This book represents an important step in the conceptualization of the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in adults. The book is divided into 14 chapters. The second chapter offers an excellent literature review related to the evolution and validation of the ADHD diagnosis, as it applies to adults. It also offers a solid discussion related to the prevalence of the disorder in adults. In Chapter 3, the authors address some of the problems associated with the DSM-IV diagnostic classification structure for ADHD, in relation to diagnosing adults. This chapter contains information that is essential for any clinician working, in a diagnostic context, with adults who potentially suffer from ADHD. This chapter covers important information such as the trouble with the generalizability of the diagnostic criteria from children to adults and the difficulties with the age criteria (before 7 years) associated with the diagnosis. The chapter also discusses the concept of impairment associated with the diagnostic criteria and guidelines associated with establishing the existence of impairment. For instance, in relation to defining impairment, the authors caution against comparisons to ‘some high-functioning specialized peer group or index of general cognitive ability, such as IQ scores.’ Some neuropsychologists will likely find these clinical cautions to be thought-provoking, if not somewhat controversial.
The rest of the chapters in the book address the clinical and research implications associated with two large studies related to ADHD in adults. These studies are referred to as the UMASS Study and the Milwaukee Study. A thorough discussion of the methodologies associated with these studies can be found in Chapter 4. The reader will find the structure of the book's chapters to be extremely helpful, as each includes a summary section which provides bullet points that summarize the primary conclusions and clinical implications associated with each chapter. The chapters themselves are organized around some of the most important questions in the field of adult ADHD and each chapter includes a literature review so that the reader can better understand the historical underpinnings of the issue in question.
Chapter 5 offers an interesting discussion related to the DSM nosology and the utility of identified ADHD symptoms, in relation to diagnostic conceptualization. The authors offer insights from the UMASS and Milwaukee Studies in relation to more efficient diagnostic/syndromal thresholds for performing a diagnosis of ADHD in adults. The authors also offer an excellent argument in this chapter for establishing separate ADHD diagnostic criteria, in the next iteration of the DSM, for adults. Chapter 7 offers an engaging discussion of new symptoms identified through the UMASS and Milwaukee Studies that show good diagnostic classification rates in identifying ADHD in adults. The following chapters address timely issues in relation to ADHD such as comorbid psychiatric presentations, educational and occupational functioning in adults with ADHD, issues related to drug use, money management, driving, establishing relationships and overall psychological adjustment.
Neuropsychologists will find Chapter 13 of interest as it deals directly with neuropsychological functioning and the neuropsychological assessment of adults with ADHD. The authors provide a review of the literature associated with the neuropsychological evaluation of adults with ADHD. The authors also provide results from the UMASS Study and the Milwaukee Study related to neuropsychological assessment. The authors conclude that adult ADHD can be associated with specific deficits in executive functioning that are not typically present in control groups. They note that these areas of deficit are most commonly found on tests that emphasize attention, inhibition (interference control), working memory and design fluency. The authors appropriately point out that a sizeable minority of ADHD adults perform normally on these tests (false-negatives) and that individuals with other clinical conditions may perform poorly on these tests, creating difficulties with neuropsychological differential diagnosis (false-positives). As a result, the authors conclude that neuropsychological test performance should not be used to diagnose individuals with ADHD. Instead, the authors recommend neuropsychological testing to help in delineating an individual's neurocognitive strengths and weaknesses. The authors contend that neuropsychological assessment is particularly useful when the evaluation is focusing on academic or work-related accommodations or on the documentation of a legal disability.
In sum, the structure of this book is an excellent representation of the scientist practitioner model approach to adult ADHD. The presentation of data from the UMASS and Milwaukee Studies offers important insights into questions that have arisen about adult ADHD over the course of the past two decades. The book serves as an important advancement in the field of ADHD and it offers the neuropsychologist invaluable insights into various aspects associated with the clinical and social manifestations of the disorder. Neuropsychologists will find the information presented in the book useful as they construct or update their evaluation approaches for adult ADHD population. The book stands as an extremely important work, in the field of adult ADHD.