Attention Deficit Hyperactivity Disorder. A Handbook for Diagnosis and Treatment

Psychiatric practitioners, seasoned and new alike, should welcome the recent publication of the third edition of Russell Barkley’s classic textbook on attention-deficit/hyperactivity disorder (ADHD). The first edition was published in 1981 and was followed by the second edition, which was published 17 years later in 1998. Fortunately, Dr. Barkley has not waited another 17 years to update his classic textbook, as research in the field of ADHD has accelerated considerably in recent years, making this new edition a much needed and anticipated addition to any practicing clinician’s library. While the structure of the new edition is basically the same in terms of chapters and topics (with the exception of 1 new chapter on combined child therapies), there are many new and welcome added features. Most notably, there is now a section at the end of each chapter entitled “Key Clinical Points,” which highlights and summarizes learning points for the reader. The value of this cannot be overstated, particularly for the busy clinician! Furthermore, Dr. Barkley has included in Appendix I, at the end of chapter 1, an International Consensus Statement on ADHD that he and many other experts coauthored in 2002, which does much to dispel many of the myths about ADHD propagated in the media and by some special interest groups. The book is very well written, well edited, and well referenced and includes material dated through the year 2004 and some references from 2005. The lag between the date of these articles and the publication date of this book in 2006 is to be expected, given the long lead time for the compilation and publication of textbooks. Lastly, there is now an accompanying “Clinical Workbook” that provides many useful forms and rating scales for the busy practitioner. Dr. Barkley invited back all of the principal authors of chapters from the 1998 edition of the book, and some chapters were written by other experts. The first-time reader of any edition of this book will find the initial chapters particularly fascinating, especially chapter 1 on the history of ADHD, as these chapters summarize trends and changes in the field that have occurred since the 1930s. It is also noteworthy in this era of massive textbooks with multiple contributors that Part I of this book on the “Nature of ADHD,” with 7 chapters, is written and updated entirely by Dr. Barkley. This section forms a solid basis upon which the other 2 sections of the book, “Assessment” and “Treatment,” can build. A high point in the first part of the book is Dr. Barkley’s conceptual, theoretical model of self-regulation and executive dysfunction presented in chapter 7, which integrates quite well extant research findings in imaging, neurobiology, and neuropsychology. Part II of this new edition, “Assessment,” includes 4 expanded and improved chapters on topics such as the diagnostic interview, rating scales, tests, and the assessment of adults with ADHD. There is also an expanded chapter 10, which includes 10 clinical cases presented to integrate and facilitate the development of diagnosis and treatment strategies. This chapter will be particularly useful for clinicians, since it presents a variety of cases of ADHD and the common or challenging psychiatric comorbid disorders such as oppositional defiant, anxiety, and bipolar disorder. Part III, “Treatment,” includes 11 chapters on interventions, such as medications, psychotherapy, and psychoeducation for patients and their families. A particularly well written chapter is chapter 20 on combined child therapies, in which Dr. Barkley and his coauthors review findings from the historic National Institute of Mental Health Multimodal Treatment Study of Children With ADHD. There are a few minor suggestions for the next edition that would make this already valuable book even better. Expansion of the number of figures and tables, particularly in the section on treatment, and the addition of flowcharts to aid in decision making would highlight key recommendations in the text. It would also be helpful if such decision trees included further recommendations or even algorithms on addressing the psychiatric comorbid disorders such as tic disorders, obsessive-compulsive disorder, and the others described in chapter 10. The author index is valuable; perhaps one comprehensive bibliography at the end of the book might reduce some redundancy incurred with the individual chapter bibliographies. In this era of the Internet, a future edition could include a CD-ROM or a linked Web page, where at least the bibliography would be incorporated so as to facilitate retrieval of the primary research articles and references for future research. In summary, this new edition is a compelling update to a vast and ever-growing literature on a very prevalent, potentially devastating disorder. We highly recommend this book to clinicians and investigators in mental health.