Attention-Defecit Hyperactivity Disorder: A Cognitive-Behavioral Approach to Assessment and Treatment

Abstract

Attention-Deficit Hyperactivity Disorder: A Cognitive-Behavioral Approach to Assessment and Treatment Cognitive-Behavioral Therapy with ADHD Children: Child, Family, and School Interventions. Braswell, Lauren, & Bloomquist, Michael L. New York: The Guilford Press, 1991. (391 pp.) $40.00 (hard cover). Attention-deficit hyperactivity disorder (ADHD) represents a significant childhood and adolescent disorder whose symptoms are thought to be exhibited by approximately 3%-5% of school-age children (Barkley, 1988). Because the major features of ADHD (i.e., attention-span difficulties and distractibility, impulsivity, hyperactivity) can interfere with a child's academic performance and social functioning, an extensive body of literature, empirical and otherwise, has accumulated relative to the assessment and treatment of this troublesome disorder. In their comprehensive text, Braswell and Bloomquist provide an overview of the etiological, diagnostic and assessment, and treatment issues related to ADHD. Because the disorder can no longer be considered a problem that affects only prepubertal children (Henker & Whalen, 1989), it is encouraging to find a text that adopts a life-span developmental perspective in which the authors have outlined age-group specific (i.e., preschoolers, elementary school-age children, adolescents, adults) treatment needs and suggested intervention strategies. Braswell and Bloomquist describe various assessment methods (i.e., parentchild interviews, parent-teacher rating scales, observational approaches, intellectual and achievement testing, laboratory measures, and parent-report measures) which when used in combination will facilitate "moving away from an oversimplified view of assessment (and) adopting a whole-child approach rather than a diagnosis-focused viewpoint" (p. 49). Recognizing the variability that exists from one ADHD child to the next, the authors address the diagnostic challenge of differentiating ADHD from other disorders (e.g., anxiety, bipolar disorder) whose symptoms may resemble those of ADHD. Likewise, attention is given to coexisting problems (e.g., conduct disorder, oppositional defiant disorder) which can further complicate the diagnostic process. The authors emphasize the need for a multimodal approach to treatment. After reviewing the literature on pharmacotherapy, behavior therapy, and cognitivebehavioral interventions, Braswell and Bloomquist state that "it is clear that no one form of intervention is adequate for meeting the needs of most ADHD children" (p. 103). As such, the authors recommend an interdisciplinary team approach which involves the participation of medical, psychological, and educational professionals. Following their general review of basic issues, the authors offer what represents the major contribution of their text: "an ecological-developmental model of cognitive-behavioral therapy for ADHD children and adolescents" (p. 104). Braswell and Bloomquist acknowledge that die "domain of cognitive-behavioral intervention with ADHD children is afflicted by having more reviews of treatment outcome than actual treatment outcome studies" (p. 91). Accordingly, they apologize that their ecological-developmental model, when taken as a whole, has not been empirically tested. Despite die clear need for empirical scrutiny, the model does offera very practical, almost step-by-step approach to dealing with the individual, familial, and scholastic factors which clinicians must consider in their work with ADHD children. For example, treatment planning is conceptualized according to the child's cognitive (e.g., problem-solving deficits) and behavioral (e.g., noncompliant behavior) areas for growth, the parents' cognitive needs (e.g., dysfunctional attributions), and the family's, behavioral (e.g., ineffective discipline) as well as cognitive and behavioral (e.g., dysfunctional communication) deficits. The authors emphasize the need to form a working relationship with the child and his or her family to evaluate clients' motivation to engage in treatment as well as individual members' resistance to intervention. …