7 of 8 people found the following review helpful:
5.0 out of 5 stars
Authoritative, July 8, 2010
This review is from: Attention-Deficit Hyperactivity Disorder, Third Edition: A Handbook for Diagnosis and Treatment (Hardcover)
I'm a patient. Self-help books written for a general audience can be great, but if you find yourself on the last page with too many unanswered questions about details or causes or evidence - if you want the final word (insofar as there can be one) - and you can deal with college-level material and some jargon, then this book is what you need. At least it's the best such book. You may find yourself reading several "textbooks" after this, as I did, but this is the best. Barkley is probably the single most respected and cited expert in the field. He wrote more than a third of the book and selected the best people in the field to write the other chapters. This is a summary and overview of all that was known scientifically as of 2006, and there's nothing newer that's nearly as comprehensive. As an academic work should, it has all the citations of peer-reviewed journal articles etc. that you'd need to get even further into the subject.
For an adult patient or the parent of an affected child, the knowledge you can gain here will allow you to better understand the particular form/nature of the disorder you're facing. It's said that every case of ADD is different - really different. No self-help book can address the nuances and peculiarities of an individual case. But armed with the scientific data in this book you can both get a more clinical look at your own case and be better able to read those self-help books with insight and a critical eye.
For primary care practitioners, mental health and social work professionals, educators, caregivers in specialized fields related to ADD, and any other professionals who might run into ADHD kids or the 4% to 8% (or so) of adults who have some form of the disorder: a plea from a patient who wasn't diagnosed until age 54. Please read this book. Please. Had anyone suggested to me that I might have ADHD just a year earlier, not to mention ten or thirty years earlier, I might have saved myself (and others) much pain and many difficulties. This book can help you make that difference for someone. And of course if you're routinely dealing with ADHD this book is a must-read.
Lots of researchers disagree with Barkley, though usually just in part. There's still much that's mysterious about this disorder. I don't want to imply that this book is the beginning and end of the subject. Only that it's a great overview and starting point for the scientifically-minded.
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3 of 4 people found the following review helpful:
5.0 out of 5 stars
Full Coverage - Barkley Does It Again, June 28, 2011
This review is from: Attention-Deficit Hyperactivity Disorder, Third Edition: A Handbook for Diagnosis and Treatment (Hardcover)
One of the most frequent and important topics of concern is medication for ADHD. Barkley stresses the efficacy of pharmacotherapy among three chapters under the following headings: 1) stimulants, 2) antidepressants, modafinil, and anti-hypertensives, and 3) others.
Although psycho-social interventions are invariably recommended to accompany pharmacotherapy, treatment with stimulants alone results in reported behavioral improvement in 70% to 90% of students diagnosed with ADHD, and all three subtypes (Inattentive, Hyperactive-Impulsive, and Combined) respond well. Barkley stresses that stimulants should be used first before other medications. In fact, he recommends prescribing various stimulant medications before trying other forms of medication. What is very important is that the variability of outcome is largely due to the presence of co-morbid disorders. For example, among children with major depressive disorder (15% to 30% of children with ADHD), a favorable response to stimulants may be reduced. The same is indicated with children with co-morbid anxiety disorders (25% to 30% of children with ADHD). However, stimulant medication should be administered first because it generally does not exacerbate the anxiety, and its efficacy can be assessed very quickly.
It appears that the fear of a student developing tics or Tourette's Syndrome is unfounded. Even if tics appear or increase, they almost always return to the pre-medication level in a couple of months, even when medication is continued. In addition, the author believes that the scare from 12 deaths of children who were taking Addreall XR is also unfounded. Among these children, five already had serious heart problems, and the death rate from similar problems is the same as that among children not taking medications. Based on meta-analyses of large numbers of studies, the author concluded that among healthy children, routine blood work and monitoring of the heart is not needed. However, monitoring of the child's height and weight should be done twice a year.
With a number of students taking stimulant medication, a "rebound" phenomenon is sometimes noticed in the afternoon or evening when the medication wears off. With this, the increase of ADHD types of behaviors may exceed what was observed before pharmacotherapy began. This has important implications for parents; it may appear that medication has no effect, or is even making things worse. Barkley recommends a longer-acting preparation, or the administration of a small dose of stimulant medication about one hour before the rebound symptoms are usually noticed.
During 1990-2000, stimulant use for ADHD children two to four years of age increased threefold. The efficacy of pharmacotherapy is more variable with this young population, and side effects are more often reported. The majority of the side effects seem to center on changes in their emotions - sadness, irritability, outbursts, and clinging behaviors. When pharmacotherapy is being used with this young population, it is imperative that the parents, teachers and physicians keep monitoring the children for emotional as well as physical changes.
Although Barkley wrote that stimulants should be the first drugs tried, he also considers Strattera to be a first-line medication, and he seems to favor it. Strattera is a new class of drug that has been developed, and it is the first non-stimulant drug to be FDA approved. (No others have been approved since.) It takes several weeks for the effects to be seen, but, compared to stimulants, fewer problems were observed with appetite suppression, growth and weight, and parents reported fewer emotional difficulties and greater self-esteem in their children.
The second-line agents for ADHD are to be considered for the up to 30% of those who do not respond to stimulants and/or suffer from severe side effects. The most frequently used and recommended are antidepressants, specifically tricyclic antidepressants (Imipramine, Nortriptyline, and Desipremine), Bupropion, Venlafaxine, and Fluoxetine. The tricyclics seem to show improvement to approximately the same extent as stimulants, and they often have positive effects on mood, anxiety, sleep, oppositionality, and tics. However, the author still emphasizes that they should be used as a second-line drug. It is recommended when there is co-morbid anxiety, depression, or tic disorders. Bupropion, Venlafaxine, and Fluoxetine are not recommended because of little research to date and/or a high incidence of serious side effects.
The third-line drugs are Modafinil, antihypertensive agents, and an anticonvulsant (Tegretol). These are to be considered if there is an unsatisfactory response to the first- and second-line drugs, if there are severe side effects with them, or if there is concern about tics or heart problems. Modafinil was originally prescribed to improve wakefulness by activating parts of the hypothalamus. However, it should not be used with children, and there are numerous side effects. Research has shown that the antihypertensive agents are clearly not as effective as stimulants, but they can be beneficial in reducing aggressiveness, explosive outbursts and conduct problems. It takes up to three months to determine efficacy, and the drugs need to be administered two to three times a day. Among the antihypertensive drugs, Clonidine is probably the most effective and fewer side effects are noted. Finally, Tegretol is used for treating ADHD in Europe, but it is felt that much more research is needed and there is more potential for side effects than with other drugs.
Antihistamines, benzodiazepines, and lithium have not proved to be effective for the treatment of ADHD.
Although the number of students taking medication for ADHD has doubled and even tripled in the past decade, Barkley appears to advocate increased applications, both throughout the lifespan and throughout the day. ADHD continues throughout one's life among about half of the individuals with this disorder, so the author concludes that stimulant medication should probably continue throughout their lifespan. He also "emphasizes extended treatment of symptoms throughout the day." This seems to contradict other realities; namely, the increasing ability, as one matures, to control one's behaviors and/or environment. For example, as a group, symptoms of ADHD-HI tend to decrease with age, more often than symptoms of ADHD-I do. Barkley himself speculates that adolescents may have developed more ability to inhibit motor responses, while other adolescents may be continuing the behavior in a "disguised" fashion (moving their legs or tapping their fingers while otherwise seated quietly). Should not we be advocating this self-control, hopefully without the use of medication, as much as possible? Of course, among many people with ADHD, many areas of their lives will be significantly affected, and they will need medication. However, with counseling many will also be able to choose and structure environments in which ADHD will not significantly impair their functioning. In addition, Barkley does not comment on the "reinforcement contingencies" with those who are affected by a student's ADHD. It is quite obvious that it makes life much easier for teachers, parents, and administrators if the symptoms can be reduced in a simple and effortless fashion. This is not to say that pharmacotherapy should not be used; rather, only that it should not be encouraged. Finally, since there are still not many long-term studies, it seems almost dangerous to encourage not only the lifetime ingestion of the drugs, but also the round-the-clock use of it.
Sometimes it may be helpful to inform parents and teachers of the "associated problems" that are thought to often accompany ADHD, such as learning disabilities, oppositional defiant disorder, conduct disorder, anxiety, and depression. However, caution is needed. Barkley cites extensive research about these problems related to ADHD, and most of it is conflicting. Moreover, these "associated problems" are often observed among non-ADHD children, so their existence should not indicate a diagnosis of ADHD. It is important to inform people that although there is a higher incidence of these problems among ADHD students, there is no evidence of causal connections, and many non-ADHD students have these problems.
However, Barkley specifies cognitive problems that invariably accompany ADHD; these are the ones that are most helpful in understanding and treating the disorder. The most obvious is that the ADHD student is observed by most people to have a lack of self-control. Self-control manifests itself in inhibiting one's responses when needed (staying in one's seat or not blurting out an answer or opinion), sustaining effort (completing assignments), and attending. The main factors that lie at the heart of self-control, according to Barkley, are the mechanisms used to delay reinforcement.
These mechanisms are executive functioning, memory, planning, and internalized speech. They are invariably impaired or delayed in development among ADHD students. In addition, many of the associated problems seem to stem from these difficulties. For example, students with ADHD have lower adaptive functioning (as a group), relative to their intelligence, than students with average intelligence and those who are retarded. Barkley writes that "deficits in executive functions may....explain (or contribute to) the deficits found in adaptive functioning in ADHD" (p. 124). It has often been reported that ADHD students tend to talk more than non-ADHD students, but that this is with spontaneous conversation as opposed to explanatory speech. Barkley points out that "their problems are not so much in speech and language...
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