ADHD and the Nature of Self-Control

ADHD AND THE NATURE OF SELF-CONTROL. Russell A. Barkley. New York: Guilford Press, 1997. xix + 410 pp. $40.00 (hardcover).

Russell Barkley is a giant in the field of Attention Deficit Hyperactivity Disorder (ADHD). His encyclopedic reference text, Attention Deficit Hyperactivity Disorder (1990), was the work of a deeply devoted, true pioneer who, with the help of his associates, staked out their claim on the field. Barkley exhaustively catalogued the vast area of ADHD research and clinical observations up to 1990 and it is noteworthy that he himself had by then authored or co-authored numerous publications relevant to the field.

It is with the same intense passion that Barkley undertakes the extraordinary task to provide us with a theory of ADHD. We need a theory of ADHD because current research and clinical models (DSM-IV), are purely descriptive, thus non explanatory. Furthermore, lacking a theory of ADHD, we cannot differentiate subtypes (hyperactiveimpulsive, inattentive and combined) and we can never be sure of our clinical intervention.

According to Barkley, we cannot understand ADHD without first understanding self control and we cannot understand self control without postulating and describing socalled executive brain functions. If inattention in ADHD is context dependent, i.e., the affected individual is unable to sustain attention (rule governed, goal directed and internally guided attention), in the absence of external sources of motivation or control. We must look more closely at the neurobehavioral deficits underlying inattentiveness.

Barkley wastes no time introducing us to new ideas. In the preface he tells us that ADHD involves delay in the...