The newly released third edition of Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment stands as a definitive and comprehensive resource in the field. Continuing the legacy of its initial version, Hyperactive Children: A Handbook for Diagnosis and Treatment, this edition, spearheaded by Dr. Barkley, maintains its authoritative voice and serves as an unparalleled reservoir of information for clinicians, researchers, and anyone seeking a deep understanding of ADHD. Dr. Barkley, in this updated edition, has successfully reunited many of the original contributing authors from the 1998 publication while integrating critical new research findings across all chapters, ensuring the handbook remains at the forefront of ADHD knowledge.
The book is meticulously structured into three distinct sections: 1) The Nature of ADHD (Attention Deficit Hyperactivity Disorder); 2) Assessment; and 3) Treatment. These core sections are further divided into twenty-two chapters, each thoughtfully concluding with a list of key clinical points, facilitating quick review and practical application of the presented information.
The handbook begins by tracing the historical evolution of our understanding of ADHD. Consistent with previous editions, the discussion on primary symptoms and diagnostic criteria remains central. However, even within this foundational chapter, readers will find fresh insights, such as a detailed description of the predominantly inattentive subtype as a heterogeneous group and an updated review of current prevalence research concerning Attention Deficit Hyperactivity Disorder.
Chapters two and three delve into associated and comorbid conditions linked with ADHD. The concept of a potentially reduced life expectancy in individuals with ADHD is addressed, alongside the significant issue of impaired driving ability. The author also highlights the increased utilization of the medical care system by children with ADHD, raising important healthcare considerations. Furthermore, the clinically significant observation that children with ADHD are more likely to have parents with ADHD is thoroughly explored. In relation to ADHD-PI (Predominantly Inattentive Presentation), the increased likelihood of internalizing disorders in the subset characterized by sluggish cognitive tempo (SCT) is also affirmed as a key clinical reality.
The chapter dedicated to “etiologies” presents a robust review supported by empirical data. Notably, it examines molecular genetic research pointing to the role of the DRD4 gene in its 48-bp form and with 7 or more repeats, and the association of the D5 dopamine receptor gene with ADHD. Importantly, the handbook clarifies the current understanding that psychosocial factors are not considered causative agents for ADHD itself.
Chapter six offers a sensitively written exploration of ADHD in adults. Rather than solely focusing on the deficits often associated with adult ADHD, it provides a balanced perspective by considering both adults diagnosed in childhood and self-referred adults. Two critical points are emphasized: the recognition of adult ADHD as a genuine disorder and the presence of neuropsychological disturbances in self-referring adults with ADHD. The key clinical points in this chapter comprehensively cover the ongoing risks throughout the lifespan of an individual with ADHD, including academic, social, and comorbidity risks, as well as high-risk sexual behaviors, accident proneness, and risk-taking behaviors impacting adaptive functioning.
Chapter seven presents a more conceptually challenging, yet crucial, “theory of ADHD.” Dr. Barkley introduces a hybrid model integrating self-regulation and executive functions. To aid comprehension, the chapter includes numerous diagrams illustrating the different components of this theoretical framework. Behavioral inhibition, upon which four key executive functions depend, is examined first. These functions are identified as nonverbal working memory, verbal working memory, self-regulation of affect and motivation/arousal, and reconstitution. The central argument revolves around how these executive functions play a pivotal role in guiding external behaviors through internal actions. The core tenet of this theory is that deficits in behavioral inhibition are not only central to ADHD but also characterize it as a disorder of self-regulation. While this chapter’s placement might be debated – perhaps earlier, before the phenomenological description of ADHD – its depth is undeniable.
The subsequent exploration of the theory’s implications for ADHD treatment is particularly valuable. It offers a framework for understanding the daily challenges faced by individuals with ADHD, moving beyond simply excusing behaviors as solely a consequence of the disorder. Barkley’s insightful concept of “blindness to time” as a significant, yet often underestimated, disability in ADHD is powerfully articulated. This resonates deeply with clinicians who consistently observe time management difficulties in their ADHD patients. Another practical idea is the advocacy for treatments delivered “at the point of performance,” aiming to support individuals with ADHD in utilizing their existing skills and knowledge effectively. The rationale for medication in ADHD is well-supported, arguing that psychostimulants and other effective medications are uniquely positioned to improve inhibition while active in the brain. The importance of externalizing motivation and adopting a chronic disability perspective in the overall management of ADHD are also emphasized.
Chapter eight marks the beginning of the assessment section. Over the next four chapters, the handbook details interview techniques, rating scales, and observational measures essential for ADHD assessment. This chapter includes a highly practical table offering differential diagnostic tips for distinguishing ADHD from other comorbid mental disorders. This clinician-friendly resource is invaluable for quick reference in diagnostic settings. Furthermore, it provides updated guidance on navigating legal and ethical considerations in the treatment of individuals with ADHD, specifically addressing guardianship/custody issues, mandatory reporting of suspected abuse or neglect, and the legal accountability of children with ADHD.
Chapter nine clarifies that psychological testing, in isolation, is not diagnostic of ADHD. It highlights Continuous Performance Tests (CPTs) as the most evidence-based psychological tests currently available for aiding in ADHD diagnosis.
Chapter ten is presented as essential reading, offering ten detailed clinical case vignettes. These cases effectively illustrate the application of theoretical knowledge to real-world clinical scenarios. While experienced child psychiatrists will likely recognize similar cases from their own practice, these vignettes serve as crucial reminders for trainees and researchers about the ultimate clinical purpose of ADHD assessment and understanding – to effectively help individuals affected by the disorder.
Chapter eleven systematically explores the assessment of ADHD in adults. It outlines four key areas for evaluation: establishing the presence of symptoms before the age of 12, documenting impairment across multiple life domains, exploring alternative explanations for presenting symptoms, and clarifying the presence of comorbid disorders.
The final section, dedicated to treatment, is substantial, comprising eleven chapters. Chapter 12 focuses on parent training treatment formats, while the subsequent chapter contrasts this with parent training in large group settings. A COPE (Community Parent Education) model is described, detailing its integrated principles, large group structure, cost-effectiveness, and limitations. The discussion of limitations, including accessibility issues and varied benefit across families, is particularly insightful. However, the handbook notes that COPE programs have been rigorously evaluated and compared favorably to other interventions, such as social learning parent training models.
Chapter 14 provides practical tools for managing ADHD in adolescents, presenting a biobehavioral family systems model. The chapter’s focused style clearly outlines parenting principles for adolescents with ADHD, describing specific interventions with illustrative clinical excerpts.
The following chapter shifts focus to teachers and school systems as crucial intervention points. This chapter is rich with actionable information for supporting patients within educational settings. The two primary goals of school-based interventions are defined as educating teachers about ADHD and enhancing home-school collaboration. Functional behavior assessments and nine key management strategies are recommended. Core interventions include practical, common-sense approaches such as modifying classroom layout and adapting academic programs to individual student abilities.
An innovative intervention approach is described in chapter 16, where peers are utilized to assist children with ADHD in regulating impulsive behavior through student-mediated conflict resolution programs. Playground mediation and its role in reducing bullying experiences are thoroughly explored.
Chapter 17 offers comprehensive information on the history, indications, pharmacology, and clinical effects of stimulant medications. The discussion on treating comorbid symptoms in ADHD and the detailed review of acute side effects are particularly valuable. The subsequent chapter briefly but relevantly describes the use of antidepressants and SNRIs in ADHD treatment. Chapter 19 addresses the management of complex, treatment-resistant ADHD cases, discussing the use of antidepressants, modafinil, and clonidine. It also covers the use of anticonvulsants and specific populations where antipsychotic medications may be indicated. Practical guidelines are provided for clinicians managing polypharmacy in ADHD, such as in cases with co-occurring Tourette’s disorder or severe anxiety.
Chapter 20 advocates for combined child therapies to maximize symptom reduction. It also acknowledges potential side effects within psychosocial treatments, such as behavioral contagion in social skills training and conflict escalation in behavioral family therapy. The final two chapters detail psychological counseling and pharmacotherapy interventions specifically for adults with ADHD.
Overall, Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment is exceptionally well-referenced and incorporates the latest research. Having reviewed previous editions, this edition is notably more engaging and accessible in its presentation. It serves as an essential reference book for individual professional libraries and is a must-have resource for departmental libraries. This handbook is an invaluable tool for anyone working with or seeking to understand Attention Deficit Hyperactivity Disorder.
