Book Review

Hyperactivity Disorders of Childhood

N Engl J Med 1997; 336:969March 27, 1997

Article

Hyperactivity Disorders of Childhood
(Cambridge Monographs in Child and Adolescent Psychiatry.) Edited by Seija Sandberg. 517 pp. New York, Cambridge University Press, 1996. $95. ISBN: 0-521-43250-2

Disorders of attention and overactivity are commonly diagnosed in North American children. Some studies estimate that attention-deficit–hyperactivity disorder (as defined by the American Psychiatric Association) affects as many as 24 percent of children in the United States. There is much concern in the lay press about the apparent epidemic of this disorder and the parallel use of stimulant medication for its treatment. There is also concern that in these times of megatechnology, stringent schedules, and overstressed working parents, many professionals are being asked to and do prescribe stimulant medication for behavior that does not meet criteria for the diagnosis of attention-deficit–hyperactivity disorder. It has even been suggested that many North Americans medicate their children only because of poor parenting skills. In northern Europe, the prevalence of hyperkinetic disorder (as defined by the World Health Organization) is usually less than 5 percent, use of medication for this disorder is rare, and behavioral interventions are the norm. This difference between North America and Europe is due in part to major differences in the methods used for the diagnosis of hyperkinetic disorder and attention-deficit–hyperactivity disorder and to whether coexisting conditions such as conduct, learning, or aggressive disorders are considered the primary diagnosis or secondary to attention deficit and overactivity.

Although written mainly from the European viewpoint and from the perspective of empirical research rather than clinical practice, Hyperactivity Disorders of Childhood presents an extremely informative and readable discussion of hyperactivity and the critical facets of the disparity between Europe and North America in the approach to attention-deficit–hyperactivity disorder. Readers who are knowledgeable about research on attention-deficit–hyperactivity disorder in the United States will appreciate the comparison of and contrast in the epidemiology, diagnosis, consideration of concomitant conditions, and treatment between the United States and Europe. A succinct review of the role of attention in these disorders is targeted to readers with a relatively advanced background in experimental psychology. The chapter on biologic perspectives reviews neuroimaging, electrophysiologic, neurochemical, and environmental studies, but it lists very few references published after 1990 and none after 1993.

A clear and informative review of the historical development of hyperkinetic disorder follows its evolution in the 20th century from a “defect of moral control,” through a condition resulting from “minimal brain damage” and “minimal brain dysfunction,” to a “hyperkinetic disorder.” The early developmental precursors and course of childhood hyperactivity are presented concisely in the context of developmental psychology. There is a thorough and exceptionally readable review of differences between the sexes in the prevalence of the disorder, in its behavioral characteristics, in the overlap with conduct disorder, and the factors responsible for these differences. An excellent chapter deals with psychostimulants and tricyclic antidepressants, behavioral interventions focused on social skills and training in parenting skills, and combined interventions. It should be particularly valuable for trainees in pediatrics, psychiatry, and neurology who treat attention deficits in children.

Pauline A. Filipek, M.D.
University of California, Irvine, College of Medicine, Orange, CA 92668