Attention-Deficit Hyperactivity Disorder in Adults and Children Edited By Lenard A. Adler, Thomas J. Spencer & Timothy E. Wilens. Cambridge University Press. 2015. £75.00 (hb). 410 pp. ISBN 9780521113984

This is a book summarising research and practice around the topic of attention-deficit hyperactivity disorder (ADHD) as seen from a very American perspective. It consists of 29 chapters by 50 experts covering everything from history, diagnostic classification, assessment and treatment in all age groups through to imaging, genetics and comorbid conditions. The chapters are of variable length and quality and are extensively referenced. As a compilation of published work to date on ADHD, it has merit. There is, however, little evident editorial input and no attempt to draw together material from different chapters into a coherent whole. There is a considerable degree of repetition and overlap between chapters, which means that attempting to read it through is a frustrating task.

For a UK psychiatric readership, there are a number of issues which will be seen as unsatisfactory. While there is an increasing acceptance of the diagnosis of ADHD in children and adults in the UK, with services reasonably well established for children and developing patchily for adults, there is nevertheless a concern about threshold and diagnostic drift which is barely acknowledged in the book. A more balanced acknowledgement and engagement with this debate would have given it more credibility. One chapter which does this topic some justice is that by Weiss (Chapter 4) on functional impairment. Weiss eloquently addresses the issue of measuring functional impairment and the importance of this alongside counting symptoms. Interestingly, she also bemoans the damage done to the concept of ADHD by overemphasising the negative outcomes, which leaves patients and relatives at risk of feeling hopeless about the possibility of adaptive change, understanding or recovery.

The chapter on epidemiology and societal burden (Chapter 3) is also well written, with reference to the relative merits of ICD and DSM and a considered debate on the issues of predictors of persistence into adulthood and comorbidity. It is one of the few chapters to refer to the ICD-10 classification system. Also interesting is the chapter on the debate about the development of DSM-5 (Chapter 5). British readers may be surprised to hear that there was a widespread view that DSM-5 did not go far enough in widening the diagnostic criteria for ADHD for fear of ‘increasing the prevalence too much’. The author suggests that readers go beyond the DSM-5 criteria to get around this issue!

Chapters on genetic and imaging research provide a good summary of the state of current knowledge and the author of Chapter 23, while acknowledging the absence of controlled trials on psychosocial interventions, does give a good description of techniques which can be used in such programmes, which are widely advocated here in the UK. Chapters on medication cover the evidence available on both Food and Drug Administration (FDA) approved and non-approved treatments. A startling statistic quoted in Chapter 22 is that 50% of patients diagnosed do not respond to treatment with stimulants or have side-effects or worsened comorbid conditions.

In summary, this is a compilation of papers on ADHD, which, while providing a plethora of references to published work on ADHD, is less successful at drawing together conclusions regarding the topic as a whole. The individual chapters may be of use to those wishing to understand the background research evidence in specific areas but it does not readily lend itself to being read in its entirety and is not likely to be seen as providing the non-expert or trainee with an overview to assist with practice in the UK.