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An Overview of The
New Brown Executive
Function/Attention
Scales
(Brown EF/A Scales)

Presenter and Author

Thomas E. Brown, PhD

Department of Psychiatry,
Keck School of Medicine
University of Southern California.

Author of the Brown Attention-Deficit

Disorder Scales® (Brown ADD
Scales) (1996, 2001) and the New Brown
Executive Function/Attention Scales
(Brown EF/A Scales) coming out later this
year

Welcome Everybody!

Change in
Understanding ADHD

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 Attention Deficit
Hyperactivity Disorder

Old Understanding Of ADHD:

“disruptive behavior disorder of childhood”

New Understanding Of ADHD:

Developmental impairments of brain’s

self-management system, its
“executive functions”

Executive Functions

• Wide range of central control processes of

the brain

• Connect, prioritize, and integrate cognitive

functions–moment by moment

• Like conductor of a symphony orchestra

Executive Functions:
“Will you do it and, if so, how
and when?”
(Lezak, 2004)

Will you do it?

Motivation/Activation

How will you do it?

Planning/Organizing

When?
Timing/Remembering

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Executive Functions:
Development and Demands
• EF capacity develops through childhood, into
adolescence, and beyond; it is not fully present in
early childhood
• Environmental demands for EF increase with
age, from preschool through adulthood
• EF impairments often are not noticeable
by age 12!

Model of Executive
Functions in ADHD

Brown’s Model of Executive Functions

Impaired in ADHD

(Brown, Outside the Box: Rethinking ADD/ADHD. 2017, Attention Deficit Disorders, 2005)
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1. Organize, Prioritize, and Activate

• Difficulty organizing tasks, materials

• Difficulty estimating time, prioritizing tasks

• Trouble getting started on work

(Brown, Outside the Box: Rethinking ADD/ADHD. 2017, Attention Deficit Disorders, 2005)

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2. Focus, Shift, and Sustain

Attention
• Loses focus when trying to listen
or plan

• Easily distracted–internal/external

• Forgets what was read, needs

to re-read

(Brown, Outside the Box: Rethinking ADD/ADHD. 2017, Attention Deficit Disorders, 2005)

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3. Regulating Alertness, Effort,

and Processing Speed
• Difficulty regulating sleep and alertness

• Quickly loses interest in task, especially longer

projects; doesn’t sustain effort

• Difficult to complete task on time, especially in

writing–“slow modem”

(Brown, Outside the Box: Rethinking ADD/ADHD. 2017, Attention Deficit Disorders, 2005)

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4. Manage Frustration, Modulate
Emotion
(Not included in DSM-V criteria)

• Emotions impact thoughts, actions too much

• Frustration, irritations, hurts, desires, worries,
etc., experienced “like computer virus”
• “Can’t put it to the back of my mind”

(Brown, Outside the Box: Rethinking ADD/ADHD. 2017, Attention Deficit Disorders, 2005)

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5. Utilize Working Memory, Access

Recall
• Difficulty holding one or several things “on line” while
attending to other tasks

• Difficulty “remembering to remember”

• Inadequate “search engine” for activating stored

memories, integrating these with current info to guide
current thoughts and actions

(Brown, Outside the Box: Rethinking ADD/ADHD. 2017, Attention Deficit Disorders, 2005)

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6. Monitor and Self-Regulate Action

(Not just hyperactivity/impulsive behavior)

• Difficulty controlling actions, slowing self and/or
speeding up as needed
for tasks
• Doesn’t size up ongoing situations carefully
• Hard to monitor and modify own actions to fit
situation/aims

(Brown, Outside the Box: Rethinking ADD/ADHD. 2017, Attention Deficit Disorders, 2005)

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5
Brown’s Model of Executive
Functions Impaired in ADHD
Symptom Characteristics
• Dimensional, not “all-or-nothing”
 Everyone sometimes has some impairments in
these functions; in ADHD, it is a chronic,
severe impairment
• Situational variability: “If I’m interested”
 Most persons with ADHD have a few activities
where ADHD impairments are absent

ADHD looks like a willpower problem, but it isn’t!

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The Central Mystery of ADHD

Situational Variability of Symptoms

• Why focus for this, but not that?

“If it really interests me” (attraction)

• Why focus then, but not now?

If I feel the gun to my head” (fear)

• Why is motivation in ADHD so variable in one

situation to another?

(Brown, Outside the Box: Rethinking ADD/ADHD. 2017)

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Two Hypotheses on the Central Mystery of

ADHD

Will Power

vs

Erectile Dysfunction of the Mind

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6
When Are ADHD
Impairments Noticeable
• Some are obvious very early and are
noticeable in preschool years

• Some are not noticeable until middle

elementary or middle school

• Some are not apparent until child leaves

home to go to college or later

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Executive Functions
operate in dynamic, integrated
ways
• Most tasks requiring EF require integrated use of
multiple aspects of EF

• EF usually operate without conscious

deliberation, with automaticity, as in driving a car.

• Measured not with neuropsych tests, but with

clinical assessment of functioning in daily life
across time.
(Brown, Outside the Box: Rethinking ADD/ADHD. 2017; Intl..J. Disability, Devel.& Ed.2006)

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Assessing Executive
Function

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How Can Executive Function
Impairments of ADHD Be
Assessed?
• When ADHD was seen as just a disruptive
behavior disorder in childhood, diagnosis was
based on observing overt behavior

• Self/collateral report of performance on

complex, everyday, self-managed tasks in
clinical interviews and normed rating scales is
a more sensitive diagnostic indicator of EF
impairments than observation or neuropsych
“tests of EF”.

Brown EF/A Scales

• Fully updated norms (for ages 3 through adults)

• New and updated test items that improve clarity and
clinical relevance
• Based on Dr. Brown's six cluster model of executive
functions
• New parent form available for adolescents
• Both gender-specific and combined-gender norms
available for all age groups
• Includes DSM-5 symptoms of ADHD and more
• Digital administration and scoring available with Q-
global® web based system

What makes Brown EF/A Scales

different?
Items are more specific and contextual: Patients with ADHD
experience much situational variability with ability to focus on specific
activities which hold strong interest for them, but more limited ability to
focus on less interesting tasks, even when they may be important. The
Brown EF/A scales include items that ask about difficulties encountered
in specific contexts, e.g. difficulty remembering what has been read
(when reading is assigned, not self-selected texts).

Multiple Perspective Assessment: The Brown EF/A scales will provide

a comprehensive evaluation of an individual's ADHD symptoms by
assessing functioning using multiple perspectives: self-perspective,
teacher's perspective and parents' perspective.

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What makes Brown EF/A Scales
different?
Focus on severity as opposed to frequency: Unlike other instruments,
items on the Brown EF/A scales focus on severity of specific problems
rather than frequency. This allow examinees to report more accurately
how much difficulty they experience with each specific symptom.

Includes DSM-5 symptoms of ADHD and more: In addition to

diagnostic criteria for ADHD defined in DSM-5, the Brown EF/A scales
also assess other important aspects of executive function impairments
found in persons with ADHD, but not yet included in DSM-5 diagnostic
criteria for ADD/ADHD.

Based on Dr. Brown's model of Executive Functions: The Brown

EF/A scales are based on Dr. Brown's six cluster model of executive
functions that has been well recognized and explained in books and
articles for more than a decade.

Available Forms

• 3 - 7 years Parent, Teacher

• 8- 12 yrs. Parent, Teacher, Self-Report

• 13 – 18 yrs. Self-Report, Parent (new)

• 19+ years Self-Report

(can be completed at home then reviewed in session, or administered

orally by examiner)

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Brown Scales Assess for

Situational Variability of EF/A
impairments

• Differentiates between tasks, e.g. reading,

with strong or minimal interest for the
individual
• Inquires about “when writing or talking…”
• Restless, fidgety when have to wait
• Hard for me to stop doing things I like to
do, even when I know I should

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9
Dimensions for Item Responses

Most other ADHD or EF rating scales ask

frequency of behaviors related to ADHD in terms
of “how often ?” But “frequency” does not always
indicate how much that problem actually impairs
functioning.

Brown EF/A scales ask how big a problem?

0. No problem
1. Little problem
2. Medium problem
3. Big problem

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Scoring and Report of the Brown

EF/A Scales -3 options
Q-global® Web-based Administration, Scoring, and Reporting -
Administer assessments using our digital Q-global platform. It enables
you to quickly assess and efficiently organize examinee information,
generate scores, and produce accurate comprehensive reports all via
the Web.

Paper Administration, Q-global Web-based Scoring and

Reporting – Administer assessments using record forms and score
them using our digital Q-global platform. It enables you to quickly
assess and efficiently organize examinee information, generate
scores, and produce accurate comprehensive reports all via the Web.

Paper Administration and Manual Scoring – Administer

assessments using record forms and score them yourself with answer
sheets and scoring rules mentioned in the manual.

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Brown EF/A Scales

Cluster Items

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10
Cluster Items
The following slides illustrate the 6 clusters
included in the Brown EF/A Scales with some
items (similar to the Brown EF/A Scales) included
in each of the 6 clusters of executive functions
often impaired in individuals with ADHD more than
in most others of the same age.

Brown EF/A Scales use the 6 clusters to

provide a profile of the individual’s reported
functioning relative to age-based and gender-
based norms.

1. Activation
• Feels overwhelmed
• Has difficulty setting priorities
• Procrastinates excessively
• Has difficulty getting organized
• Is slow to react
• Is excessively rigid; a perfectionist
• Is hard to wake up in the morning
• Misunderstands directions

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2. Focus
• Spaces out” when reading
• Becomes sidetracked easily
• Loses track in required reading; must reread
• Tries to pay attention but mind drifts
• Has difficulty grasping main idea in reading
• Gets lost in daydreaming
• Becomes distracted easily
• Stares off into spaced; seems “out of it”
• Doesn’t seem to be listening; gets complaints
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3. Effort
• Feels sleepy during day
• Needs extra time to complete tasks
• Is criticized as lazy
• Produces inconsistent quality of work
• Does not work to potential
• Begins but effort fades quickly
• Has sloppy, hard-to-read penmanship
• Needs reminders for tasks
• Does not finish tasks
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4. Emotion
• Is excessively impatient
• Is sensitive to criticism
• Becomes irritated easily; short-fused
• Has difficulty expressing anger
• Exhibits depressed mood
• Tends to be loner among peers
• Appears apathetic

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5. Memory
• Is excessively forgetful
• Intends to do things but forgets
• Makes repeated restarts in writing
• Misplaces words/letters in writing
• Loses track of items
• Has difficulty memorizing

36

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6. Monitoring and Self-Regulating
Action
• Hard to work on or play with one thing for a long
time, unless really fun
• Often butts in or interrupts
• Does papers too fast, hard to slow down enough
to be careful
• Often grabs things or starts without waiting for
permission or directions
• Parents complain about having to give same
direction repeatedly
• Does too much teasing, arguing, etc. after being
asked to stop it.

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Uses for Brown EF/A Scales

• Screener to identify individuals who

should receive a full evaluation for ADHD

• Use with clinical interview for evaluation

of possible ADHD and related problems

• Tool for monitoring response to treatment

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Books by Thomas E. Brown, Ph.D.

www.BrownADHDclinic.com

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Questions or Comments

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Want to Learn More?

http://www.pearsonclinical.com/brownefascales

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