Larry B. Silver’s handbook,
currently in its third edition, claims to be aimed at "health and mental
health professionals." Written in a straightforward, if at times vague
language, I’d nevertheless recommend this book to anyone concerned with
Attention-Deficit/Hyperactivity Disorder (ADHD). Parents of such children and
adolescents will find a wealth of information within the book’s pages. They
might even find ways to cope with their own inattention/distractibility, hyperactivity
and impulsivity (the three cornerstones of ADHD). Silver clearly states that
despite the belief that most children outgrow the disorder, approximately 50%
take their difficulties into adulthood. Throughout, ADHD is clearly identified
as a.) a neurological disorder (the brain is seen to be "wired
differently" from a very early age) and b.) that it is a long-duration
disorder.

On the whole, this is not a
technical book, the author doesn’t use a great deal of clinical jargon and when
he does he explains it to enable non-medical parents to understand what
he’s saying. His usage of case studies, examples, anecdotes from his own
private clinical practice (he’s a child and adolescent psychiatrist in Washington,
D.C.) make the book very relevant, accessible and current.

Divided into six principal
sections: Introduction and Overview; Diagnosis; Associated Disorders;
Treatment; Special Topics; and Conclusions, the author leads his readers deftly
through the minefield that is ADHD. There is also a useful resources section
and index at the end of the book. Concerned parents would do well to read the
entire book and not be tempted to turn immediately to the treatment section. As
Silver says himself — education is crucial. Understanding the underlying
reasons behind the presenting behaviors will give vital clues for the clinician
to make a diagnosis. This is a book which advocates what I call a Holistic
approach — taking the individual’s entire life — their social skills, family,
school, health etc. into account when attempting to diagnose and ultimately
treat. Wise words. Each individual is different after all.

Silver blows stereotypes we might
have about the disorder out of the water when he advocates awareness, education
and being on the alert for controversial therapies. The fourth section
on treatment is the longest section in the book and covers everything from the
importance of finding the right medication for the client to behavioral
therapies, education for schools, parents and relevant others, to controversial
therapies (using herbs, vitamins, biofeedback etc.) The author also provides
useful tables throughout (although the sheer quantity of DSM-IV-R tables may
overwhelm the non-technical reader in the Diagnosis section, they are a nod
towards the clinician though they might have been better placed in an index).

Silver highlights several important
issues throughout the book namely:

a.)    the fact that
ADHD rarely occurs alone but is accompanied by other neurologically-based
disorders.

b.)    
that the cause of the child’s problems needs to be established
before a diagnosis can be formulated.

c.)    that ADHD
impacts all aspects of the child’s life (the problems are not just apparent at
school but also seen at home and elsewhere.)

d.)    that medication
is recommended to cover all aspects of the child’s day and that a mixture of
Type 1 and Type 2 drugs might be required for optimal results.

e.)    the fact that
the dosage of these drugs cannot be determined on body weight requires a great
deal of trial-and-error in order to figure out the correct medication for each
individual. Parents and other concerned persons should be made aware of this
fact.

f.)      that
there are huge individual differences in the behaviors exhibited by a sufferer
of ADHD. They can’t all be labeled in exactly the same way.

g.)    but labeling is
useful when using the law to obtain all the advantages that the client is
legally entitled to. This book is heavily American-oriented. People from other
countries should be advised (but aren’t) to look up the relevant laws in their
own countries.

It has to be said that the book is
very weak on a few topics — brain anatomy, cell biology (in particular
where/how the drugs prescribed work at a cellular level) and, as a clinician, I
felt that this vagueness lets it down. There is for example a growing
literature of Biofeedback/Neurofeedback and ADHD, both in America and
elsewhere. Silver donates one vague, non-committal paragraph to this therapy
and in his enthusiasm for medication at all costs turns his back on these, as
he names them, controversial therapies. The jury is not yet out on the
issue of Bio-/ Neurofeedback. The author also has a habit of mentioning research
but gives few or no names within the text itself and only sometimes does he
list which research he is referring to at the end of chapters. This leads to
the growing sense of vagueness as you move through the pages. I think he may
have been going for readability at the expense of completeness, but using
numbers to denote research publications throughout the text doesn’t break up
its readability and interested readers can, in such a way, be directed to the
appropriate, original papers.

To give Silver his due he does say:
"I am using poetic license with anatomy and physiology." (pg 122) He
also tries to qualify his statements throughout, a practice that introduced
doubt into this reader’s mind. Research into ADHD is a rapidly expanding field,
one which many clinicians have trouble finding the time to keep abreast of,
especially if they run busy clinics. Silver does attempt, with this book, to
bring all the current relevant information together, his ultimate goal is:

"€¦that the information in this book helps you
to be effective in working with individuals who have ADHD." (pg 228)

The greatest gift this book has to offer in my opinion
however can be summed up in the author’s words (italics added):

"Unless the total
individual is understood and helped, progress might be limited. A complete
evaluation should be done." (pg 227)

He also believes in trusting
"parents’ intuition" (pg 54) and he advocates a multimodal treatment
approach. Throughout the book it is clear that Silver cares about young people
and their parents who have to live with this disabling condition. I agree with
him that education is the single most powerful tool in any ADHD sufferer’s
arsenal. Parents shouldn’t be put off by the book’s sub-title, it is actually
(in my opinion) written for them.

It should be a standard text in
staff rooms of schools and in relevant clinics and general medical practices
across the world, with a relevant section on that country’s law. Larry B.
Silver’s book is on the whole a useful edition to the growing literature that
is available on ADHD. At the very least it should enhance awareness about this
very disabling condition, never a bad thing when you consider that some
clinicians and members of the public still doubt its very existence.

 

Link: Publisher’s
web page for book

 

© 2005 Ruth Mark

 

Ruth Mark is lecturer of
neuropsychology at the University of Tilburg in the Netherlands. She
specializes in Alzheimer’s disease, stroke, epilepsy and other neurological
disorders. Her personal website can be viewed at: www.remark.be

Categories: ChildhoodDisorders, MentalHealth