Table Of ContentA
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Medical Psychiatry
Series Editor Emeritus
William A. Frosch, M.D.
Weill Medical College of Cornell University
New York, New York, U.S.A.
Advisory Board
Jonathan E. Alpert, M.D., Ph.D. Siegfried Kasper, M.D.
MassachusettsGeneralHospitalandHarvard MedicalUniversityofVienna
UniversitySchoolofMedicine Vienna,Austria
Boston,Massachusetts,U.S.A.
Mark H. Rapaport, M.D.
Bennett Leventhal, M.D. Cedars-SinaiMedicalCenter
UniversityofChicagoSchoolofMedicine LosAngeles,California,U.S.A.
Chicago,Illinois,U.S.A.
1. Handbookof DepressionandAnxiety: ABiological Approach, editedby
JohanA.den Boerand J.M.Ad Sitsen
2. AnticonvulsantsinMoodDisorders,editedbyRussellT.JoffeandJoseph
R. Calabrese
3. Serotoninin AntipsychoticTreatment:Mechanismsand ClinicalPractice,
editedbyJohn M.Kane,H.-J.Mo¨ller, andFransAwouters
4. Handbookof Functional Gastrointestinal Disorders,editedby
KevinW.Olden
5. ClinicalManagement of Anxiety,editedbyJohanA. denBoer
6. Obsessive-CompulsiveDisorders:Diagnosis(cid:127)Etiology(cid:127)Treatment,edited
byEricHollander and DanJ.Stein
7. BipolarDisorder:BiologicalModelsandTheirClinicalApplication,editedby
L.TrevorYoung andRussellT. Joffe
8. DualDiagnosis and Treatment: SubstanceAbuseand Comorbid
MedicalandPsychiatricDisorders,editedbyHenryR.KranzlerandBruce
J.Rounsaville
9. GeriatricPsychopharmacology,editedbyJ.Craig Nelson
10. PanicDisorder andIts Treatment, editedbyJerroldF. Rosenbaumand
MarkH. Pollack
11. Comorbidity inAffectiveDisorders,editedbyMauricioTohen
12. PracticalManagementoftheSideEffectsofPsychotropicDrugs,editedby
RichardBaton
13. PsychiatricTreatmentofthe MedicallyIII, editedbyRobertG. Robinson
andWilliam R. Yates
14. MedicalManagement of theViolent Patient:ClinicalAssessment and
Therapy,editedbyKenneth Tardiff
15. BipolarDisorders:BasicMechanismsandTherapeuticImplications,edited
byJairC. Scares andSamuel Gershon
16. Schizophrenia:A NewGuide forClinicians,editedby
JohnG. Csernansky
17. Polypharmacyin Psychiatry,editedbyS. NassirGhaemi
18. Pharmacotherapy forChildand Adolescent Psychiatric Disorders:
SecondEdition, Revisedand Expanded,David R. Rosenberg,
PabloA. Davanzo, andSamuel Gershon
19. Brain Imaging InAffectiveDisorders,editedby JairC. Scares
20. Handbookof MedicalPsychiatry,editedbyJairC. Scares and
SamuelGershon
21. Handbookof DepressionandAnxiety: ABiological Approach,
SecondEdition, editedbySiegfried Kasper,JohanA. denBoer,
andJ. M.AdSitsen
22. Aggression: Psychiatric Assessmentand Treatment, editedby
EmitlCoccaro
23. DepressioninLaterLife:AMultidisciplinaryPsychiatricApproach,editedby
JamesEllison andSumerVerma
24. AutismSpectrum Disorders,editedbyEric Hollander
25. Handbookof ChronicDepression: Diagnosis andTherapeutic
Management,editedbyJonathanE. Alpertand MaurizioFava
26. ClinicalHandbookofEatingDisorders:AnIntegratedApproach,editedby
TimothyD. Brewerton
27. DualDiagnosis and PsychiatricTreatment:Substance Abuseand
ComorbidDisorders: Second Edition,editedbyHenry R.Kranzler and
JoyceA. Tinsley
28. AtypicalAntipsychotics:From BenchtoBedside,editedby
JohnG. Csernansky andJohn Lauriello
29. Social Anxiety Disorder, editedbyBorwinBandelow and DanJ.Stein
30. Handbookof SexualDysfunction, editedbyRichardBalon and
R. TaylorSegraves
31. Borderline Personality Disorder,editedbyMaryC. Zanarini
32. Handbookof BipolarDisorder: Diagnosis and TherapeuticApproaches,
editedbySiegfriedKasper and RobertM.A. Hirschfeld
33. Obesityand Mental Disorders,editedbySusanL.McElroy,
DavidB. Allison, and GeorgeA.Bray
34. Depression: TreatmentStrategies and Management,editedby
ThomasL. Schwartz andTimothy J.Petersen
35. Bipolar Disorders: BasicMechanismsand TherapeuticImplications,
SecondEdition, editedbyJair C. Soaresand Allan H. Young
36. Neurogeneticsof PsychiatricDisorders,editedbyAkiraSawa andMelvin
G.Mclnnis
37. AttentionDeficit Hyperactivity Disorder:Concepts,Controversies,
NewDirections, editedbyKeithMcBurnett and LindaPfiffner
A
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Concepts, Controversies,
New Directions
Edited by
Keith McBurnett
University of California, San Francisco, USA
Linda Pfiffner
University of California, San Francisco, USA
InformaHealthcareUSA,Inc.
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Attentiondeficithyperactivitydisorders:concepts,controversies,newdirections/
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1. Attention-deficithyperactivitydisorder. I.McBurnett,Keith.II.Pfiffner,LindaJo.
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Preface
This book bridges the gap between the several existing introductory works
on attention deficit hyperactivity disorder and those more advanced texts
thatfocusonanarrowissueorsubpopulation.Ittargetsreadersintraining
(medicalandnursingstudents,residents,graduatestudents,etc.)ratherthan
a lay audience, and thus it is a natural companion to the attention deficit
hyperactivity disorder section in the Diagnostic and Statistical Manual of
MentalDisorders-IV-TR.Althoughitcanbeusedasanintroductorytext,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,inordertopresentreaderswithmoreofwhattheymightneedto
know rather than what they already know about attention deficit hyper-
activity 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
attentiondeficithyperactivitydisorderisalreadywidelydisseminatedonline
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 treat-
ment.ItstemsfromthefactthatthefirstreportedresultoftheMultimodal
Treatment of ADHD Study—that well-managed pharmacotherapy is more
effective than psychosocial treatment, and that little is gained from adding
psychosocialtreatmenttopharmacotherapyalone—isoftenover-interpreted.
Byconsideringabroadercontext,Pelham’schapterstimulatesthereaderinto
becoming more sophisticated about medication versus psychosocial issues.
Diller’s chapter reminds the reader that, even with the amount of research
iii
iv Preface
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
betterabletodefendtheirviews.
Our choice of emphases should not be misconstrued. Our personal
views are that attention deficit hyperactivity disorder is a valid and under-
treated disorder, that multimodal treatment (medication and psychosocial)
is often the best treatment, that federal funding of research on this and
relateddisordersshouldbequadrupled,andthatmajorrevisionsareneeded
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.
Weoweadebtofgratitudeforthescholarlyeffortsofthecontributors
to this book. Special thanks are due to Russell Schachar, Joel Nigg, and
Glen Elliott, who helped in the conceptualization and early planning.
Keith McBurnett
Linda Pfiffner
Contents
Preface iii
Contributors ix
SECTION I: ASSESSMENT
1. The Diagnosis and How We Got There 1
Keith McBurnett
2. Differential Diagnosis of Attention and Auditory Processing
Disorders 9
Laurent Demanez
SECTION II: CLINICAL CONCEPTUALIZATIONS
3. Clinical Testing of Intelligence, Achievement, and Neuropsychological
Performance in ADHD 21
Leah Ellenberg and Joel Kramer
4. Self-Esteem and Self-Perceptions in ADHD 29
Nina M. Kaiser and Betsy Hoza
5. The Family Context of ADHD 41
Charlotte Johnston and Douglas Scoular
6. Comorbidity as an Organizing Principle 51
Linda J. Pfiffner
7. DysfunctionsofAttention,Learning,andCentralAuditoryProcessing:
What’s the Difference? 63
Juliana Sanchez Bloom and George W. Hynd
SECTION III: CLINICAL NEUROSCIENCE
8. Neuroanatomy of ADHD 71
F. Xavier Castellanos and Eleanor Ainslie
v
