This book is quite extraordinary in its clarity, its broad coverage of the subject and comprehensive discussion of ADHD. People With Hyperactivity: Understanding and Managing Their Problems, as suggested in the cover notes, ”will be of interest to all professionals involved in treating ADHD and related problems: pediatricians, child psychiatrists, psychologists, head teachers and special needs teachers, educational psychologists, and general, forensic and substance abuse psychiatrists”. I would add to this list, concerned parents and general primary school teachers. Most of the chapters   are written very well and with the exception of some sections dealing with pharmacology, are quite accessible to a wide-ranging readership.

I think it is extremely important that primary school teachers are trained to recognize the symptoms and characteristics of young children with ADHD. There is one thing this book stresses above most other aspects of handling ADHD, and it is that the earlier the detection the greater chance the afflicted child has of doing well at school academically and adjusting to social interactions in adolescence and adult life. One of the key factors in diagnosing this affliction is the presence of it before age seven. Unlike some other psychological illnesses ADHD does not suddenly appear in late adolescence, like bipolar for example. I would add a caution to my suggestion that the book will be useful to parents and general teachers and that is, professional diagnosis of this rather complex illness is essential.

Comorbidity is a medical term which means that two or more illnesses may be present in an individual and at times mask each other and consequently display symptoms which could give a false diagnosis if not professionally assessed. As stressed throughout this book ADHD rarely occurs alone, it may be accompanied by dyslexia, ODD (Oppositional Defiant Disorder) or depression in varying degrees and intensity. Appendices are included throughout the book which contain standard assessment questions and procedures. These are intended for professional use, however, they will serve the purpose of informing and educating the lay reader, so if they suspect ADHD in their child or pupil they will be better equipped to refer the child for professional assessment and management.

People With Hyperactivity is edited by Eric Taylor, a Professor and Honorary Consultant Child Psychiatrist at King’s College, London. There are fourteen chapters each dealing with a different aspect of  the diagnosis, treatment and management of ADHD and its most prevalent comorbid associates. I found Taylor’s own chapter Clinical And Epidemiological Foundations simply brilliant as a general introduction and precise overview of ADHD. There is, a perhaps unavoidable tendency, for several of the chapters to cover the same ground, especially those describing pharmacological intervention. This is not prevalent enough to become tedious, and as the book does not need to be read in order but rather in areas of interest, may actually be a necessary and useful repetition.

Each chapter approaches ADHD from a specific angle, so we have: biological foundations; psychological assessment; medical investigations and testing; education; pharmacotherapy; behavioral and cognitive approaches; medical management; ADHD and sleep disorders; preschool ADHD children, and hyperactivity in children with mental retardation. The book has an emphasis, and rightly so, on childhood ADHD, with only one chapter specifically concerned with adult ADHD. Research has shown that a slightly different diagnostic methodology and treatment regime is required for adults, although this is still closely based on the childhood methodology.

The actual presence of adult ADHD is misrepresented in statistics for a number of reasons, firstly there is a tendency for psychiatrists of adults to dismiss the existence of adult ADHD. Secondly middle range, (in severity of symptoms) adult ADHD sufferers have learnt to manage the illness to at least overtly acceptable levels and consequently, hold a job, and become socially acceptable enough to get through, so to speak. This does not mean the ADHD has disappeared after childhood or that the adult would not do far better in life and feel far more at peace and contented in themselves had the illness been diagnosed early enough or treated in earlier adult life.

The chapters concerning biological foundations and medical investigations show clearly that ADHD is a genetically determined disease, this is further supported by empirical evidence of brain dysfunction involving the neurotransmitter dopamine. ADHD stays fundamentally with an individual for their lifetime. Management, not cure, is brought about by the use of stimulants which are highly effective in a majority of cases. These chapters also dispel the myth that highly refined carbohydrates, junk and processed food are the cause of ADHD, they may exacerbate the symptoms but like bad parenting are not the cause.

I have two minor criticisms of this book, two separate omissions in fact, which if included could have helped round it out completely. The first is that the approach is very much from a Western allopathic medical perspective. This is not a criticism of the book per se but of the unholistic approach of medicine itself, which the book does embrace. Parents are increasingly looking for non-drug interventions, particularly from those medications that are long term, which ADHD medication is. Traditional forms of behavioral and cognitive therapy seem not to help ADHD very much without stimulant medication. Consequently the book would have benefited from at least one chapter which dealt with “alternative” treatment possibilities. I’m not in any way suggesting “snake oil remedies” but serious approaches such as neurofeedback training, which it seems has been achieving promising, positive results. “Overall, results of several studies indicate that neurofeedback training is effective in over 80% of cases in significantly reducing the undesirable ADHD symptoms, and the effects appear to be lasting” (see http://home.iprimus.com.au/rboon) We have a small number of clinics in Australia which specialize in this form of treatment, a nurse and friend of mine works in one such clinic in Melbourne and her anecdotal evidence supports the above scientific studies reported by Rosemary Boon.

Secondly, a chapter that presented interviews with actual sufferers of ADHD, both children and adults, would help give healthcare professionals a better understanding of just what the suffer experiences and feels. That is, rather than only concentrating on the external effects of hyperactivity, for example, in the classroom, it would help to see inside the sufferer and what they were experiencing at the time of their disruptive behavior. This phenomenological, qualitative approach is now a bona fide methodology for devising treatments and of course helping diagnosis in many fields of health care.

Putting these two minor criticisms aside, this book I’m sure, will become a definitive resource and reference manual for all those who have an interest in the diagnosis, causes and treatments of ADHD.

© 2007 Rob Harle

Rob Harle is an artist and writer, especially concerned with the nature of consciousness and high-body technologies. His current work explores the nature of the transition from human to posthuman, a phenomenon he calls the technoMetamorphosis of humanity. He has academic training in philosophy of mind, comparative religious studies, art and psychotherapy. Rob is an active member of the Leonardo Review Panel. For full biography and examples of art and writing work please visit his web site: http://www.robharle.com

Categories: ChildhoodDisorders