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ADHD Diagnosis and Management: A Practical Guide for the Clinic and Classroom

Andrews, Debbi MD, FRCP(C)

Journal of Developmental & Behavioral Pediatrics: October 2011 - Volume 32 - Issue 8 - p 590
doi: 10.1097/DBP.0b013e31822d5694
Book Review

Division of Developmental Pediatrics, University of Alberta, Edmonton, Alberta, Canada

by Mark Wolraich, MD, George DuPaul, PhD, Baltimore, MD, Paul H. Brookes Publishing Co., Inc., 2010, 216 pp, Paperback, $34.95

This is an excellent book. Written for professionals working in the field, it is a concise, current, highly readable, evidence-based review of what we know about the diagnosis and management of attention deficit/hyperactivity disorder (ADHD). Mark Wolraich and George DuPaul have managed to fill this important niche, which surprisingly had not yet been covered by the plethora of ADHD books already on the market.

The book is well organized. Wolraich and DuPaul guide us systematically through the literature on ADHD. They start with an overview and history of the condition, from original descriptions by Still and Bradley to the development of the criteria for the disorder through the various iterations of the DSM. This leads into a discussion of epidemiology and etiology, including key studies of the neuroanatomy, neurophysiology, and neurochemistry. Chapter 3 presents one of the most lucid discussions I have ever read on the issues of screening. In this case, the focus is on ADHD and comorbid disorders, but the chapter could easily be used as assigned reading on screening for developmental conditions in general. Whom do we screen? When? How do we decide cutpoints in a normative sample? What are the risks and benefits? How do we balance sensitivity and specificity?

Chapters 4 and 5 both deal with aspects of the assessment process. The first chapter describes the diagnosis of ADHD and its comorbidities and parallels the American Academy of Pediatrics' 2000 Clinical Practice Guideline. This is followed by a discussion of functional impairments found in individuals with ADHD, citing the literature that demonstrates how these impairments have been identified in research subjects. Having easy access to these data is critical for those occasions when I am dealing with parents, teachers, and even some physicians who still adhere to the old model of ADHD as a moral deficit or a failure of parenting. Particularly useful is the section “Impairments in Relationships with Peers and Authority Figures.” In these days where autism spectrum disorders are constantly in the news and the general public worries that any child who can't make friends must be autistic, it is good to be able to remind people of the evidence for ADHD as a major cause of social impairment.

The next 3 chapters provide an overview of treatment—both pharmacologic and behavioral, including the groundbreaking The Multimodal Treatment Study of Children with ADHD study and all of its follow-up data right up to the 8-year longitudinal results published in 2009. A short section addresses treatments for which there is no empirical support. The family's role in collaboration and advocacy is presented. The excellent chapter “School Procedures and Interventions” will be of particular use to school personnel who want an evidence-based approach to developing specific and effective interventions for students with ADHD. Especially helpful and clear are the discussion about the effect sizes of various behavioral and academic approaches and the presentation of 4 principles that guide intervention development: proactive versus reactive strategies, use of multiple mediators to deliver treatment, consideration of a behavior's function, and periodic data collection to help with treatment decisions. As with the rest of the book, these sections are well supported with specific references.

The book ends with chapters on coordinated communication, future directions in ADHD research—in other words, what's not in the literature—and well-chosen sets of resources for health professionals, teachers, parents, and children, including a 2-page section labeled “Suggestions for Assessing the Veracity of Available Resources” to help parents and professionals find quality evidence to support care decisions for children with ADHD.

Wolraich and DuPaul's broad experience with both clinical aspects and ADHD research is readily apparent. Despite the many references to studies and statistics, the book is very readable, and I found it enjoyable from cover to cover. The careful organization of contents, chapter headings, and index also allow the user to dip in and quickly locate specific information.

I will be recommending this volume to pediatric residents and other trainees who have some basic knowledge of ADHD and want to familiarize themselves with the core literature but who don't have time to read all the original sources. However, they will have to use a library copy or buy their own, because this book is going to live on the bookshelf right next to my desk so I can easily find the summaries of the evidence I need for my own ADHD-related teaching and practice.

Disclosure: The author has financial and consulting relationships with University of Albert/Edminton Pediatric Services; receives presentation funds from the Canadian Pediatric Society, and travel funds from World Health Developmental Disabilities Committee and Canadian Pediatric Society.

Debbi Andrews, MD, FRCP(C)

Division of Developmental Pediatrics

University of Alberta, Edmonton

Alberta, Canada

© 2011 by Lippincott Williams & Wilkins