by Stanley I. Greenspan and Jacob Greenspan, Cambridge, MA, Da Capo Press, 2009, 198 pp, Hardcover, $25.00.
In the midst of ongoing media coverage of the risks of attention deficit hyperactivity disorder (ADHD) stimulants and parents' and professionals' concerns about their safety, this new book presents the authors' technique of nonpharmacological treatment for ADHD. The first chapter lays out the authors' view of the multiple types and etiologies of ADHD. They describe issues including differences in motor sequencing, levels of reactivity to sensation, and visual-spatial processing that they find commonly in children with this condition.
The book then turns to a series of chapters addressing treatments for these differences. They describe a myriad of exercises designed to help with specific difficulties such as motor planning or sensory responsiveness. One example from their sequential strategy is to perform increasingly complex treasure hunts to provide practice in motor activity, sequencing, and planning. Other activities seek to increase self-awareness and reflection on a child's strengths and weaknesses.
The authors then discuss the important topic of self-esteem in children with ADHD. They continue by examining the child's context including advice on creating a supportive family environment and on considering the physical environment, including the role of diet in ADHD. After a chapter on adults with ADHD, the book closes with a recommendation for further evaluation should the techniques in this book not provide sufficient improvement after a defined period of time. Appendices include a questionnaire to evaluate a child's unique sensory processing and motor abilities and a brief bibliography and list of further resources.
This book is squarely aimed at parents who have significant hesitation about medication treatment and wish to embark on a nonpharmacological treatment program themselves. It is a slim volume, written in an engaging and enthusiastic voice that should be easy for most parents to read.
The activities contained within this book are clearly of low risk compared with stimulant medication. However, one limitation is the relative lack of peer-reviewed evidence for the sensory, motor, and visual-spatial techniques described in this book. In addition, waiting 6 months to initiate other treatments, as the authors suggest, may result in a significant delay in obtaining other treatments that have demonstrated efficacy. Finally, because of the number of exercises described, it may be difficult for a family to design and implement a program for their child's specific motor, sensory, and visual-spatial needs. The authors recommend that parents might hire a high school or college student to carry out the activities should they not have sufficient time.
Ultimately, how this book is viewed will depend on the reader's opinion of sensory, motor, and visual-spatial treatments for ADHD. For those who see such approaches as being important therapies or adjuncts to other therapies, this book will be a welcome recommendation for parents. For those who view these approaches as unproven and likely ineffective treatments, this volume will be more difficult to recommend.
Mihael Ching, MD, MPH, FAAP
Tripler Army Medical Center