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64 Rohde, Buitelaar, Gerlach & Faraone -analyses of psychosocial interventions for ADHD that are methodologically sound and adequately attentive to both beneficial and adverse effects. Yet despite the lack of evidence from rigorous empirical studies and meta-analyses, the following psychosocial interventions can be adapted by clinicians to provide helpful care for children, adolescents and adults with ADHD. It is generally agreed that combined psychosocial and medication treatments are usually optimal for care of those with ADHD, However, even when medication treatment may not be utilized or available, the following interventions may be useful. EDUCATION OF PATIENTS AND FAMILIES ABOUT UPDATED UNDERSTANDING OF ADHD Described below are five basic facts about ADHD important for patients and fa- milies to understand. Clinicians may adapt and utilize these descriptions for their conversations with patients and family members. Additional information available online or in selected videos or publications is included within this section of text and in the reference section at the end of this chapter. ADHD IS A COMPLEX DISORDER OF THE BRAIN’S COGNITIVE MANAGEMENT SYSTEM The disorder currently identified as ADHD has long been associated with chronic difficulty in paying attention as well as impulsive and hyperactive behavior. More recent research has expanded that behavioral model to recognize that ADHD is associated with developmental impairments in the brain’s cognitive management system, its executive functions. Although current diagnostic criteria for ADHD do not explicitly refer to “executive functions”, many symptoms included in the present list of diagnostic criteria are related to executive functions. These executive functions develop slowly starting in early childhood; they are not fully matured until the late teen years or early twenties. These cognitive func- tions mature and come “online” only gradually over the long course of develop- ment from early childhood to early adulthood. Assessment of impairments in EF should always be in comparison to others of comparable age. Several models and various rating scales have been proposed to describe exe- cutive functions impaired in ADHD. 3-5 Most of these include impairments related to the following cognitive functions as described by Brown: 6 1 Activation: organizing tasks and materials, estimating time, prioritizing tasks, and getting started on work tasks. Patients with ADHD describe chro- nic difficulty with excessive procrastination. Often they will put off getting