Dikkat Eksikliği ve Hiperaktivite Bozukluğu ile Baş Edebilme

Russell Barkley's comprehensive guide for parents. Its original title is Taking Charge of ADHD: The Complete, Authoritative Guide for Parents. The first edition was published in 1995 by Guilford Press; a revised edition came in 2000, a third edition in 2013 and a fourth edition in 2020. According to the publisher it has sold more than half a million copies.

On this site I wrote earlier about Barkley's Taking Charge of Adult ADHD, which he wrote for adults. The names are similar but this is a different book: its reader is the parent of a child with ADHD.

There is a Turkish edition. Palme Yayınevi published it in 2021 as Dikkat Eksikliği ve Hiperaktivite Bozukluğu (DEHB) ile Baş Edebilme; its subtitle says it is a comprehensive and authoritative guide for parents. The translators are Şebnem Sevinç and Ülkü Pişkin Abidoğlu, and the book is 362 pages. I saw these details on the publisher's site and at Nobel Kitabevi. I could not verify which English edition it was translated from, so I do not know whether the novelties of the fourth edition are in the Turkish; when buying it, the contents need to be checked.

Why Barkley wrote this book

Barkley is one of the most cited researchers in the field of ADHD. He has a large share in the present form of the theory that frames ADHD less as an attention problem than as a problem of self-regulation and executive function.

The first edition came out at a time when a significant part of the information in parents' hands was either missing or blaming. In those years ADHD was often discussed in public in terms of bad parenting, sugar or lack of discipline.

The whole tone of the book reads like an answer to this context. Barkley tells the parent first what ADHD is not, then what it is, and then what they can do.

Four parts

The table of contents of the fourth edition is open on Guilford's site. The book opens with a guiding philosophy for parents and consists of four parts.

Part one: understanding ADHD. What ADHD is, why the child's real problem is difficulty with self-regulation, what causes ADHD and what does not, how the picture changes with age, and the place of a child with ADHD within the family.

The chapter devoted to what does not cause ADHD is by itself worth the price of the book. Much of parental guilt is resolved here. Barkley explains the weight of heredity and why the frequently suggested causes do not explain the picture.

Current data supports this line. The review by Faraone and Larsson (2019) gives heritability as about 74 percent. I took up the detail in the article is ADHD hereditary.

Sugar is the best known of these wrong causes. The meta-analysis by Wolraich and colleagues (1995), which combined double-blind studies, concluded that sugar does not affect children's behavior or cognition. If we think of a parent having a different cause whispered in their ear every day, this chapter works as a shield.

The chapter on how the picture changes with age is also important. One of the questions parents ask most often is whether the child will get over this. Barkley's framework is realistic: the look of the symptoms changes, restlessness may decrease with age, but a significant part of the difficulties can carry into adolescence and adulthood.

This answer can feel discouraging on a first reading. But setting expectations correctly means not being caught unprepared for the new difficulties that come in adolescence.

The family context chapter acknowledges that ADHD affects not only the child but the parents' relationship, the siblings and the whole order of the home.

Part two: becoming a managing parent. Deciding on an evaluation, preparing for it, coping with the diagnosis, and the parent looking after themselves.

One of the load-bearing ideas of the book is in the title of this part: the managing parent. Barkley asks the parent to take on, from outside and for a time, the child's missing executive functions, to build structure, reminders and planning for the child.

This concept felt very familiar to me as an adult with ADHD too. This was exactly what I tried to build for myself in adulthood: putting outside the plan, the reminder, the sequence that I could not hold inside my head. If someone had taken this on for me as a child, perhaps I would not have had to learn these skills from scratch and with shame in adulthood. In Barkley's framework this outside support means a missing function being carried by someone else for a time.

In earlier editions of the book this part had numbered guiding principles for parents; their number changed from edition to edition. In 2020 Barkley collected the principles of parenting separately in a short book called 12 Principles for Raising a Child with ADHD.

The chapter devoted to the parent looking after themselves is short but important. Feelings after the diagnosis, guilt and burnout are discussed as burdens of the parent that also need to be addressed.

Part three: life at home and at school. Eight steps for behavior, problem solving at home, peer problems, adolescence, healthy living, school life and keeping school achievement in the right place. The adolescence chapter was written with Arthur Robin, and the two school chapters with Linda Pfiffner.

Part four: medications. Approved stimulant medications and other medications.

The eight steps

The most hands-on and most debated place in the book is the behavior plan.

The plan begins with learning to use the power of positive attention and praise. It continues with reward and incentive systems and a point system that works inside the home. It includes setting up an effective time-out practice and carrying the rules outside the home, into public places.

The logic of the order is sound: before punishment comes, the relationship and positive attention need to be established. Time-out works only while the child is receiving positive attention, because time-out means temporarily leaving that attention.

This approach is an example of the type of intervention we call parent behavior management training. The American Academy of Pediatrics guideline on ADHD in children and adolescents (Wolraich et al., 2019) recommends this type of parent training as the first step for preschool-age children. For school-age children it recommends using medication together with behavioral interventions.

So Barkley's plan cannot be counted as a list of advice put together at whim; it is the version, written for parents, of a family of interventions that has evidence.

Where I stopped

I objected to two places as I read the plan.

The first is the tone. Details such as point charts, the values of rewards and the amount of punishments bring the book close to a management manual. This precision may be reassuring for the parent. For the child, the home risks turning into a performance evaluation system.

As a person with ADHD, I thought about what I would have learned if, as a child, I had been approached only through points and losses. Probably that love is something that can be calculated.

Barkley cannot be said to be unaware of this risk; the first step of the plan is already positive attention. But the book's distribution of pages gives more weight to the system than to the relationship. The parent's warmth is described as a precondition for the next step, and does not stand as a goal in itself.

The second is feasibility. A consistent point system, checking at the same hour every day, not forgetting a promise given: all of these demand strong executive functions. Because ADHD is hereditary, a significant share of the parents of children with ADHD also have ADHD.

The fourth edition adding advice for parents who may have ADHD is an important correction in this respect. Still, the default parent of the plan is still someone orderly, consistent and patient. For a parent who has ADHD themselves, this plan first passes through their own treatment. The article being a parent with ADHD can be a start on this.

Adolescence and negotiation

It is meaningful that the adolescence chapter was written with Arthur Robin. Robin is a clinician who has worked for many years on adolescents with ADHD and their families, and he also wrote with Barkley on defiant behavior in adolescents.

In adolescence the shape of the tools in the parent's hands changes. A time-out that works with a small child often cannot be applied in the same way with an adolescent. Rewards turn into privileges, one-sided rules into rules made together, and into bargaining. The chapter devoted to problem solving at home can be read as a preparation for this transition.

I marked this part as the place I valued most. What an adolescent with ADHD needs least is a chain of orders growing a little harsher every day. An adult willing to talk in both directions is much more useful at that age.

The health side

The healthy living chapter and the health risks chapter added to the fourth edition treat ADHD as a health matter beyond school and behavior.

It is known that in Barkley's research in recent years he has given more and more weight to the effects of ADHD on accidents and general health. These chapters look like the reflection of that body of work toward parents.

The medication chapter

As in Barkley's adult book, the account of medication here is balanced. He explains the effects of stimulant medications, their side effects and in which situations care is needed. He stresses that medication does not teach skills; it can prepare the ground that makes learning possible.

This chapter is one of the best preparations a parent can read before going to a child psychiatrist. The decision about medication is made with a doctor; the book does not replace that appointment.

The medications available in Turkey and their licensing status differ from those in America. The drug names and forms in the chapter should not be carried over directly to here.

The school chapters and Turkey

The school chapters are the longest part of the book and are largely written according to the American education system. The legal rights there, the processes of making a written plan with the school and the special education services do not correspond one to one with the arrangement in Turkey.

Even so, most of the advice on classroom accommodations, cooperation with the teacher and homework routines at home is independent of the system. The chapter devoted to keeping school achievement in the right place is also valuable. It tries to take grades out of being the measure of the child's worth.

What was added in the fourth edition

According to Guilford, the fourth edition added a new chapter on health risks associated with ADHD, updated information about causes, current medication information, a new discussion about siblings, advice for parents who may have ADHD, and downloadable tools.

The addition of the sibling issue is important. In homes with a child with ADHD, the other children feeling neglected or treated unfairly is a little-discussed subject.

How to read it

It is not a book to be read from start to finish. It is a reference book of more than three hundred pages with a high density of information.

If the diagnosis is new, part one and the chapter on coping with the diagnosis come first. If behavior problems weigh heavily, the eight steps. If adolescence is approaching, the adolescence chapter.

Instead of trying to apply the eight steps on your own, it is far more effective to carry them out together with a child psychiatrist or a specialist who gives parent training. The book works as the map of that process.

For whom, and for whom not

For the parent whose child has just been diagnosed and who wants to tell what is right from what is wrong. For one who is lost among the contradictory information they have heard about ADHD.

Especially for the parent who blames themselves for their child's ADHD.

If you are looking for warmth, acceptance, a search to understand your child's inner world, this book will not satisfy you. Barkley gives information; he does not console. For that need, you also need to look at sources that approach the question how should a child with ADHD be treated from different angles.