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12 and HoldingA Guide to Asperger SyndromeA Lethal InheritanceA Mother's Courage: Talking Back to AutismA Parent's Guide to Asperger Syndrome and High-Functioning AutismA Special EducationA Toss Of The DiceA Tribe ApartA User Guide to the GF/CF Diet for Autism, Asperger Syndrome and AD/HDA Walk in the Rain With a BrainABC of Eating DisordersADD-Friendly Ways to Organize Your LifeADHD Grown UpADHD in the Schools: Assessment and Intervention StrategiesAdolescence and Body ImageAdolescent DepressionAggression and Antisocial Behavior in Children and AdolescentsAll Alone in the UniverseAlpha GirlsAmericaAnother PlanetAntisocial Behavior in Children and AdolescentsAsperger Syndrome and Your ChildAsperger Syndrome, Adolescence, and IdentityAsperger's and GirlsAssessment of Childhood DisordersAttention Deficit DisorderAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderAutism - The Eighth Colour of the RainbowAutism and MeAutism's False ProphetsAutistic Spectrum DisordersBad GirlBeen There, Done That? DO THIS!Before I DieBetween Two WorldsBeyond AppearanceBig Mouth & Ugly GirlBipolar ChildrenBipolar Disorder in Childhood and Early AdolescenceBipolar DisordersBipolar KidsBlackwell Handbook of Childhood Cognitive DevelopmentBody Image, Eating Disorders, and ObesityBody Image, Eating Disorders, and Obesity in YouthBoy AloneBrain-Based Therapy with Children and AdolescentsBreaking PointBreathing UnderwaterBringing Up ParentsBullying and TeasingBullying PreventionBut I Love HimCan't Eat, Won't EatCaring for a Child with AutismCatalystChild and Adolescent PsychiatryChild and Adolescent Psychological DisordersChild and Adolescent PsychopathologyChild NeuropsychologyChild Well-BeingChildren and SexualityChildren Changed by TraumaChildren with Emerald EyesChildren with Sexual Behavior ProblemsChildren, Sexuality and SexualizationChildren’s Dreaming and the Development of Consciousness City of OneCommunication Issues In Autism And Asperger SyndromeConcepts of NormalityConcise Guide to Child 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Revised EditionTaming the Troublesome ChildTemple GrandinThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anti-Romantic ChildThe Bipolar ChildThe Boy Who Loved WindowsThe Boy Who Was Raised as a DogThe Buffalo TreeThe Bully Action GuideThe Bully, the Bullied, and the BystanderThe Burn JournalsThe Color of AbsenceThe Curious Incident of the Dog in the Night-TimeThe Depressed ChildThe Developing MindThe Dragons of AutismThe Einstein SyndromeThe EpidemicThe Evolution of ChildhoodThe Explosive ChildThe Eyes of van GoghThe Fasting GirlThe Field of the DogsThe Flight of a DoveThe Hidden Gifts of the Introverted ChildThe Horse BoyThe Identity TrapThe Inner World of a Suicidal YouthThe Inside Story on Teen GirlsThe Kindness of StrangersThe Last Normal ChildThe Little MonsterThe Medicated ChildThe Myth of LazinessThe New Gay TeenagerThe Nurture AssumptionThe OASIS Guide to Asperger SyndromeThe Other ParentThe Perversion of YouthThe Philosophy of AutismThe 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Book for BoysWhat's Happening to My Body? Book for GirlsWhat's Happening to Tom?When Nothing Matters AnymoreWhen Your Child Has an Eating DisorderWhose America?Why Don't Students Like SchoolWill's ChoiceWinnicott On the ChildWorried All the TimeYou Hear MeYoung Minds in Social WorldsYoung People and Mental HealthYour Child, Bully or Victim?
It is difficult for formal coursework in clinical psychology to represent the challenges of actual clinical work, for many reasons. One reason is that different disorders frequently co-occur in clinical practice, and information that a student has learned about one disorder may not apply to a client who has an additional disorder as well. This problem of comorbidity (the existence of multiple disorders in the same individual) is especially prevalent in attention deficit hyperactivity disorder (ADHD); more than half of individuals who meet criteria for an ADHD diagnosis also meet the criteria for other psychological disorders.
In Treating ADHD and Comorbid Disorders, Steven Pliszka tackles the challenges posed by comorbidity head on. A psychiatrist who splits his time between research and clinical practice, Pliszka is in an ideal position to translate recent studies on ADHD treatment into useful guidelines for clinicians, and his book does not disappoint. The book is clearly written, well-organized, and a thoughtful integration of clinical wisdom and cutting-edge research.
Each chapter considers the relationship between ADHD and another disorder (or class of disorders): bipolar disorder, anxiety disorders, impulsive aggression, etc. Each chapter reviews the diagnostic criteria for potential comorbid conditions, summarizes research on the comorbidity relationships, and discusses treatment implications. While covering this information, Pliszka does not shy away from controversial issues. For instance, in the chapter on bipolar disorder, he opens by discussing the current "epidemic" of bipolar disorder among children, offering a balanced perspective. Although he seems a bit credulous regarding the high rates of pediatric bipolar diagnosis, Pliszka does consider alternative explanations of the reported prevalence rates, and he notes that many symptoms of mania could be explained as either severe ADHD or ADHD with comorbid conduct problems. Throughout the discussion of complex issues such as these, Pliszka does an excellent job of carefully and accessibly presenting research findings.
Multiple narrative case studies are also included in each chapter, to illustrate the concepts covered. These case studies demonstrate nicely the complexities of clinical work, highlighting the clinical issues raised by comorbidity. For instance, in one chapter, Pliszka discusses the case of 9-year-old Karen, who was already being treated for anxiety when her parents requested a second opinion about the medication that Karen was taking. The parents endorsed many symptoms of ADHD, and there were also signs of stubbornness and negativity that didn't quite fit with anxiety. Medication changes were of little benefit, whereas a behavior modification intervention worked surprisingly well. As is typical in the case studies, Pliszka places more emphasis on finding an effective way of meeting Karen's needs, rather than focusing on diagnosis per se. Although I had hoped for more information about diagnostic issues, many practicing clinicians will appreciate the book's pragmatic, treatment-focused approach.
Speaking of treatment, I should note that as the case study of Karen indicates, Pliszka does not have a bias favoring medication over psychotherapy. Even in his discussion of disorders closer to the "medical" end of the spectrum, Pliszka covers research-based psychological treatments. For instance, in the chapter on bipolar disorder, there is a fairly detailed account of the RAINBOW therapy system, which addresses a variety of psychosocial variables. Still, the discussions of medication management algorithms (which medications to try first, which next, etc.) will be most useful to those who have prescription privileges.
Overall, then, Treating ADHD and Comorbid Disorders is a helpful guide for practitioners who are looking for an accessible overview of research on ADHD comorbidity as well as down-to-earth advice about how to treat children who present with a variety of problems that include ADHD-related symptoms.
© 2010 Benjamin J. Lovett
Benjamin J. Lovett, Ph.D., is an assistant professor of psychology at Elmira College, where his research interests focus on psychiatric diagnosis and psychoeducational assessment.
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