Metacognitive Remediation in Adult ADHD

Treating Executive Function Deficits via Executive Functions

Authors

  • JEANETTE WASSERSTEIN,

    Corresponding author
    1. Comprehensive Neuropsychological Services and Department of Psychiatry, Mount Sinai School of Medicine, New York, New York 10032, USA
    • Address for correspondence: Jeanette Wasserstein, Ph.D., Co-Director, Comprehensive Neuropsychological Services, 277 West End Avenue, Suite 1C, New York, NY 10023. Voice: 212-724-1107; fax: 212-724-2597; cnsnyc@aol.com.

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  • ANTOINETTE LYNN

    1. Comprehensive Neuropsychological Services and Department of Psychiatry, Mount Sinai School of Medicine, New York, New York 10032, USA
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Abstract

Abstract: The neuropathology underlying ADHD most consistently points to dysfunction in corticostriatal pathways—leading to inactivation, or insufficient engagement, of frontal and prefrontal lobes. By implication there may be functional disconnection between the anterior and posterior higher cortical regions, instead of a fixed dysfunction in either one. Given this premise, reconnection of these systems via cognitive interventions constitutes a logical remedial approach in the treatment of ADHD, which this paper introduces. In particular, a hybrid model is developed which proposes integration of existing psychodynamic, cognitive, and neuropsychological interventions. An organizing theme is expansion of metacognitive understanding through these procedures, powerfully exemplified via use of metaphor in clinical vignettes.

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