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Book Forum: Disorders of Childhood and Beyond   |    
ADHD in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment
EDWARD V. NUNES, M.D.
Am J Psychiatry 2001;158:512-512. doi:10.1176/appi.ajp.158.3.512
View Author and Article Information
New York, N.Y.

By Margaret Weiss, M.D., Ph.D., Lily Trokenberg Hechtman, M.D., C.M., and Gabrielle Weiss, M.D., C.M. Baltimore, Johns Hopkins University Press, 1999, 376 pp., $49.95.

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Up until the past decade, and certainly when many of us took graduate and clinical training, attention deficit hyperactivity disorder (ADHD) was presented confidently as a disorder of childhood that most affected youngsters "outgrew." Now, as if proof of the old admonition that half of what you have been taught is wrong, mounting evidence suggests that ADHD often persists into adulthood and continues to produce considerable suffering and disability throughout the life cycle. This book is a comprehensive and authoritative text on the subject that combines a scholarly command of the literature and the extensive clinical experience of the authors into a masterful synthesis of the current state of knowledge. The book will be invaluable for both clinicians and researchers.

The introductory chapter provides a scholarly overview of the literature on ADHD, addressing key issues, including the clinical course of the disorder in adolescence and adulthood and adult outcomes of children with ADHD, diagnostic features and criteria for ADHD in adulthood, associated symptoms common in adult ADHD but not included in the diagnostic criteria, effects of ADHD on employment and other realms of adult functioning, gender differences in the presentation of ADHD, and roles for biological, genetic, and environmental determinants in the etiology of ADHD.

The next chapter provides a comprehensive guide to diagnostic assessment. In addition to a practical guide to available instruments and techniques, there are also illuminating chapters on the extensive comorbidity of ADHD with other disorders such as unipolar and bipolar affective disorders, anxiety disorders, and substance abuse. There is a chapter on difficult diagnostic situations often confronted by clinicians working with adult patients, such as the patient with adult ADHD symptoms in whom the childhood syndrome cannot be elicited. The remaining chapters furnish a comprehensive guide to pharmacotherapy and psychosocial therapies for adults with ADHD and reviews of the effects of the disorder on school, work, and family functioning, the latter being particularly critical given the high likelihood that an identified patient will have parents, siblings, or children who also have ADHD. The climax of the book is a remarkable chapter in which each of the members of a family—mother and young son who have ADHD and father and daughter who do not—have written down their life stories in their own words, affording an intimate glimpse into the subjective experience of patients and their families.

A consistent feature throughout this work is its blending of elegant case descriptions with clinical experience and the scientific literature, making the text a pleasure to read and conveying a real clinical feel that is generally missing from data-based articles and even most literature reviews. This book is a must read for clinicians treating patients of all ages who want to improve their diagnostic and therapeutic acumen regarding this previously underrecognized disorder.

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