Attention Deficit Hyperactivity Disorder: Concepts, Controversies, New Directions PDF

Preface

This book bridges the gap between the several existing introductory works on attention deficit hyperactivity disorder and those more advanced texts that focus on a narrow issue or subpopulation. It targets readers in training (medical and nursing students, residents, graduate students, etc.) rather than a lay audience, and thus it is a natural companion to the attention deficit hyperactivity disorder section in the Diagnostic and Statistical Manual of Mental Disorders -IV-TR. Although it can be used as an introductory text, it also covers specialized topics that will be of interest to seasoned clinicians and to anyone affected by attention deficit hyperactivity disorder who wishes to broaden their understanding of the disorder.

We asked experts around the world to contribute chapters, with the guideline that they be brief and concise. We granted significant "wiggle room" when contributors needed more length. Some topics received extra emphasis, in order to present readers with more of what they might need to know rather than what they already know about attention deficit hyperactivity disorder. For example, because most of what is known about the disorder comes from research with school-age boys, we thought it essential to include chapters spanning ages and genders. We also overweighted psychosocial approaches to treatment, because the sub-modalities of evidence-based psychosocial treatment are rarely presented. Coverage of medication was limited to the essentials, because pharmacotherapy of attention deficit hyperactivity disorder is already widely disseminated online and in book form and because continuing medical education and pharmaceutical-medical liaisons are sources of continual updates for the prescribing community.

This book also asks readers to challenge their assumptions about attention deficit hyperactivity disorder. The chapter by Pelham is an iconoclastic manifesto on the primary importance of psychosocial treatment. It stems from the fact that the first reported result of the Multimodal Treatment of ADHD Study—that well-managed pharmacotherapy is more effective than psychosocial treatment, and that little is gained from adding psychosocial treatment to pharmacotherapy alone—is often over-interpreted. By considering a broader context, Pelham's chapter stimulates the reader into becoming more sophisticated about medication versus psychosocial issues. Diller's chapter reminds the reader that, even with the amount of research currently available on the disorder, much work remains to be done before some fundamental questions can be put to rest. Regardless of the reader's viewpoint, the chapters in the "Controversies" section will leave the reader better able to defend their views.

Our choice of emphases should not be misconstrued. Our personal views are that attention deficit hyperactivity disorder is a valid and undertreated disorder, that multimodal treatment (medication and psychosocial) is often the best treatment, that federal funding of research on this and related disorders should be quadrupled, and that major revisions are needed to how treatment is provided and reimbursed. Everyone is affected by attention deficit hyperactivity disorder, whether they have it or not. Given the worldwide estimated prevalence of 5.29%, chances are that one out of every 20 people one encounters (including drivers of other cars) has the disorder. Untreated and under-treated, it closes off many paths to better education, better jobs, better health, and better social relationships. It is a costly disorder for everyone. We know a great deal about identifying and helping individuals with attention deficit hyperactivity disorder, but we mustn't allow ourselves to smugly think we know enough. If our book stimulates readers to consider new views on it and to develop their own insights, it will have done its job.

We owe a debt of gratitude for the scholarly efforts of the contributors to this book. Special thanks are due to Russell Schachar, Joel Nigg, and Glen Elliott, who helped in the conceptualization and early planning.