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Book Review of "Smart but Stuck" by Dr. Thomas Brown

Wednesday, February 8, 2017  
Posted by: Christina Mimms
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Reviewed by Dr. Brent Betit, Head of The Fletcher School, Charlotte, NC

We’ve all had at least one of those students: the super-charged kid with boundless energy, often paired with an inquisitive, frenetic approach that can be overwhelming. In an earlier era, our default pedagogical response might have been punitive, perhaps flavored with a pinch of moralistic judgement: “You try harder to sit still right now, Johnny, or I will sit you still.”

Thanks to leading theorists including Russell Barkley, Edward Hallowell, John and Nancy Ratey, and Thomas Brown, and advocacy organizations, such as CHADD, we have now come to understand that these super-charged kids have Attention Deficit Disorder, which has a neurobiological basis and clear diagnostic criteria. Thus, we can acknowledge that ADD impacts roughly 15 million people in the U.S. and is a global, genetic condition. Because ADD is neurobiological and neurochemical in origin, telling a kid with such a diagnosis to sit still without providing the support and strategies needed to master her biologic tendencies is equivalent to saying, “Lisa, stop making your eyes look blue.” 

In any given classroom of 20 students, prevalence statistics predict that at least one student will carry a diagnosis of ADD (sometimes called ADHD, or attention deficit hyperactivity disorder).  ADHD profoundly impacts a student’s ability to self-manage, due to neurobiological differences and neurochemical variances that distinguish him from what is currently termed the “neurotypical” learner. Without appropriate interventions (sometimes including medication) and effective strategies, individuals with ADHD can be highly disruptive members of an academic class or social community. Their impulsivity, inattention, distractibility, and sometimes manic propensity to talk, talk, talk, can threaten the peaceable classroom environment that teachers strive to establish. 

However, students with ADHD are often bright, creative learners who sometimes – counterintuitively – hyper focus on discrete areas of interest and achieve break-through understandings because of their obsessive pursuit of the topics that interest them and because of the innate intelligence and curiosity that drives their learning. There are gifts accompanying ADHD. So, as one critical step toward understanding the gifts associated with ADHD, educators should regard neurodiversity as a difference or distinction that enriches our communities and cultures, contributing to a plentiful landscape of ideas and capabilities, which undergirds an inclusive and holistic society that embraces difference and that celebrates distinction.

At The Fletcher School in Charlotte, NC, the majority of students in the middle and upper schools have ADHD. However, at Fletcher, ADHD is not synonymous with failure. As just one example, a 5-year longitudinal analysis of ACT college readiness benchmark scores demonstrates that Fletcher graduates significantly outpace their North Carolina college-bound peers on three of the four college readiness benchmarks. We know that ADHD leads to academic and life failure only when it is unrecognized and unaddressed. Our program helps students stay on track to success. We can do this in part because we understand and support students with ADHD and other learning challenges.

Dr. Thomas Brown’s most recent book, Smart but Stuck: Emotions in Teens and Adults with ADHD, provides sensitive insights into how students with ADHD approach learning and life – insights that can assist all educators in more fully understanding students with ADHD, and consequently, in providing the support and strategies these extraordinary young people require to attain their potential. 

To support such students, it is critical to develop a detailed understanding of the executive function (EF) model – a model that Dr. Brown shares and explicates in Smart but Stuck. As Brown notes, “clinical and neuroscience research has revealed that ADHD is essentially a complex set of dynamically interacting impairments of the brain’s management system, otherwise known as its ‘executive functions.’” Brown’s model identifies a critical, previously missing link in our understanding of ADHD:  the role of emotion in executive function. His 6-part EF model represents the best conceptualization of executive function currently available, delineating how the interacting combinations of activation, focus, effort, emotion, memory, and action impair those with ADHD and too often prevent them from attaining their potential.  

Students with ADHD get “stuck” because of the powerful role that emotion plays in self-regulation and self-management. From Brown’s perspective, emotion is integral to all the other executive function domains; his renowned EF model is consequently predicated on the role of emotion as an integral aspect of executive function. He is not alone in this realization. Brown notes that Barkley now advocates for including “deficient emotional self-regulation” as a fundamental diagnostic criterion for ADHD combined type. Our understanding of ADHD continues to evolve.

 Smart but Stuck provides an accessible overview of Brown’s EF model, while also integrating several illustrative vignettes drawn from his clinical practice, which reveal how substantively emotion can impact academic and life performance. These anonymous but very personal stories are poignant examples of the impact that emotion and anxiety have on people’s lives.  They bring to life the practical implications and impacts of executive function and ADHD that some of us may have only read about or studied clinically previously. Through this book, we understand how powerfully emotion impacts learning, by hearing directly from those it has impacted: “People with ADHD report that momentary emotion often gobbles up all the space in their head, as a computer virus can gobble up all the space on a hard drive, crowding out other important feelings and thoughts.”  

While it is highly accessible to read, and not overly technical in nature, Smart but Stuck references useful empirical data, including: “A study of over two hundred children with ADHD showed that brain networks that support self-management tend not to fully mature in those with ADHD until two to five years later than in most of their peers.” This kind of insight is very helpful in interpreting and understanding the behaviors that educators encounter in their classrooms. The book is also convincing in decrying our tendency to consider ADHD a “lack of willpower,” instead of the neurobiological condition that it is. Lisa cannot turn her eyes from blue to green; she also cannot stop her mind from wandering when the sun is shining and birds are trilling outside her window – unless and until we help her recognize this tendency, learn to self-cue when she drifts, and automatize her new, self-regulating behavior over time. Then she will outscore her neurotypical college-bound peers on the ACT and perhaps one day change the world.

I have recommended Smart but Stuck: Emotions in Teens and Adults with ADHD to several Fletcher parents, and one recently remarked, “That is my son!” – finally achieving powerful insight into the struggles that her child experiences every day, both at home and at school. Through his excellent book, Smart but Stuck, Dr. Thomas Brown humanizes the executive function model and personalizes the diagnostic characteristics of ADHD. He shows us that every human being has latent potential. Each deserves the opportunity to achieve that potential, whatever it may be. Students will flourish if we assist them; they will shine if we let them. Our enduring purpose as educators must be to create joyful learning environments that embrace difference – that help students unlock their gifts and find their distinctive genius. Smart but Stuck articulates that message in multiple ways and establishes new insight into education and life for students with ADHD, and for the teachers who so ably serve them.

 

 

 

 

 

Dr. Brent Betit is head of The Fletcher School in Charlotte, NC. 


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