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Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 4th Ed. Russell A. Barkley, Ed. (2014) New York: The Guilford Press. 898 pp.

Mavrides, Nicole MD

The Journal of Nervous and Mental Disease: January 2016 - Volume 204 - Issue 1 - p 66
doi: 10.1097/NMD.0000000000000412
Book Reviews

Assistant Professor of Psychiatry and Behavioral Science University of Miami Miller School of Medicine FL

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Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric illnesses that child and adolescent psychiatrists and therapists treat on a daily basis and is also one of the most frequent referrals made in the United States and elsewhere. When asked to review the fourth edition of Russell Barkley's Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, I was thrilled to educate myself on the newest aspects of etiology, assessment, and treatment of ADHD. Although the book itself is massive and seems intimidating, the chapters are well written and succinct enough for any clinician or researcher to appreciate. There are a plethora of books on the assessment and treatment of ADHD, but Russell Barkley's Handbook for Diagnosis and Treatment is an indispensable guide with clinical tools and teaching resources.

The purpose of this book, now in its fourth edition, is to present state-of-the-art evidence, based on treatments and supported by the newest advancements in the understanding of one of the most frequently encountered psychological disorders in children, adolescents, and more recently diagnosed in adults, ADHD.

The authors of each of the book's chapters are distinguished scholars and clinical investigators as well as experts in their individual fields. They have been successful in updating, addressing, and sharing the newest findings, conclusions, and clinical recommendations for each aspect of ADHD.

The textbook is divided into four parts—the nature of ADHD, the assessment of ADHD, treatment of children and adolescents with ADHD, and treatment of adults with ADHD. The book's effectiveness is enhanced by the consistency of each of its well-organized chapters. Each chapter is dedicated to a specific issue or psychopathologic feature of ADHD. Included is the array of treatment options, from behavioral to psychopharmacologic and to complementary alternatives. Key Clinical Points is located at the end of each chapter, which assists clinicians as they summarize the major conclusions and recommendations discussed in the text.

This updated version of Russell Barkley's book defines aspects of the etiology of ADHD and discusses common problems that individuals with ADHD suffer from. In one of the newer chapters, titled Peer Relationships of Children With ADHD, the author discusses a major concern of parents with ADHD children. The boys and girls tend to have difficulty in socializing and in establishing lasting friendships. They also emphasize that peer rejection and bullying predict greater emotional and behavioral problems in children with ADHD than they would in typical children. Even though additional research is needed, the authors effectively demonstrate that adolescents with ADHD are at higher risk of engaging in sexually risky behaviors and experience social impairments when using online social media than are their peers without ADHD.

Oftentimes, parents ask if there are effective natural or alternative treatments available to help their children with ADHD. It was refreshing to see that an entire chapter in this fourth edition textbook is devoted to the complementary and alternative medicine (CAM) options for ADHD. CAM has been used by up to 38% of US adults older than 18 years and by 12% of US children. These numbers, taken from studies in 2007, demonstrate an impressive increase from years past. The chapter reviews mind-body therapies such as yoga, massage, and meditation as well as encouraging patients to exercise and spend additional time outdoors. It also touches upon the effectiveness or ineffectiveness of acupuncture as well as dietary supplements and elimination diets. The authors support their conviction that pharmacotherapy with stimulants works faster than any of the natural methods of treating ADHD.

As a practicing child psychiatrist, I found the detailed account of the execution of treatment to be most valuable. The 10 chapters on the treatment of children and adolescents and 5 chapters on the treatment of adults are extremely thorough and well thought out. The chapter on executive function training for children with ADHD (Chapter 26) is a fairly new, innovative, nonpharmacological treatment. This methodology is demonstrating initial evidence that with facilitative intervention training and mindfulness, children's impairment with ADHD will lessen. This newly published information provides clinicians with more data and treatment options to try if medications are not effective and/or if parents are not interested in pharmacotherapy. Barkley stresses the efficacy of pharmacotherapy in Chapter 27. While impressing upon the reader that medications should be used as part of a “larger” comprehensive psychoeducational plan of interventions for children with ADHD” (p. 681), he also discusses the stimulant and nonstimulant options of treating children with ADHD. This textbook includes a combination of accepted evidence-based therapies with those that have been polished and updated to reflect effective, study-based innovations in knowledge and protocols.

The charts and tables in most chapters, like the one on stimulant options and doses, greatly contribute to the dissemination of clinical material. The studies reviewed were excellent in helping to demonstrate to patients and clinicians alike the amount of research dedicated to the understanding and treatment of ADHD.

In conclusion, Barkley's fourth edition of his textbook on ADHD upholds the tradition of excellence seen in his previous editions as being an exceptional resource for clinicians. It should also be the textbook of choice, for all of those in mental health training programs (especially child and adolescent psychiatry fellowships). This book continues to demonstrate that ADHD is a valid mental disorder that extends throughout a lifespan. It also shows there are a multitude of therapeutic options available to its treatment. The book Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment has absolutely surpassed its objectives in providing state-of-the-art scientific knowledge, expanding topical areas covered on ADHD, presenting empirically tested therapy, and teaching clinicians how to implement these therapies in a clear and concise manner.

Nicole Mavrides, MD

Assistant Professor of Psychiatry

and Behavioral Science

University of Miami Miller School of Medicine


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The author declares no conflict of interest.

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