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Managing attention deficit disorders in children: A guide for practitioners
Archives ofClinicd Neump~~hology. Vol. 7. pp. 553-556. Printed in the USA. All rights reserved.
1992
0887-6177192 $5.00 + .oO Copyright Q 1992 National Academy of Nwopychology
Book and Test Reviews Arthur MacNeill
Horton, Jr., Associate Editor
Psych Associates, Towson, MD
Managing Attention Deficit Disorders in Children: A Guide for Practitioners, By S. Goldstein 8z M. Goldstein, New York: John Wiley & Sons, 1990,451 pp. Considering the fact that various estimates suggest that some 3-6% of the school-age population suffers from Attention Deficit Disorder (ADD), it is surprising that this book was not published long ago. This volume is really the first comprehensive volume to specifically target strategies on how to work productively with children who suffer deficits in attention, impulse control, and motor regulation. The authors of this volume, Sam Goldstein and Michael Goldstein, are very well qualified to write such a book, as Sam Goldstein is a child psychologist who specializes in the multidisciplinary evaluation and treatment of children with ADD and Michael Goldstein is a pediatric neurologist. Although neither of the authors have published research on ADD in the traditional scientific literature, they have written two other books together: A Parent’s Guide to Attention Deficit Disorders in Children, and A Teacher’s Guide to Attention Deficit Disorders in Children. This volume is generally very well written, current with the literature, and presents a concise guide for the diagnosis and treatment of ADD. The book is divided into three sections. The first section, Overview, Background, and Etiology, presents two chapters. The first chapter provides an excellent overview of the history of thought regarding what is now referred to as Attention Deficit Hyperactivity Disorder (ADHD). Importantly, this first chapter addresses the difficult issue of what nomenclature best describes this disorder. As they point out, the most recent revision of the DSM-III has produced a great deal of controversy and the diagnostic criteria for what is referred to as ADHD are not well accepted. Two points are emphasized by these authors. First, despite the listing of diagnostic criteria in the DSM-III-R, the listing of symptoms is not adequate for a diagnosis of ADHD. Second, they present their working definition of ADHD and note five criteria for diag-
554
Book and Test Reviews
nosis of ADHD. These include meeting the DSM-III-R criteria, elevated rating scale scores, objective measures of ADHD, the need for situational data, and the need for a differential diagnosis. Their articulation of these criteria is a significant contribution by itself; more importantly, however, the remainder of the book is derived from this diagnostic perspective. The remainder of the first chapter discusses the developmental course of ADHD and how possible outcomes might be predicted. The first and the second chapters should be required reading for any parent, teacher, or student who is interested in ADHD. The second chapter discusses the literature regarding etiology. Topics covered include brain injury, the possible impact of refined sugar, the Feingold diet, lead ingestion, and other factors that have been associated with ADHD, including both medical and nonmedical problems. These sections are current with the literature, well written, and accurate in their conclusions. The second section is also very well done. Chapters 3-7 focus on The Medical Evaluation, School and Home Evaluation, Clinical Evaluation, and Making the Diagnosis of ADHD. The third chapter should be a must reading for psychologists and physicians alike. In Chapter 3, there is an excellent discussion of what the authors refer to as the physician’s dilemma. As they point out, the diagnosis of ADHD does not conform well to the typical mode of medical evaluation, as the physician must rely on the reports of others to derive the diagnosis, and diagnostic tests often provide confusion and frequently conflicting information. This dilemma is addressed by providing guidelines for the role of the physician in the diagnostic evaluation. Discussions of various diagnostic tests and when medication is contraindicated conclude the chapter. Chapter 4 focus on assessment procedures including those typically administered such as the Connor’s Checklist and Achenbach Child Behavior Checklist to methods for direct observation. Chapter 5 discusses ways in which objective data can be obtained from parents, including home situation methods. In Chapters 4 and 5, examples of these methods of assessment are provided, and these may be especially helpful to the reader who is unfamiliar with assessment procedures for ADHD children. The discussion is current and targets procedures most widely accepted by clinicians. Chapter 6 presents information on what is referred to as “clinical evaluation” of attentional problems. In this chapter, assessment tasks range from behavioral observation during assessment to psychometric assessment, including measures of vigilance, memory span, cancellation tasks, to assessment of academic performance and personality. While the assessment procedures discussed in the chapter are common enough to most clinicians, it would appear that these procedures are really not primary in making the diagnosis of ADHD. since the criteria for diagnosis are behavioral, not psychometric. Clearly, these procedures are needed to fully articulate the many deficits that ADHD children may have in academic perfor-
Book and Test Reviews
555
mance or in social-emotional functioning, but their use in the diagnosis of ADHD is not essential unless one wishes additional information on the ADHD child. Nonetheless, this chapter provides a usefut resource on additional clinical measures that might be of value in the overall assessment of the child. Chapter 7 is the central chapter in this volume, as it deals with making the diagnosis of ADHD. The chapter provides an integrative model for the differential diagnosis of ADHD and incorporates a useful discussion of other possible concomitant disorders that may be derived through the clinical assessment. A number of illustrative case reports are provided in which the relationship between ADHD and other behavioral, neurologic, and psychiatric disorders is demonstrated. This is a very useful chapter for the clinician and underscores the clinical complexities associated with arriving at the diagnosis of ADHD and other concomitant disorders. This chapter should be required reading for beginning cfinicians, as the information presented illustrates well an integration of the research literature and clinical diagnosis. The third section, Chapters 8-13, provides an overview of various approaches to intervention. Discussed are the importance of the multidisciplinary/multitreatment model, medical intervention, cognitive-mediational interventions, managing the ADHD child, social skills treatment, and teaching parents to cope with their ADHD child. Chapters 8 and 9 on multidisciplin~ and medical treatment are especially well written and informative. The remaining chapters provide a useful summary of various approaches to management and treatment. These latter chapters could have been improved significantly if case studies had been included and discussed in the context of the text of the chapters. Also, what might be viewed as bothersome to those with a more empirical perspective is that the meager literature v~idating the usefulness of these approaches specifically with ADHD children is not highlighted; most likely because such studies do not exist and those studies that are in the literature have failed to document long-term treatment effects. Clearly, Chapters 8 and 9 are excellent and the remaining chapters present an overview of techniques and procedures that may help on a case by case basis. Fir&y, there are a number of appendices which provide additional information in support of the previous text. An excellent subject and author index are provided as well. Overall one might ask what is the relative contribution of this volume? This is an especidly important question as Barkley (1990) has also just published an outstanding book on ADHD. This book delivers exact& what it promises; it is a comprehensive guide for practitioners. Barkley’s (1990) volume is an equally outstanding contribution but is very clearly more oriented toward the researcher or practitioner who is more interested in a solid theoretical and scholarly treatment of ADHD. Nonetheless, Goldstein and Goldstein’s volume should be on every practitioner’s bookcase as a solid and comprehensive guide for both the physician and clinical practitioner alike.
556
Book and Test Reviews
REFERENCE Barkley, R. A. (ed.) (1990). Attention deficit hyperactivity disorder. New York: The Guilford Press. Jose Gonzalez & George W Hynd University of Georgia
1992
0887-6177192 $5.00 + .oO Copyright Q 1992 National Academy of Nwopychology
Book and Test Reviews Arthur MacNeill
Horton, Jr., Associate Editor
Psych Associates, Towson, MD
Managing Attention Deficit Disorders in Children: A Guide for Practitioners, By S. Goldstein 8z M. Goldstein, New York: John Wiley & Sons, 1990,451 pp. Considering the fact that various estimates suggest that some 3-6% of the school-age population suffers from Attention Deficit Disorder (ADD), it is surprising that this book was not published long ago. This volume is really the first comprehensive volume to specifically target strategies on how to work productively with children who suffer deficits in attention, impulse control, and motor regulation. The authors of this volume, Sam Goldstein and Michael Goldstein, are very well qualified to write such a book, as Sam Goldstein is a child psychologist who specializes in the multidisciplinary evaluation and treatment of children with ADD and Michael Goldstein is a pediatric neurologist. Although neither of the authors have published research on ADD in the traditional scientific literature, they have written two other books together: A Parent’s Guide to Attention Deficit Disorders in Children, and A Teacher’s Guide to Attention Deficit Disorders in Children. This volume is generally very well written, current with the literature, and presents a concise guide for the diagnosis and treatment of ADD. The book is divided into three sections. The first section, Overview, Background, and Etiology, presents two chapters. The first chapter provides an excellent overview of the history of thought regarding what is now referred to as Attention Deficit Hyperactivity Disorder (ADHD). Importantly, this first chapter addresses the difficult issue of what nomenclature best describes this disorder. As they point out, the most recent revision of the DSM-III has produced a great deal of controversy and the diagnostic criteria for what is referred to as ADHD are not well accepted. Two points are emphasized by these authors. First, despite the listing of diagnostic criteria in the DSM-III-R, the listing of symptoms is not adequate for a diagnosis of ADHD. Second, they present their working definition of ADHD and note five criteria for diag-
554
Book and Test Reviews
nosis of ADHD. These include meeting the DSM-III-R criteria, elevated rating scale scores, objective measures of ADHD, the need for situational data, and the need for a differential diagnosis. Their articulation of these criteria is a significant contribution by itself; more importantly, however, the remainder of the book is derived from this diagnostic perspective. The remainder of the first chapter discusses the developmental course of ADHD and how possible outcomes might be predicted. The first and the second chapters should be required reading for any parent, teacher, or student who is interested in ADHD. The second chapter discusses the literature regarding etiology. Topics covered include brain injury, the possible impact of refined sugar, the Feingold diet, lead ingestion, and other factors that have been associated with ADHD, including both medical and nonmedical problems. These sections are current with the literature, well written, and accurate in their conclusions. The second section is also very well done. Chapters 3-7 focus on The Medical Evaluation, School and Home Evaluation, Clinical Evaluation, and Making the Diagnosis of ADHD. The third chapter should be a must reading for psychologists and physicians alike. In Chapter 3, there is an excellent discussion of what the authors refer to as the physician’s dilemma. As they point out, the diagnosis of ADHD does not conform well to the typical mode of medical evaluation, as the physician must rely on the reports of others to derive the diagnosis, and diagnostic tests often provide confusion and frequently conflicting information. This dilemma is addressed by providing guidelines for the role of the physician in the diagnostic evaluation. Discussions of various diagnostic tests and when medication is contraindicated conclude the chapter. Chapter 4 focus on assessment procedures including those typically administered such as the Connor’s Checklist and Achenbach Child Behavior Checklist to methods for direct observation. Chapter 5 discusses ways in which objective data can be obtained from parents, including home situation methods. In Chapters 4 and 5, examples of these methods of assessment are provided, and these may be especially helpful to the reader who is unfamiliar with assessment procedures for ADHD children. The discussion is current and targets procedures most widely accepted by clinicians. Chapter 6 presents information on what is referred to as “clinical evaluation” of attentional problems. In this chapter, assessment tasks range from behavioral observation during assessment to psychometric assessment, including measures of vigilance, memory span, cancellation tasks, to assessment of academic performance and personality. While the assessment procedures discussed in the chapter are common enough to most clinicians, it would appear that these procedures are really not primary in making the diagnosis of ADHD. since the criteria for diagnosis are behavioral, not psychometric. Clearly, these procedures are needed to fully articulate the many deficits that ADHD children may have in academic perfor-
Book and Test Reviews
555
mance or in social-emotional functioning, but their use in the diagnosis of ADHD is not essential unless one wishes additional information on the ADHD child. Nonetheless, this chapter provides a usefut resource on additional clinical measures that might be of value in the overall assessment of the child. Chapter 7 is the central chapter in this volume, as it deals with making the diagnosis of ADHD. The chapter provides an integrative model for the differential diagnosis of ADHD and incorporates a useful discussion of other possible concomitant disorders that may be derived through the clinical assessment. A number of illustrative case reports are provided in which the relationship between ADHD and other behavioral, neurologic, and psychiatric disorders is demonstrated. This is a very useful chapter for the clinician and underscores the clinical complexities associated with arriving at the diagnosis of ADHD and other concomitant disorders. This chapter should be required reading for beginning cfinicians, as the information presented illustrates well an integration of the research literature and clinical diagnosis. The third section, Chapters 8-13, provides an overview of various approaches to intervention. Discussed are the importance of the multidisciplinary/multitreatment model, medical intervention, cognitive-mediational interventions, managing the ADHD child, social skills treatment, and teaching parents to cope with their ADHD child. Chapters 8 and 9 on multidisciplin~ and medical treatment are especially well written and informative. The remaining chapters provide a useful summary of various approaches to management and treatment. These latter chapters could have been improved significantly if case studies had been included and discussed in the context of the text of the chapters. Also, what might be viewed as bothersome to those with a more empirical perspective is that the meager literature v~idating the usefulness of these approaches specifically with ADHD children is not highlighted; most likely because such studies do not exist and those studies that are in the literature have failed to document long-term treatment effects. Clearly, Chapters 8 and 9 are excellent and the remaining chapters present an overview of techniques and procedures that may help on a case by case basis. Fir&y, there are a number of appendices which provide additional information in support of the previous text. An excellent subject and author index are provided as well. Overall one might ask what is the relative contribution of this volume? This is an especidly important question as Barkley (1990) has also just published an outstanding book on ADHD. This book delivers exact& what it promises; it is a comprehensive guide for practitioners. Barkley’s (1990) volume is an equally outstanding contribution but is very clearly more oriented toward the researcher or practitioner who is more interested in a solid theoretical and scholarly treatment of ADHD. Nonetheless, Goldstein and Goldstein’s volume should be on every practitioner’s bookcase as a solid and comprehensive guide for both the physician and clinical practitioner alike.
556
Book and Test Reviews
REFERENCE Barkley, R. A. (ed.) (1990). Attention deficit hyperactivity disorder. New York: The Guilford Press. Jose Gonzalez & George W Hynd University of Georgia