I came to this book as a skeptic, and as someone who wants nothing to do with the meds. I had avoided reading Barkley because I knew him to be a big drug guy.
However, I found his explanation of ADHD as a problem of inhibition rather than attention to be interesting and to ring true. He also talks about how this relates to troubles with language, motor skills, learning problems and other things that are seen with some ADHD kids. It shed some light on the larger picture, and was very interesting and useful in thinking about the whole child, not just the ADHD behavior part. It was more in-depth than other explanations I had read of ADHD, and more convincing.
As for the drugs, he really does not emphasize them as much as I expected. Clearly, he believes they are effective and safe, but at one point he actually says that if you are just anti-drug don't bother trying them because you won't stick with it. Like other pro-drug things I have read, he does not really address the issue of how or when you decide to get off the drugs. I guess the drug companies aren't funding studies of that question.
One funny point -- in a section advising parents to take care of themselves, he cautions them to avoid caffeine and nicotine because they are stimulants and can make your heart race and increase your blood pressure. Not good for parents, but apparently OK for the kids.
The book actually spends a lot more time on behavior modification techniques than it does on the drugs. Ironically, many of these techniques are similar to those recommended by David Stein in his book Unraveling the ADD/ADHD Fiasco, which is as anti-diagnosis and drugs as Barkley's is pro. I have found many of these techniques to be useful, although I think the tokens and points thing is unwieldy and unrealistic.
The biggest negative of this book is the author's tone, which is offensive in several ways. First, he is paternalistic, frequently lecturing the reader to be critical of sources, etc, yet giving the impression that one should accept his information as scientific and accurate because he says it is.
Second, he gives a seemingly endless litany of ways in which these children will struggle and fail -- learning, friendship, behavior, work, etc. It was so depressing I had to put the book down for awhile. His one positive comment is that some ADHD kids may do well in the arts or in sales, but he is careful to qualify that remark by noting that they won't be better than "normal" kids, they just might be as good as "normal" kids in these areas.
Third, and most striking, is his complete lack of empathy for his patients. Once in awhile he seems to express at least some sympathy for the parents and their struggle, but I cannot think of any examples in which he puts himself in the ADHD kid's place and dicusses how it might feel to be on the receiving end of these problems, meds and other treatments. The child is viewed as the problem to be solved. He makes very clear that there are ADHD kids, and there are normal kids, and the two groups do not overlap. He sees these kids as very disabled and in need of sheltering from the normal demands of life. I'm sure that some days this is true, but it is a very pessimistic and condescending view in the long run, one that does nothing to prepare a person to live in the real world as an adult. He does not ever discuss the potential psychological consequences to the child of being treated by parents, teachers and doctors as so disabled and incapable of ever performing "normally." Treating your child as being as disabled as Barkley says may be a self-fulfilling prophecy. He could use to read a copy of Martin Seligman's book Learned Optimism.
Despite the negatives, I recommend this book. It has a practical focus, but still provides a detailed and interesting discussion of ADHD symptoms, behavior, etc. It favors the meds, but it does not beat you over the head with it or dismiss other approaches. In fact, it says that meds must be used in conjunction with other treatments.
Finally, Barkley seems to be a big cheese in the ADHD field, and even if you don't agree with him, it is useful to know what the mainstream point of view is. You may be surprised, as I was, to find more of value here than you expected.
