ADHD and The Nature of Self-Control

ADHD and The Nature of Self-Control Russell A. Barkley. New York: The Guilford Press (www.guilford.com). 1997, 410 pp., $42.00 (hardcover).

Russell Barkley has been among the most productive and prolific scientists in the field of Attention Deficit/Hyperactivity Disorder (ADHD). This work represents the culmination of a five-year project during which he attempted to develop a unifying explanatory model for ADHD. This model argues that the disorder fundamentally reflects a disruption in self-control mechanisms rather than attention per se. In this book, Barkley takes on the ambitious task of reviewing and synthesizing the voluminous theoretical and descriptive literature regarding ADHD and integrating it with related writings in philosophy, child development, and neuropsychology. Most of the ideas presented were previously published in a review article (Barkley, 1997), but are greatly expanded here.

Essentially, Barkley argues that ADHD reflects a core deficit in inhibitory control, which then prevents the optimal use of "executive functions," all of the above thought to be mediated by the prefrontal cortex. Thus, ADHD is seen as a disruption in the developmental process of inhibition, mediated by the prefrontal cortex, whereby behavior is internalized, regulated, and directed toward the future. Deficits in attention are seen as secondary and not universal characteristics. Notably, this is a conceptual shift which is being increasingly embraced in the field.

Barkley is not the first to focus on delays in the development of inhibition and self-regulation, nor is he the first to...