Taking Charge of ADHD, Revised Edition

I was lucky enough to be able to read Russell Barkley's (2000) Taking Charge of ADHD around the same time as David Stein's Ritalin is Not the Answer Action Guide (2002).  Both are guides to parents in learning to recognize, cope and manage a child with ADD/ADHD.  Taking Charge purports to be an Authoritative guide.  From what I have seen, I would tend to agree. Barkley is one of the leaders in the field of ADD/ADHD study and his book gives parents a readable survey about what is known and not known about the disorder. The book is divided into four parts, in part I, parents are educated about the putative causes of ADD, what to expect and psychosocial aspects of the disorder.  Part II is focused towards practical parenting issues such as when to have a child evaluated, what to ask the evaluator, how to cope with the evaluation and how to provide self-care.  Barkley also advocates a behavioral model and in part III, puts forth "8 steps to better behavior" as well as techniques towards improved problem solving and family communication. In part IV, Barkley describes common pharmacologic treatments for ADD in plain terms.

In all, I find this a well-rounded resource.  The book is full of case studies describing many different manifestations of the disorder.  I am confidant that parents will be able to identify and "see their child" within the myriad of case examples used to give a human face to the material.  The book is written in a convenient question and answer format with answers organized under the topic headings and short descriptions and scientific references to back up the assertions.  What I like most about the book is the fact that Barkley encourages parents to be active "scientists" in treating the disorder.  There is a plethora of information and misinformation out there on ADHD and (oftentimes desperate) parents should have some basic skills in being able to evaluate the differing opinions, theories and treatment.  I find Barkley's approach the most empirically sound view that I have thus-far seen and a great starting point for parents as they build a model of their own understanding of the disorder(s).

You might have noticed that I made the word disorder (possibly) plural.  In this, I mean to suggest that the disorder we call ADHD, may actually consist of several different disorders.  In my review of Ritalin is Not the Answer Action Guide I suggested that there may be no magic bullet, and I do not believe that Barkley is suggesting that there is one.  In fact, I find the tenor of the discussion in the book rather even tempered.  

The approach can best be described as biopsychosocial (a stance by some practitioners in the field that any disorder has biological, psychological and social components). While any "psychiatric" disorder may have all three of these issues that may play a role in the maintenance, cause and effects of the problem, different children may have a different weighting of these variables.  Thus, one child may have greater social dysfunction (with concomitant underlying psychological distress) and another might have biological dysfunction, with resultant social dysfunction. Barkley seems to lean towards the biological pole of this equation (as do I) and posits a model of ADHD that is associated with frontal lobe dysfunction (the part of the brain that acts as the managerial executive over the other areas) in which a child has a problem with inhibition and self-control.  He believes that this dysfunction necessitates that children be given stricter behavioral guidelines and control to help them overcome their dysfunction. It seems that Barkley is suggesting that all ADHD children suffer from the same underlying problem, a point in which I cannot bring myself to agree), however, this model is respected and well represented in the more "scientific" aspects of the field.  I should mention that I felt that Barkley's coverage of neurofeedback (eeg biofeedback) was almost nonexistent (a few paragraphs). Though he rightly states that much research needs to be done in the field before we know if it works, I found his coverage and description rather dismissive and unrepresentative of the research that has been done. 

In short, I would recommend Barkley's book.  No book is perfect, but this is the best book for parents that I have seen so far.

© 2003 Michael Sakuma
 

Michael Sakuma is Chair of the Psychology Department at Dowling College, Long Island, New York.