Xavier Castellanos, M.D., The Child Study Center at NYU Langone Medical Center, Department of Child and Adolescent Psychiatry

Comprehensive, compassionate, and clear, Brown's authoritative survey on attention deficit disorders integrates rich clinical experience with cutting-edge neuroscience and epidemiology. The book provides a textured overview of ADD/ADHD's manifold symptoms and comorbidities, shifting phenomologically across the life course and statistically across changing diagnostic systems. Brown's own out of the box views on such topics as measurement bias and non-pharmaceutical adjunctive treatment are compelling. This rigorous yet approachable text is ideal for clinicians, academic researchers, parents and patients alike.—Ronald C. Kessler, Ph.D., McNeil Family Professor, Department of Health Care Policy, Harvard Medical School

Tom Brown's clearly written evidence-based update on Attention-Deficit/Hyperactivity Disorder is a must-read for professionals working with people struggling with ADHD as well as for adolescents and adults with ADHD who are seeking a deeper understanding of the disorder. The many clinical vignettes add interest and remind us of the person behind the diagnosis. Sections debunking common misunderstandings and summarizing important facts about ADHD are gems!—Mina K. Dulcan, M.D., Head, Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Professor of Psychiatry and Behavioral Sciences and Pediatrics, Northwestern University Feinberg School of Medicine

Dr. Brown, a leading international expert in ADD and related conditions, provides a superb, nuanced introduction to this multifaceted condition and a rich, personal, compassionate exploration of the challenges faced by at least 5% of the world's population. His advice and guidance on how to anticipate and deal with the realities of ADD, make this a must read for teachers, psychologists and medical professionals as well as for the parents, teens, adults, and partners whose lives are directly touched, and potentially derailed, by ADD. Dr. Brown's guidance is especially important in today's world with its vast array of information, much of which is incomplete, contradictory, unscientific, outdated and at times simply wrong.—James F. Leckman, M.D., Ph.D., Neison Harris Professor of Child Psychiatry, Psychiatry, Pediatrics and Psychology, Yale University

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