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Book Review   |    
Justin J. Trevino
Psychiatric Services 2008; doi:
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by Russell A. Barkley, Kevin R. Murphy, and Mariellen Fischer; New York, Guilford Press, 2007, 489 pages, $50

Dr. Trevino is assistant professor of psychiatry at Wright State University Boonshoft School of Medicine and assistant chief clinical officer at Twin Valley Behavioral Healthcare, Dayton, Ohio.

Rigorous, comprehensive, informative, and impressive are words that come to mind after reading this book. This effort rewarded me with a clear understanding of the issues involved in identification of patients with adult attention-deficit hyperactivity disorder (ADHD), the serious implications of the disorder in regard to life's functional domains, and a conceptualization of the core cognitive issues underlying the condition. The book's goal is to "report the results of two of the largest and most comprehensive studies of adults with ADHD conducted to date, juxtaposing the results for clinic-referred adults with the disorder against those for children with the disorder who have reached young adulthood." The diagnostic and clinical implications of the collected data are highlighted throughout ADHD in Adults, and selected comments regarding treatment interventions are offered. The authors clearly indicate that the work is not meant to cover potential etiologies of adult ADHD or treatment interventions in a comprehensive manner; they do provide alternative informational resources for these important areas.

The book begins with a comprehensive overview of the history of ADHD among adults and its measured prevalence. This is followed by a review of the DSM-IV criteria for diagnosis that includes the authors' observations regarding issues for consideration as DSM-V criteria are developed. Studies discussed throughout the book are the University of Massachusetts (UMASS) study of clinic-referred adults with ADHD and the Milwaukee Study, a longitudinal study of children given a diagnosis of ADHD at age six years or younger and followed to age 27 years. These studies are reviewed in detail as a prelude to in-depth discussions of the applicability of the DSM-IV symptom list (noted by the authors to have been developed with young children in mind) and age-of-onset requirement (before age seven years) to the diagnosis of adult ADHD. In light of the findings of the aforementioned studies, the authors provide recommendations for modification of these two diagnostic criteria domains.

The remainder of the work reviews the findings of the UMASS and Milwaukee studies in a very systematic manner. The overall burden of impairment in major life activities related to adult ADHD is discussed, followed by extended considerations of disorder-related impairment in several specific life domains, including education, occupation, health, money management, driving, dating and marriage, parenting, substance use, social behaviors, and neuropsychological functioning. In the chapters addressing this material, the format is uniform, with an introductory section reviewing the existing literature, a structured recitation of the pertinent findings of both noted studies (including highlighting differences in ADHD and control groups studied), and a "Conclusion and Clinical Implications" section reiterating important points of the chapter. The final chapter serves as an overall summary, emphasizing important issues related to patient assessment and behavioral management.

I appreciated the authoritative tone throughout the work. These authors' extensive involvement in the relatively underresearched field of adult ADHD was apparent. The literature reviews in each chapter were extensive and informative. The study data presentations provided information that often addressed noted gaps in the literature. The writing is clear and the data presentation well organized. Each chapter has numerous data tables and figures, and the conclusion sections are comprehensive. I was consistently impressed with the rigor in the material presentation and the obvious attention to detail demonstrated in the study designs, data processing and presentation, and discussions of the implications and limitations of the data.

I would strongly recommend this work to those routinely involved in the assessment and treatment of patients with adult ADHD, as well as to those actively involved in or planning research activities with this patient population. For the clinician who encounters these patients less frequently, the concluding chapter and the conclusions of chapters of interest would provide excellent information and guidance. The authors succeed splendidly in their effort to communicate the severity of adult ADHD and to advance concepts about its nature and ideas for addressing its related impairments.

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