ADHD: A Handbook for Diagnosis and Treatment

Its full title is Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. It was published by Guilford Press. According to the sources I have, this is the fourth edition. On the publisher's page the hardcover is dated October 17, 2014 and the paperback October 23, 2018, and both run to 898 pages. In reference lists it sometimes appears as 2014, sometimes as 2015; in the reference lists of the articles on this site I wrote it as 2015.

This is not a single-author book. Russell A. Barkley is the editor; he wrote some of the thirty-five chapters himself, and other names in the field wrote the rest. The first edition dates from 1991, the second from 1998, the third from 2006. The publisher presents the fourth edition as "the standard clinical reference" and writes that more than ninety-five thousand copies are in circulation. I have not seen a new edition after the fourth.

I could not find a verified Turkish edition, so I write it under its original title. Barkley has other books that have been translated into Turkish, for example the book I reviewed on this site as the parent's guide. This handbook is something very different from those.

Who the editor is

Barkley was born in 1949 and earned his doctorate in clinical psychology at Bowling Green State University. He worked first at the Medical College of Wisconsin, from 1985 to 2000 at the University of Massachusetts Medical School, and then at the Medical University of South Carolina and Virginia Commonwealth University. He founded and edited the newsletter The ADHD Report, which has reached thirty volumes, and he led the first international consensus statement on ADHD in 2002. On this site I explained his theory through two of his books: ADHD and the Nature of Self-Control and Taking Charge of Adult ADHD, which he wrote for general readers.

The editor's position in this handbook is interesting. Barkley is both the referee of the experts he places side by side and the most prominent theorist in the field. As we will see later, this double role is both the book's strength and its problem.

The starting idea

The purpose of a handbook is to keep the knowledge of a field in one place, up to date and referenced. The publisher's text for the fourth edition says that new chapters were added compared with the previous edition: social skills training, dietary management, executive function training, driving risk in young people, complementary and alternative medicine, adult therapies. New chapters also came into the part on the nature of the disorder: neuropsychological aspects, emotion regulation, peer relationships, age-specific impairments and sluggish cognitive tempo.

At the end of each chapter there is a summary titled "Key Clinical Points." The publisher lists its target readers as clinical psychologists, psychiatrists, neuropsychologists, school psychologists and social workers, and adds pediatricians and family physicians as well.

Let me add a note: this review is based on the book's table of contents, the publisher's description and published reviews. I do not claim to have read the contents of the chapters page by page. Below I pass on the chapter titles and their authors from the publisher's list, and I interpret the content only as far as the title and the sources support it.

Inside the book: part one, the nature of ADHD

Seventeen chapters. This is the heaviest part of the book.

It opens with the history chapter Barkley wrote himself. The second chapter is by Roberts, Milich and Barkley: primary symptoms, diagnostic criteria, subtypes and prevalence. The title of the third chapter also shows the book's stance: emotional dysregulation is a core component of ADHD. Barkley wrote it himself, and the chapter runs to about thirty-five pages. When I was writing the emotion regulation article on this site I thought about this debate separately, and I will come back to it below.

From the fourth to the eighth chapter the axis is the child and the family: Weyandt and Gudmundsdottir on developmental and neuropsychological deficits, Pliszka on comorbid psychiatric disorders, DuPaul and Langberg on educational problems, Johnston and Chronis-Tuscano on families, McQuade and Hoza on peer relationships. The ninth chapter is by Owens, Cardoos and Hinshaw: developmental progression and gender differences.

From the tenth chapter on, the weight shifts to the adult. Solanto writes on executive function deficits in adults. The next three chapters, which Barkley wrote himself, cover health problems, impairments in adulthood in education, occupation, dating, marriage and finances, and comorbid psychiatric disorders. Looking at the chapter titles, you see that ADHD is framed as a picture that does not end with school but reaches all the way to money and relationships.

The last four chapters are the theory layer. Chapter fourteen is on causes (Barkley), chapter fifteen on theories (Willcutt). The title of chapter sixteen is long, but it carries the book's philosophy: executive functioning and self-regulation as an extended phenotype. This is where Barkley's executive function theory enters the book. Chapter seventeen is sluggish cognitive tempo under the name "Concentration Deficit Disorder," an area that gets mixed up with the inattentive side of ADHD and whose debate has gone on for a long time.

Part two: assessment

There are only three chapters, and this proportion tells me something about the book's priorities: thirty-two of the thirty-five chapters are about nature and treatment, and assessment gets three. Barkley writes on the psychological assessment of children. J. Russell Ramsay writes on the assessment of adults; he is the name I introduced on this site with the books Rethinking Adult ADHD and The Adult ADHD Tool Kit. Adler and Alperin describe the diagnosis of adult ADHD in primary care. This last title caught my attention: you can read in the title the idea that adult ADHD should be handled outside psychiatry too, in primary care.

Parts three and four: treatment

There are ten chapters on the treatment of children and adolescents. Parent training (Chacko and colleagues), working with families of adolescents (Robin), social skills training (Mikami), school interventions (Pfiffner and DuPaul), dietary management (Hurt and Arnold), executive function training (Rapport and colleagues), stimulant and nonstimulant medications (Connor), combined treatments (Smith and Shapiro), driving risk in young people (Fabiano and Schatz), complementary and alternative medicine (Bader and Adesman). The driving question caught my interest, because I wrote about ADHD and getting a driver's license on this site, and seeing this title in a handbook shows the clinical seriousness of the subject.

Adult treatment gets five chapters. Murphy writes on counseling adults, Knouse on cognitive-behavioral therapies (it can be read together with the cognitive behavioral therapy article on this site), Gordon, Lewandowski and Lovett on ADA accommodations in education and the workplace, Gina Pera on working with couples affected by ADHD, and Prince, Wilens, Spencer and Biederman on medication treatment in adults. The ADA is the US disability rights law; as someone with a legal education, let me say that the chapter's legal framework does not carry over to Turkey, but the logic of accommodation does. Pera is also the author of Sen mi, Ben mi, Erişkin DEHB mi? (Is It You, Me, or Adult A.D.D.?), which I reviewed on this site.

Its strongest points

Breadth. From what a child goes through at school to an adult's marriage, from medication to driving safety, you would have a hard time finding this much ground in a single volume anywhere else. The reviews quoted on the publisher's page emphasize this too: Mark Stein describes the book as something like the encyclopedia of the field, Brooke Molina highlights the way it combines theory, evidence and practice and its quick-reference format, and James McGough mentions its lifespan perspective and the "Key Clinical Points" boxes. These are quotes the publisher chose and do not count as neutral criticism, but the same features can be seen from the table of contents as well.

The second strength: the developmental line. There is a theoretical coherence stretching from childhood into adulthood, and the adult chapters do not look like an appendix to the child chapters.

The third is the different voices. Even Molina, in the publisher's own quote, draws attention to the diversity of perspectives across chapters. In an edited volume this is a good thing.

Weak points and debates

Executive function theory is not the only explanation. Barkley's framework in chapter sixteen is one of the strong theories in the field, but not the only one. The meta-analysis of 83 studies by Willcutt and colleagues, published in Biological Psychiatry in 2005, says that people with ADHD perform measurably worse on executive function tests, but that these deficits are neither necessary nor sufficient to explain every case. In other words, executive function is an important part of ADHD, but not its only part. That is why it makes sense to read Barkley's theory side by side with Willcutt's chapter on theories in the same volume. I cannot judge how consistent the two chapters are with each other, because I have not seen the conclusion Willcutt's chapter reaches.

Is emotional dysregulation a core symptom? Since 2010 Barkley has argued that emotional impulsivity and deficient emotional self-regulation should be included in the core of ADHD, and the third chapter in the book is the long version of this claim. DSM-5 did not add these symptoms to the criteria. The 2019 clinician review by Faraone and colleagues says that emotional impulsivity and deficient emotional self-regulation may be specific enough to ADHD, while irritability should not be counted as an ADHD symptom; it also reminds us that emotional dysregulation is seen in only some people with ADHD and is also found in some people who do not have ADHD. The 2019 study by Nigg and colleagues with 514 children found that emotional dysregulation was linked more to the genetic risk for ADHD than to the risk for depression. So Barkley's claim finds support, but the field has not closed the matter yet. The question is open.

Sluggish cognitive tempo changed its name. The title of chapter seventeen is "Concentration Deficit Disorder." A work group report published in JAACAP in 2023 renamed this construct "cognitive disengagement syndrome." The report is by Becker and colleagues, and Barkley is among its thirteen authors. The 2023 systematic review by Fredrick and colleagues argues that these symptoms are distinct from the inattentive symptoms of ADHD, but at the same time writes that very few studies controlled for ADHD inattentive symptoms and that the biological correlates are limited and largely unreplicated. The field has moved on since then. If you are going to read this chapter, read it comparing the name and the framework with current sources.

The authors of the medication chapter. Three of the four names who wrote the chapter on medication treatment in adults (Wilens, Spencer, Biederman) were names that Charles Grassley examined in the US Senate in 2008: the investigation concerned whether they had underreported the payments they received from drug companies. They had their own defense too: they said they believed they had followed the rules. It does not follow from this that the scientific content of the chapter is wrong. But keeping the conflict of interest in mind while reading the medication chapters is, I think, the reader's right.

Age. The book is twelve years old. The basic clinical framework does not go out of date, but the research that came in the post-DSM-5 years, and newer studies on adult ADHD diagnosis and comorbid conditions, are not in this volume. So the book should not be put in place of the current literature, but used as a starting point on the way to it.

Price and size. On the publisher's page the hardcover was listed at 132 dollars and the paperback at 88. It is a volume of close to nine hundred pages. It is not a book you finish over a weekend.

Who it is for, and who it is not for

The book is for clinicians, psychology and psychiatry students, and readers who research ADHD in depth and want to look at the citations and check the source themselves. A parent or adult reader can go to the chapter related to a specific question (for example how medication works, or the effect of ADHD on a marriage) and read it, but the book was not written for that.

It should not be the first book for someone who has just been diagnosed. The chapter titles are in clinical language: deficits, disorders, impairments. It is not a structure built to tell a person's story. For someone who first wants to understand themselves, books for general readers are a better door.

Its place on the shelf

This handbook of Barkley's is cited a lot in the articles on this site; in the reference lists it appears as "Barkley, R. A. (2015)." There are three Barkley books on the books shelf, and each one is a different door: a guide for parents, Taking Charge of Adult ADHD for adults, Self-Control for theory. The handbook is the evidence store behind all of them. On the treatment side, the workbooks by Safren and Ramsay come from the same family of methods as the cognitive-behavioral chapter in this volume.

My stance

To get hold of this book, going to a library or using a university subscription makes more sense than buying it. Its real value is having a concrete source in hand when you want to check a claim: a chapter, an author, a date. Both those who agree with Barkley's theory and those who object to it have to come back to the same volume, because one side of the debate is written there. Still, it should be read not as a rule book but as a conversation within the field itself.