Book Review

Attention Deficit Hyperactivity Disorder: From Genes to Patients

N Engl J Med 2006; 354:2198May 18, 2006

Article

Attention Deficit Hyperactivity Disorder: From Genes to Patients
(Contemporary Clinical Neuroscience.) Edited by David Gozal and Dennis L. Molfese. 559 pp. Totowa, N.J., Humana Press, 2005. $165. ISBN: 1-58829-312-2

Phil, stop acting like a worm,

The table is no place to squirm . . .

. . . He turns

And churns

He wiggles

And jiggles

Here and there on the chair

Phil, these twists I cannot bear.

The story of “Fidgety Phil” in this German poem by Heinrich Hoffmann from the mid-1800s reminds us that attention deficit–hyperactivity disorder (ADHD) is not simply a disease of modern times or a contrivance of the pharmaceutical industry, as some observers have suggested. Rather, ADHD is a remarkably common disorder that affects children, adolescents, and adults, and it has been a vexing problem for parents and clinicians for a very long time. Not surprisingly, a disorder of such high prevalence (affecting up to 10 percent of all children) has been the focus of considerable investigation, controversy, and speculation.

Some of this work has appeared in numerous scientific journals, papers, and books, as well as in books for the general public and in the media. In Attention Deficit Hyperactivity Disorder, Gozal and Molfese offer yet another attempt to review the vast scientific and clinical knowledge about ADHD. In the process, they face a challenge shared with some of their predecessors — namely, how to provide an organized approach to a perplexing disorder. In some ways, they have met this challenge, but in other ways they fall short.

Roscoe Dykman is a part of the history of ADHD, and his excellent chapter on the evolution of thinking and research about ADHD is a fine introduction to the book and sets the stage for further consideration. Since ADHD was one of the first psychiatric disorders to be the focus of genetic research and to serve as a model of a complex genetic disease, there is much to consider — far more than is covered in the two chapters on animal models and the single chapter on genome scans. Although there is discussion of some neurochemical models and neuropharmacology (in a total of three chapters, plus an excellent review of neuroimaging), the balance of the book deals with the neuropsychology of ADHD. This is an important topic, but the chapters are inconsistently edited and often redundant. There is no discussion of nosology and epidemiology, and the high rates of coexisting illnesses are barely mentioned. Together, these faults make it difficult for the reader to gain a proper perspective and to have a real sense of who patients with ADHD actually are. Even though many chapters make interesting points, in the end, the reader never gets to see the patient as an integrated person struggling with a complex clinical condition. Nor is there a model for clinical practice or future research.

Attending to the complexities of ADHD is difficult, but in a comprehensive review from “genes to patients,” one could expect better organization and attention to detail. Selected chapters may be worth referencing from time to time, but students, clinicians, investigators, and patients can find better choices for reference and review.

Bennett L. Leventhal, M.D.
University of Illinois, Chicago, IL 60608