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Attention-deficit hyperactivity disorder (ADHD) was first identified over 100 years ago, but it remains an intensely controversial entity. It's common for professionals to disagree over whether an individual child has the disorder, and a few prominent psychologists and psychiatrists don't even believe that it exists. This odd state of affairs is in part due to a lack of standardized assessment techniques. Despite "best practices" guidelines developed by organizations such as the American Academy of Pediatrics (AAP), most professionals have their own preferred set of assessment tools, leading to diagnoses that sometimes say more about the evaluator than the child. Admittedly, it's hard to translate guidelines like those of the AAP into actual practice without specific instruments with which to assess the disorder. Attention-Deficit Hyperactivity Disorder: A Clinical Workbook effectively bridges this gap between official guidelines and clinical practice.
ADHD can't be diagnosed using a blood test or anything so objective, and so the most common method involves a combination of observation (especially if a child is being evaluated), interviews (with parents, teachers, and the child or adult being assessed), and behavior rating scales (standardized lists of symptoms and behaviors). Barkley & Murphy's book focuses on the latter two strategies, and has over 150 pages of interview forms and rating scales, complete with information on how to use them to assess ADHD and related conditions. Some of these instruments have been scattered in different books and journal articles, and others remain unpublished except for their presence in this text; when put together, the result is a treasure trove of clinical tools for assessing what is perhaps the most common child behavior disorder today.
The official diagnostic criteria for ADHD, from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), form the backbone of any competent ADHD assessment process, and the assessment forms found in this book cover all of those criteria. For instance, the main diagnostic criterion for ADHD states that the individual displays excessive levels of inattention, hyperactivity, or impulsivity. Many of the forms ask about specific symptoms within each of these areas (e.g., blurting out answers before questions have been completed), and the number of symptoms endorsed by informants can be tallied to estimate the severity of problems.
Another DSM-IV diagnostic criterion, one too often ignored, is "clinically significant impairment"--essentially, to qualify for a diagnosis of ADHD, an individual must not only have symptoms, but must have trouble adapting to life's demands because of the symptoms. For instance, a child who has symptoms but is able to follow instructions at home, keep up with work in school, and interact with peers appropriately would not be diagnosed with ADHD. The book's impairment-related forms will be a welcome resource for clinicians, many of whom struggle to assess this area adequately. Barkley and Murphy include forms for teachers as well as parents, helping to catch impairment in different settings.
A third DSM-IV criterion states that the symptoms must lead to impairment before age 7. Although the exact age is a topic of considerable debate among researchers, the age criterion raises the topic of onset and prognosis more generally. Since recent studies suggest that the majority of children with ADHD will continue to show deficits in their adult years, it is refreshing to see that Barkley and Murphy devote almost half of their text to assessing adults for ADHD. This section of the book includes forms investigating which symptoms were experienced back in childhood, as well as areas of impairment not relevant in young children (e.g., driving).
Two caveats hinted at earlier should be noted before readers of this review decide to purchase the book. First, the book is not a source of general information about ADHD. Although there are several "fact sheets" meant for use with clients and their parents, there are no discussions of recent research on ADHD, its causes, or its treatment. The book is instead a clinical tool for those who have specialized training and already know that information. Second, on a related point, the book is not meant for the general public, and should not be purchased by readers interested in determining whether they (or their family members, friends, coworkers, etc.) have ADHD; as with any psychological problem, a professional assessment is the best idea in this situation.
Even as a resource for trained professionals, the ADHD Clinical Workbook has certain limitations worth noting. First, although there are many forms for teachers to complete, very few focus on academic impairment: low grades, poor exam scores, lack of homework completion, etc. Since many school referrals, especially at the middle and high school levels, are prompted by academic problems, these types of impairment require more comprehensive assessment. Second, I would have liked to see more assessment instruments that help with differential diagnosis--that is, separating out ADHD from other disorders that share certain symptoms. Certain features of ADHD--especially inattention--are common to many psychological problems (e.g., anxiety, depression, etc.), and one of the hardest clinical tasks to differentiate ADHD from these related syndromes.
Despite these limitations, Barkley & Murphy's workbook remains a must-have for those who do ADHD assessments, whether they are psychiatrists, pediatricians, psychologists, clinical social workers, or others. It is not a book for laypeople, and could actually do more harm than good in the hands of the untrained, but when used by professionals in the service of identifying children, adolescents, and adults whose needs fall under the heading of ADHD, the book's contents can lead to more reliable diagnostic practices and more accurate treatment planning.
© 2007 Ben Lovett
Ben Lovett is a doctoral candidate in the psychology department at Syracuse University, where his research and clinical work focuses on children with ADHD and learning disabilities.