Abstract
Like the previous editions, Silver's text provides a comprehensive review of the diagnosis and treatment of ADHD, and comorbid disorders. Some of the strengths are chapters on specific learning disabilities and psychiatric and social difficulties. The chapter on behavioural management is also detailed and helpful and provides a comprehensive approach to what is often difficult to implement with ADHD children. For example, the section on setting up an initial program is sufficiently detailed to go beyond simple generalities and makes the point that records must be individualized for each family member and be compatible with the family's style of child-rearing.
Silver's ideas about diagnosis, to which he devotes two chapters, are of interest. While he documents DSM-IV criteria for ADHD and the inattentive, hyperactive/ impulsive and combined subtypes, he hints that these categorical criteria may not always be met. Thus he hints at, but does not explore, the category versus continuum issue. He also makes the claim, not substantiated by citation, that the most common cause of hyperactivity, distractibility and/or impulsivity is anxiety (p. 44), and claims that in reality ADHD is probably the least common cause of these behaviours. While these assertions may please some, he provides no evidence for this claim or the claim that the second most common cause of the symptoms is depression and the third most common cause is learning disability. While all three comorbid problems are likely to be important in some or many children, definitive statements about causality need substantiation.
The author also has personal views on the use of rating scales to establish the ADHD diagnosis and states that he prefers to speak with teachers by telephone. Where possible it is always useful to speak with teachers if available, but the final diagnostic process is, as Silver himself points out elsewhere, likely to be an amalgam of information from a variety of sources, including parents, teachers and where available, learning and diagnostic test assessments.
Finally, the chapter on psychopharmacology is useful even if some of the medications such as guanfacine, are not available in Australia. The sections on recently available slow-release stimulants are particularly useful, as is the paragraph on atomoxetine (Strattera), a selective norepinephrine inhibitor. As this is only recently on the market, the even somewhat brief information is useful for clinicians.
Thus, this is an excellent text for paediatricians and child psychiatrists, as well as child health workers and teachers who work with ADHD children.