Gottlieb, D., Shoaf, T., Graff, R., (2006). WHY IS MY CHILD’S ADHD NOT BETTER YET? Recognizing the Undiagnosed Secondary Conditions That May be Affecting Your Child’s Treatment. New York: McGraw-Hill. 207 pages.

The unassuming, albeit catchy, title belies the comprehensive scope of information contained in this work. Created as a “how to” book for parents, the authors make good on their promise. Although conversational in tone, it packs a wallop of intelligence and thoughtful counsel into a concise two hundred pages.

The authors assert that in 70% of ADHD cases, there is a co-existing diagnosis, often bi-polar disorder or depression. In other cases, they maintain that it is not uncommon for mood and behavioral conditions to co-exist with the ADHD. Less frequently, autistic spectrum disorders can also present with ADHD. Through precise diagnosis, the authors advise that the likelihood of successful treatment is increased. Furthermore, they argue that by designing treatment with greater diagnostic specificity, the likelihood of adult outcomes associated with ADHD, such as anti-social behavior and substance abuse, may be diminished.

A review of the literature supports the authors’ thesis of co-existing disorders. The diagnosis of ADHD has evolved considerably over time and today it is accepted that the risk for co-morbidity of ADHD with other psychiatric disorders is high. The scientific literature suggests that the presence of co-existing disorders warrants special consideration when treating the syndrome. Thus, today, efforts focus, not on whether co-morbidity exists, but rather how therapies can be matched to individual aspects of secondary diagnoses associated with ADHD. With a lay audience in mind, the authors have translated current scientific research validated by their clinical experience into a practical handbook, helping parents understand and manage the symptomatic differences of the co-existing diagnoses common to ADHD.

While the authors’ dual diagnosis thesis is well-accepted, it would be incorrect to assume that there is agreement on the incidence rates of the various co-existing diagnoses. For example, one might gather from this book that bi-polar disorder and ADHD frequently co-occur. In fact, the frequency of the two disorders co-occurring is controversial. The disagreement is appropriate, as this dual diagnosis carries serious implications for choice of medication (Jenson et al., 1999).

The book’s intent, however, is to be pragmatic, not empirical. Thus, it is impressive how this compact volume summarizes the current knowledge base. David Gottleib, a clinical psychologist, hones in on the vast array of research by focusing on the psychological effect of ADHD and specific types of co-morbid syndromes. In easily understood language, Dr. Gottleib gives us a glance into the child’s experience, tells us what behavior to expect and why, then offers his advice on effective treatment choices. Thomas Shoaf, psychiatrist and researcher, discusses the neurobiology of the individual disorders. He outlines medication and behavioral therapies, de-mystifying the perplexing and often anxiety-producing menu of psychopharmacological choices confronting parents. Readers receive frank information on medications, including straight-forward caveats on side-effects. Charts classify the specific drugs prescribed for ADHD and the accompanying co-diagnoses, providing a useful reference on current medications.

 The psychological and medical formulations ground the work, but the behavioral management strategies provide solutions. Ms. Graff patiently acknowledges the daily challenges of living with the ADHD child while simultaneously presenting an operating manual for each dual diagnostic category. Parents and teachers will recognize the familiar scenarios outlined by Ms. Graff. She calmly troubleshoots difficult and oft experienced situations by describing techniques designed to mitigate the most distressing manifestations of the qualified diagnosis.

The potency of this work lies in the tools of knowledge it provides to parents and other professionals working with ADHD students. The writers, by design, briefly overview a vast subject and certainly one criticism is that the work is cursory by scientific standards. However, by trading complexity for simplicity, by couching experiences in the familiar vs. the scientific, they have enlisted parent and teacher in the art of incisive diagnosis. Who better than parents, the expert observers of their children’s behavior, and teachers working daily with ADHD, to partner with the psychologist and psychiatrist?

Patricia Holden M.A., M.F.T., is a family therapist and learning disabilities specialist in San Francisco and Marin County. She has been an associate member of AET since 2000.

Notes

Jenson, P.S., Hinshaw, S.P., et al.: NIMH Multimodal Treatment Study of Children with ADHD (MTA), 1999.