ADHD in the Schools: Assessment and Intervention Strategies. By GeorgeJ DuPauland Gary Stoner. School PractitionerSeries, edited by Stephen N. Elliott and Joseph C. Witt. NewYork: The GuilfordPress, 1994, 269 pp., $25.00 (softcover).
The authors of this interesting and informative book statethat they have attempted to focus on how to (1) identifyand assess students who might have ADHD, (2) developand implement classroom-based intervention programs forthese students, and (3) communicate with and assist physicians when stimulant medications are used to treat thisdisorder. An excellent description of the clinical picture,developmental course, and long-term outcome of childrenwith ADHD is also presented. The authors have succeededadmirably in their stated goals. In the process of so doing,they have presented most of the current diagnostic, assessment, and treatment methods for children with ADHD thatare available in the scientific literature and have extensivelyreferenced all of the above. This volume will serve as anexcellent reference book for school psychologists, guidancecounselors, and teachers.
There are, however, several problems with the authors'recommendations. This book is based on the premise thatit is both desirable and practical for a medical diagnosis(ADHD) to be made by school personnel , a highly debatableassumption. In this otherwise well-referenced book, thereare no data presented on how many schools are equippedto do what the authors propose or even how many wouldbe willing to attempt it, given their limitations in personneland funding. For example, DuPaul and Stoner suggest usingDSM criteria for the diagnosis of ADHD and for comorbidconditions. As they have noted, the use of these diagnosticcriteria requires considerable training. Staff members withsuch clinical expertise are unlikely to be available in mostschool settings. Another possible problem with the recommendations is the extensive list of evaluations and the needfor trained personnel to obtain them . Two examples are (1)the parent interview using DSM criteria for ADHD and forassociated comorbid conditions and (2) the direct observationof the ADHD subject as compared with one or rwo " typical"or "average" classmates. Conducting these evaluations willexceed the staffing, financial, and clinical capabilities of theaverage school. Few would disagree with the idea that allsuggested assessments would be helpful, if obtained andused by properly trained clinicians. However, there is therisk that school personnel without the proper training mightattempt to use this highly sophisticated diagnostic scheme.
The chapter on classroom-based intervent ion strategiesbegins with the caution that persons endeavoring to manageor alter the problematic behavior of children in a systematicfashion should have completed appropriate professionaltraining and/or will be supervised by an appropriately trained
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BOOK REVIEWS
and credentialed professional. Again it seems unlikely thatmany schools will have the necessary appropriately trainedpersonnel. The authors then present eight practical generalstrategies for classroom intervention for children withADHD. This is followed by a discussion of contingencymanagement procedures, including token reinforcement programs, home-based contingencies, and self-management interventions. Teachers will find that the section on educationalstrategies presents many specific suggestions that can be usedto advantage in the classroom.
The chapter on medication therapy covers almost everyconceivable aspect and may present too much detailed information for most school personnel. However, the betterinformed school professionals are, the better they areequipped to assist with the evaluation of medication therapyand to help parents to understand this treatment method.The authors mention desipramine as an example ofa tricyclicantidepressant used to treat children with ADHD. Desipramine is an unfortunate choice because it is no longerrecommended, due to its association with sudden death inseveral cases. This chapter reads as though most subjectswho have ADHD are first evaluated and diagnosed by schoolpersonnel, who then must decide on whether to recommendmedication therapy. The whole approach to treatment assumes that school assessment precedes medication therapy.However, in many if not most cases, ADHD is diagnosedand medication is started before the school has ident ifiedthe ADHD and often before any baseline assessments havebeen obtained. What the school personnel are to do in thissituation is not addressed in this book. The authors raisethe question of who is to be responsible for measuringresponse to medication, monitoring side effects, and adjusting dosage. It seems to me that although school personnelcan assist with some of these tasks, the responsibility anddecisions regarding medication treatment can only be thoseof the treating physician.
Despite the reservations mentioned above, this bookshould be informative and useful to school-basedpractitioners.
James H. Satterfield, M.D.Clinical Associate Professor of Psychiatry
Division of Child PsychiatryOregon Health Sciences University
Former Director, National Center forHyperactive Children
Ethics and Child Mental Health. Edited by Jocelyn Hattab,MD. Jerusalem: Gefen Publishing House, Ltd., 1994, 323pp., $60.00 (hardcover).
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