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Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment
Updating and expanding Russell Barkley's acclaimed Handbook , this new second edition incorporates the latest findings on the nature, diagnosis, assessment, and treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). As in the previous edition, Dr. Barkley includes contributions from other leading scientist-practitioners, who report on their respective areas of expertise. Readers will find current, practical information on nearly every aspect of the disorder. In-depth assessment and treatment guidelines are supported by updated outcomes documentation, and three new chapters focus specifically on adults.
Practitioners wishing to implement the assessment and treatment recommendations delineated in this edition are advised to purchase the companion Workbook , which contains a full set of forms, questionnaires, and handouts, in a large-size format, with permission to photocopy.
Practitioners wishing to implement the assessment and treatment recommendations delineated in this edition are advised to purchase the companion Workbook , which contains a full set of forms, questionnaires, and handouts, in a large-size format, with permission to photocopy.
628 pages, Hardcover
Published July 3, 1998
49 people are currently reading
342 people want to read
About the author
Russell A. Barkley
69 books437 followersRussell A. Barkley (born 1949) is a clinical psychologist who is a clinical professor of psychiatry at the Medical University of South Carolina and an author of books on ADHD. Involved in research since 1973 and a licensed psychologist since 1977, he is an expert on attention-deficit hyperactivity disorder (ADHD) and has devoted much of his scientific career to studying ADHD and related problems in children. His research interests include childhood defiance.
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Displaying 1 - 6 of 6 reviews
August 29, 2021
I've wanted to further my understanding of ADHD, and some time ago I read ADHD 2.0 by Edward Hallowell and John Ratey. However, the book was disappointing in many ways. The biggest is that it simply wasn't very scientifically rigorous. I outline some examples of why in my review of that book. I still wanted to learn about ADHD, but now I was somewhat traumatized by the poor quality I encountered.
I tried to figure out what would be the most legitimate source possible, and a person that stood out to me was Russell Barkley. He is considered one of the world experts on ADHD, being in the field for decades and having published almost 300 papers. After seeing he had a textbook on ADHD, I figured it's likely the best I could get. The textbook is of course not written by Barkley in its entirety. Like most textbooks, it has a variety of contributions from different authors. But having him as the lead author/editor gave me some confidence in its quality.
The book is huge with around 800 pages, and each page is divided into 2 columns to make it extra dense. It is very intimidating, and I was worried that it might be overkill. But I didn't want to repeat my previous experience so I figured I would risk it to make sure I was reading the best science on the topic.
The book is divided into 4 major sections, each quite large. The first being the history of ADHD, followed by the assessment of ADHD, treatment of children and adolescents, and then finally treatment of adults. It is immediately apparent from the beginning the quality of the book. It is extremely detailed and evidence-based. Although I quickly also notice its downside. The first chapter is about the history of ADHD, which alone lasts 50 pages. It feels like it explored every possible connection. I didn't find it overly tedious, but just to highlight the type of commitment.
My goal was to skip chapters that seemed less important, so I wouldn't waste too much time on irrelevant details. This is what I ended up doing, although to a lesser degree than expected. I read most of the chapters since I was a bit afraid of missing something crucial. I skipped 8 chapters, which isn't a lot since it has 35 in total.
My apprehension to skip chapters was often proven wise. For instance, I thought that chapters on children wouldn't be very relevant to me. In a way, that's true. And a lot of information is about ADHD in children and its impact on school performance. However, by reading a lot of information about child ADHD, I ended up finding some interesting nuggets that I was expecting. Through reading some research about the impacts of ADHD in children, I was able to better make sense of my experience as a child, such as getting levels of frustration, peer to peer interactions, and self-image. Social interactions in particular were interesting to me. A model called social information-processing is mentioned, which includes several stages of processing social information and adequate behaviour, and ADHD seems to alter the pattern and function of those stages. Fewer social cues are encoded, and they tend not to be systematic, likely resulting from an inability to pay attention to social information.
Childhood aside, I didn't learn a lot about ADHD in general. The general gist is that it is a mostly genetic disorder starting in early childhood and generally lasts a lifetime. It was once thought that ADHD was mostly a childhood disorder because adults seemed to overcome the symptoms they were diagnosed with as children. However, it was later found out that the symptoms only disappeared with self-reports. But when talking to other people close to the adult, such as their romantic partner or parents, it is often reported that they still display many problems related to ADHD.
The disorder is mostly characterized by impaired response inhibition, excessive task-irrelevant activity (eg fidgetting), and poor sustained attention. Nevertheless, there is a lot of details that I found insightful. While I always knew that it primarily affects executive function, before reading the textbook I didn't have a concrete idea of what that meant in practice.
It was also a good example of how learning a disorder some in-depth allowed me to better understand psychiatry as a whole that goes beyond this disorder. For instance, the executive function part was often neglected until recently because neuropsychological tests didn't show a difference between ADHD and the regular population. But it was later found that such tests were not properly testing executive function in a way that mimics everyday life, and thus the problem was the external validity with the tests being used which significantly delayed and distorted our understanding. Similar learning about psychiatry as a whole was present in other forms, such as how mental disorders are created and categorized, and the research and assumptions behind those decisions.
I also enjoyed a detailed discussion of different subtypes, which I was not very familiar with. ADHD has roughly 3 classifications: ADHD-PH, ADHD-HI and ADHD-C. The first being mostly related to attention deficits, the second is about impulsivity, and the latter being a combination. ADHD has a very high incidence of comorbidity, the most common being oppositional defiant disorder (45– 84%) followed by conduct disorder (15–56%) and related substance use disorders, anxiety (25–50%) and depression (up to 30%).
Some aspects I was surprised that I never came across in any depth before, such as its strong component of emotional regulation, and perhaps the biggest one, how often it is for ADHD and sleep disorders to co-exist. Dysregulation of one's circadian rhythm is common, and having struggled with sleep for over a decade, with either Delayed sleep phase disorder or Non-24-Hour-Sleep Disorder, gave me some extra confidence in my diagnosis and also some peace about a potential cause of my sleep issues which impacted my life significantly.
Other aspects related to the disorder that I found insightful to read was the impact of ADHD in relationships, how it relates to intellectual disability or creativity, or common daily struggles such as forgetting items or events due to affected working memory, or increase high-risk driving. Some chapters were surprisingly practical. For example, some advice was given on how parents or teachers can better deal with teenagers with ADHD.
A lot of material was also covered on how to treat the disorder, not just descriptions of it and its clinical outcomes. The most straightforward treatment is stimulant medication, with methylphenidate or mixed amphetamine salts. Although non-stimulant medications exist also. There was a lot of discussion about therapy as well. And I was pleasantly surprised to see many kinds of treatments being discussed. Even complementary and alternative medicine are covered. These are, almost universally, ineffective. However, I enjoyed the fact that they were covered with an open mind. Even though just from a mechanistic perspective it can be predicted that many of the treatments won't do anything, this aspect was mostly ignored and direct research was given primacy. Even if in theory it makes no sense, the studies about it are covered and explained.
The book despite being very long and dense is not particularly hard to read. While some basic knowledge of psychology and psychiatry is useful, it isn't for the most part very technical. There are some exceptions, for example when it discusses neural networks, or the genes that have been found to have associations with the disorder, but these are a minority. Most of the research covered are clinical studies that compare ADHD populations to normal ones and look at their differences and how it affects certain outcomes. It is a type of language that anyone can understand.
There were two factors in the book that I didn't like. The first is that at times it was repetitive, which can already be annoying in a regular book, but even more so in such a large one. Although I'm guessing this is the case because these books of topics are meant more so to be consulted for specific issues rather than read cover to cover.
The second aspect is that in certain topics I didn't finish with a very clear sense of what the research is pointing to. For example, earlier in the book a lot of research mentioned how cognitive behavioural therapy didn't seem to have the benefit predicted. But towards the end of the book, it was mentioned that more recent research has shown some benefits. From my understanding, this is mostly because CBT has been adapted and seems to be more useful in adults than in children. However, this wasn't super explicit in the book, and at times I felt like I was reading contradictory information. Not saying it is the case, just that I felt it should have been more organized. Likely a consequence of both the book being written by many authors and the fact that recent editions make changes more so by adding chapters than changing the old content.
While this is a very minor point, I also thought the chapters summaries could be improved. While I still found them very helpful, they are overly broad, and it's hard to make sense of them unless you have read the chapter. It tends to describe what was covered, instead of focusing more on the actual outcomes of specific problems. It is sometimes hard to get a sense of where the evidence stands by reading the summary alone, which I think should be the goal.
As a whole, I am very satisfied with the book. It is exactly what I wanted. I did wish that sometimes it dealt more with more "meta-questions" about the diagnosis itself, but I guess that would be more philosophy of psychiatry than anything else. Of course, it took some time to go through, but it wasn't as hard as one would expect. While it takes some effort, it's not overly hard to read one chapter in one sitting, which would make you read the whole book in one month if you read once every day.
It's not for everyone, though. If you want to take a deep dive into ADHD and learn almost everything you can, then this is great. But if you want more or an introduction or practical insights, this is overkill. While the scientific accuracy of the book is a great plus, Barkley himself has written more laymen books. He has a book about raising children with ADHD, guides for teachers that deal with ADHD, dealing with ADHD as an adult, and even a book about relationships when one person has ADHD. I'm confident that any of these will be great.
Nevertheless, don't be overly intimidated by the length of this book. It's still very doable if you put some effort in, and you can very easily skip chapters and only read what is most relevant to you. While I mentioned that I wish the summary chapters were more specific, they are still very helpful in order to determine if the chapter is worth reading or not. I would recommend taking a decent amount of time analyzing the index of the book, and perhaps making an initial list of the chapters that may be useful depending on your interests. Then read the summaries of those chapters, and make a new, more restricted list of what you should read. Doing so will spare you a lot of unnecessary reading, while still getting a lot of value from such a high-quality book.
Furthermore, even if you don't plan to read a lot of the book and if you decide to go with a more layman type book, I still think this is worth getting if you struggle with ADHD. While it is overkill if you just have a slight interest in the topic, if it's something you live with and affects your life significantly, I think it's good to have even if it's just a reference source if you don't mind the cost.
I tried to figure out what would be the most legitimate source possible, and a person that stood out to me was Russell Barkley. He is considered one of the world experts on ADHD, being in the field for decades and having published almost 300 papers. After seeing he had a textbook on ADHD, I figured it's likely the best I could get. The textbook is of course not written by Barkley in its entirety. Like most textbooks, it has a variety of contributions from different authors. But having him as the lead author/editor gave me some confidence in its quality.
The book is huge with around 800 pages, and each page is divided into 2 columns to make it extra dense. It is very intimidating, and I was worried that it might be overkill. But I didn't want to repeat my previous experience so I figured I would risk it to make sure I was reading the best science on the topic.
The book is divided into 4 major sections, each quite large. The first being the history of ADHD, followed by the assessment of ADHD, treatment of children and adolescents, and then finally treatment of adults. It is immediately apparent from the beginning the quality of the book. It is extremely detailed and evidence-based. Although I quickly also notice its downside. The first chapter is about the history of ADHD, which alone lasts 50 pages. It feels like it explored every possible connection. I didn't find it overly tedious, but just to highlight the type of commitment.
My goal was to skip chapters that seemed less important, so I wouldn't waste too much time on irrelevant details. This is what I ended up doing, although to a lesser degree than expected. I read most of the chapters since I was a bit afraid of missing something crucial. I skipped 8 chapters, which isn't a lot since it has 35 in total.
My apprehension to skip chapters was often proven wise. For instance, I thought that chapters on children wouldn't be very relevant to me. In a way, that's true. And a lot of information is about ADHD in children and its impact on school performance. However, by reading a lot of information about child ADHD, I ended up finding some interesting nuggets that I was expecting. Through reading some research about the impacts of ADHD in children, I was able to better make sense of my experience as a child, such as getting levels of frustration, peer to peer interactions, and self-image. Social interactions in particular were interesting to me. A model called social information-processing is mentioned, which includes several stages of processing social information and adequate behaviour, and ADHD seems to alter the pattern and function of those stages. Fewer social cues are encoded, and they tend not to be systematic, likely resulting from an inability to pay attention to social information.
Childhood aside, I didn't learn a lot about ADHD in general. The general gist is that it is a mostly genetic disorder starting in early childhood and generally lasts a lifetime. It was once thought that ADHD was mostly a childhood disorder because adults seemed to overcome the symptoms they were diagnosed with as children. However, it was later found out that the symptoms only disappeared with self-reports. But when talking to other people close to the adult, such as their romantic partner or parents, it is often reported that they still display many problems related to ADHD.
The disorder is mostly characterized by impaired response inhibition, excessive task-irrelevant activity (eg fidgetting), and poor sustained attention. Nevertheless, there is a lot of details that I found insightful. While I always knew that it primarily affects executive function, before reading the textbook I didn't have a concrete idea of what that meant in practice.
It was also a good example of how learning a disorder some in-depth allowed me to better understand psychiatry as a whole that goes beyond this disorder. For instance, the executive function part was often neglected until recently because neuropsychological tests didn't show a difference between ADHD and the regular population. But it was later found that such tests were not properly testing executive function in a way that mimics everyday life, and thus the problem was the external validity with the tests being used which significantly delayed and distorted our understanding. Similar learning about psychiatry as a whole was present in other forms, such as how mental disorders are created and categorized, and the research and assumptions behind those decisions.
I also enjoyed a detailed discussion of different subtypes, which I was not very familiar with. ADHD has roughly 3 classifications: ADHD-PH, ADHD-HI and ADHD-C. The first being mostly related to attention deficits, the second is about impulsivity, and the latter being a combination. ADHD has a very high incidence of comorbidity, the most common being oppositional defiant disorder (45– 84%) followed by conduct disorder (15–56%) and related substance use disorders, anxiety (25–50%) and depression (up to 30%).
Some aspects I was surprised that I never came across in any depth before, such as its strong component of emotional regulation, and perhaps the biggest one, how often it is for ADHD and sleep disorders to co-exist. Dysregulation of one's circadian rhythm is common, and having struggled with sleep for over a decade, with either Delayed sleep phase disorder or Non-24-Hour-Sleep Disorder, gave me some extra confidence in my diagnosis and also some peace about a potential cause of my sleep issues which impacted my life significantly.
Other aspects related to the disorder that I found insightful to read was the impact of ADHD in relationships, how it relates to intellectual disability or creativity, or common daily struggles such as forgetting items or events due to affected working memory, or increase high-risk driving. Some chapters were surprisingly practical. For example, some advice was given on how parents or teachers can better deal with teenagers with ADHD.
A lot of material was also covered on how to treat the disorder, not just descriptions of it and its clinical outcomes. The most straightforward treatment is stimulant medication, with methylphenidate or mixed amphetamine salts. Although non-stimulant medications exist also. There was a lot of discussion about therapy as well. And I was pleasantly surprised to see many kinds of treatments being discussed. Even complementary and alternative medicine are covered. These are, almost universally, ineffective. However, I enjoyed the fact that they were covered with an open mind. Even though just from a mechanistic perspective it can be predicted that many of the treatments won't do anything, this aspect was mostly ignored and direct research was given primacy. Even if in theory it makes no sense, the studies about it are covered and explained.
The book despite being very long and dense is not particularly hard to read. While some basic knowledge of psychology and psychiatry is useful, it isn't for the most part very technical. There are some exceptions, for example when it discusses neural networks, or the genes that have been found to have associations with the disorder, but these are a minority. Most of the research covered are clinical studies that compare ADHD populations to normal ones and look at their differences and how it affects certain outcomes. It is a type of language that anyone can understand.
There were two factors in the book that I didn't like. The first is that at times it was repetitive, which can already be annoying in a regular book, but even more so in such a large one. Although I'm guessing this is the case because these books of topics are meant more so to be consulted for specific issues rather than read cover to cover.
The second aspect is that in certain topics I didn't finish with a very clear sense of what the research is pointing to. For example, earlier in the book a lot of research mentioned how cognitive behavioural therapy didn't seem to have the benefit predicted. But towards the end of the book, it was mentioned that more recent research has shown some benefits. From my understanding, this is mostly because CBT has been adapted and seems to be more useful in adults than in children. However, this wasn't super explicit in the book, and at times I felt like I was reading contradictory information. Not saying it is the case, just that I felt it should have been more organized. Likely a consequence of both the book being written by many authors and the fact that recent editions make changes more so by adding chapters than changing the old content.
While this is a very minor point, I also thought the chapters summaries could be improved. While I still found them very helpful, they are overly broad, and it's hard to make sense of them unless you have read the chapter. It tends to describe what was covered, instead of focusing more on the actual outcomes of specific problems. It is sometimes hard to get a sense of where the evidence stands by reading the summary alone, which I think should be the goal.
As a whole, I am very satisfied with the book. It is exactly what I wanted. I did wish that sometimes it dealt more with more "meta-questions" about the diagnosis itself, but I guess that would be more philosophy of psychiatry than anything else. Of course, it took some time to go through, but it wasn't as hard as one would expect. While it takes some effort, it's not overly hard to read one chapter in one sitting, which would make you read the whole book in one month if you read once every day.
It's not for everyone, though. If you want to take a deep dive into ADHD and learn almost everything you can, then this is great. But if you want more or an introduction or practical insights, this is overkill. While the scientific accuracy of the book is a great plus, Barkley himself has written more laymen books. He has a book about raising children with ADHD, guides for teachers that deal with ADHD, dealing with ADHD as an adult, and even a book about relationships when one person has ADHD. I'm confident that any of these will be great.
Nevertheless, don't be overly intimidated by the length of this book. It's still very doable if you put some effort in, and you can very easily skip chapters and only read what is most relevant to you. While I mentioned that I wish the summary chapters were more specific, they are still very helpful in order to determine if the chapter is worth reading or not. I would recommend taking a decent amount of time analyzing the index of the book, and perhaps making an initial list of the chapters that may be useful depending on your interests. Then read the summaries of those chapters, and make a new, more restricted list of what you should read. Doing so will spare you a lot of unnecessary reading, while still getting a lot of value from such a high-quality book.
Furthermore, even if you don't plan to read a lot of the book and if you decide to go with a more layman type book, I still think this is worth getting if you struggle with ADHD. While it is overkill if you just have a slight interest in the topic, if it's something you live with and affects your life significantly, I think it's good to have even if it's just a reference source if you don't mind the cost.
February 25, 2025
An excellent, incredibly dense (or rich, depending on how you view it) history and explanation on ADHD. This book is for those affected by ADHD and those who treat it. 4 stars because I didn’t feel like enough was said concerning the actual treatment of ADHD. Still, if you’re a clinician who works with ADHD, I feel like this is worth exploring.
October 4, 2013
This was difficult for me to read and I never finished it. It really is aimed at the medical community. If you are interested in the science and history of ADHD, this is the book for you.
June 12, 2023
This is hard to rate. Firstly I haven't read all chapters and don't plan to, but I will read more.
I was actually expecting this to be an overly technical intro like most handbooks that are basically unreadable as the authors try to act overly intellectual by using confusing sentences and words to sound academic. Here it's nearly the opposite. Each chapter is actually a light encyclopedia-like intro to the topic at hand. No matter if you want to read about the history or about adults with ADHD you will get exactly what you seek. The topic itself presented in a short and accessible format. Though because it is clinical psychology, a field of research that is extremely arbitrary and often unscientific, you get what you expect: a subject that is light on proper science and evidence.
The chapters also feel a bit too basic and unspecific. Again, the author is most often not to blame it's just that clinical psychology is an extremely iffy field with a ton of pseudoscientific claims. He uses whatever studies he can find on each subject, which is hundreds, and then fills out the gaps with his own ideas and opinions that are on a very accessible yet intellectual level. The history part for example does go over most of the history and years yet there are basically zero quotes or tables. So unless you already know the history there is no way you can understand what people were thinking at what point without seeing a single drawing or citation from those periods. It's all extremely shallow. Sure, he mentions it all. But just mentioning something doesn't mean readers will get it the same way he understands it. This book feels like a book made for students to quote for exams without understanding anything.
As an intro for an unscientific topic like ADHD this is really good and you won't find much better intros out there if you understand the scientific method and how studies are conducted. But it still feels a bit hazy and I'm not sure I understand ADHD after reading chapters from the book. Maybe I could read a basic overview in an audiobook format from the author and then understand some of the unsaid stuff here. Honestly a documentary or image-filled book format would have worked better than pure text as this is very much focused on unscientific historical claims.
I was actually expecting this to be an overly technical intro like most handbooks that are basically unreadable as the authors try to act overly intellectual by using confusing sentences and words to sound academic. Here it's nearly the opposite. Each chapter is actually a light encyclopedia-like intro to the topic at hand. No matter if you want to read about the history or about adults with ADHD you will get exactly what you seek. The topic itself presented in a short and accessible format. Though because it is clinical psychology, a field of research that is extremely arbitrary and often unscientific, you get what you expect: a subject that is light on proper science and evidence.
The chapters also feel a bit too basic and unspecific. Again, the author is most often not to blame it's just that clinical psychology is an extremely iffy field with a ton of pseudoscientific claims. He uses whatever studies he can find on each subject, which is hundreds, and then fills out the gaps with his own ideas and opinions that are on a very accessible yet intellectual level. The history part for example does go over most of the history and years yet there are basically zero quotes or tables. So unless you already know the history there is no way you can understand what people were thinking at what point without seeing a single drawing or citation from those periods. It's all extremely shallow. Sure, he mentions it all. But just mentioning something doesn't mean readers will get it the same way he understands it. This book feels like a book made for students to quote for exams without understanding anything.
As an intro for an unscientific topic like ADHD this is really good and you won't find much better intros out there if you understand the scientific method and how studies are conducted. But it still feels a bit hazy and I'm not sure I understand ADHD after reading chapters from the book. Maybe I could read a basic overview in an audiobook format from the author and then understand some of the unsaid stuff here. Honestly a documentary or image-filled book format would have worked better than pure text as this is very much focused on unscientific historical claims.
September 11, 2024
A truly terrible book, if you're looking to learn about ADHD, and telling that most reviews acknowledge that they didn't read it all. Varies between entire chapters on mundane observations like 'people with low impulse control are more likely to get into traffic accidents', and chapters with sentences like 'The erythro isomers of MPH appear to produce side-effects; thus, MPH is now manufactured as an equal racemic mixture of d,l-threo-MPH', with no explanation as to what that means.
If you actually want to know how any single idea is established, you'll just be referred to a hundred other papers. Not a single result is ever actually documented in here.
And yet still fails to be rigorous. From 'even though sugar isn't shown to have any influence on ADHD, we recommend you cut it anyway because hey, what harm can it do', to rants about the 'ignorant denial of ADHD', without ever getting into the nature of what 'disorder' and 'dysfunction' really mean.
I think very few people will actually manage to slog through this, which is good, because although I learned some things, this was largely a waste of my time.
If you actually want to know how any single idea is established, you'll just be referred to a hundred other papers. Not a single result is ever actually documented in here.
And yet still fails to be rigorous. From 'even though sugar isn't shown to have any influence on ADHD, we recommend you cut it anyway because hey, what harm can it do', to rants about the 'ignorant denial of ADHD', without ever getting into the nature of what 'disorder' and 'dysfunction' really mean.
I think very few people will actually manage to slog through this, which is good, because although I learned some things, this was largely a waste of my time.
December 1, 2021
superb
Displaying 1 - 6 of 6 reviews