Abstract
The book could have been titled ‘Hyperactivity disorders of childhood Volume 2’ as there have been substantial changes in both content and authorship from the first edition reviewed in this journal in 1998 [1]. Chapters on outcome and other disorders of conduct have been replaced by chapters on genetic studies, institutional care as a risk factor for inattention/overactivity, and attention deficit hyperactivity disorder in adults. The authorship has changed substantially, although it remains mostly European. Across countries within Europe there are varying attitudes to the construct of hyperactivity and attention disorders, from the ‘pre-contemplative’ to the cautiously accepting. Only authors from countries with a cautiously accepting attitude are represented in the volume. Australians Erika Hagemann, David Hay and Florence Levy have contributed a chapter on cognitive aspects and learning (and could have contributed to the chapter on genetics). Ernest Luk, who contributed a chapter on cross-cultural and ethnic aspects, is also listed as an Australian, but he now works in Hong Kong.
A feature that sets this work apart from most ‘ADHD’ books is the emphasis given to the contribution of psychosocial factors to the aetiology and expression of the disorder. Olson, in her review of developmental perspectives, considers how disordered caregiver-infant attachment relationships may lead to hyperactivity. One candidate pathway is through an arrest in the development of the capacity for self-regulation. Problems with self-regulation are likely, however, to represent a general vulnerability to disruptive behaviour rather than a specific link to hyperactivity. An alternate candidate pathway is through delays in cognitive and linguistic competence, which are known to be associated with hyperactivity and aggression. Disordered parent-toddler interactions predict oppositionality in middle childhood rather than hyperactivity, although the two problems may co-occur. Sandberg, in her review of psychosocial contributions, finds the data on the association between family environment and hyperactivity inconclusive. Specific factors such as marital discord and maternal depression may, however, influence the development and course of hyperactivity. Sandberg is sceptical of the optimistic interpretation by Barkley and others that treatment of the hyperactive child with methylphenidate ‘normalizes’ previously maladaptive parent-child interactions. She notes that while on treatment children become less sociable, which means they initiate fewer interactions with the mother and are generally less responsive. Negative interaction may be replaced by lack of interaction, which could conceivably be just as hazardous to the development of the child. Rutter, in a chapter about institutional care as a risk factor for hyperactivity, reviews the substantive contributionmade to the field by the Romanian adoption studies. Many of the children studied have displayed behaviours along the hyperactive/impulsive continuum, but he cautions against the assumption that institutionalism leads to a variant of ADHD or hyperkinetic disorder. These children also displayed indiscriminate attachment behaviours, and other disorders of socialization. Treatment with psychostimulant medication moderated hyperactive behaviours somewhat, but the children were often left with other substantial deficits.
Similar to other volumes in the Cambridge Child and Adolescent Psychiatry series [2,3] the book is not a ‘how to’ manual. The volume comprises scholarly reviews of the scientific basis to aetiology and to treatment, but unlike many of the other 60 or so books about ADHD/hyperkinesis in print there is no guide to assessment, diagnosis or management. The chapter about treatment reviews the landmark Multimodal Treatment for ADHD Study, but there is minimal reference to other treatment research. The only pharmacological treatment for children mentioned in the book is immediate release methylphenidate, placing the book well behind current trends in treatment, which include the use of sustained release of stimulant preparations and non-stimulant drugs such as clonidine and atomoxetine. A greater range of treatments are covered in the chapter on adult ADHD, but newer agents are still conspicuously absent. In fairness, most European nations have a restricted pharmacopoeia for ADHD/hyperkinesis, so clinicians may have only had experience with immediate release methylphenidate.
‘Hyperactivity and attention disorders of childhood’ will be of most value to researchers and clinicians from the disciplines of child and adolescent mental health and community child health. The addition of a chapter on adult ADHD, however, could make the book of some interest to adult general psychiatrists. The strong European perspective makes the book quite unique.