Stimulant Drugs and ADHD: Basic and Clinical Neuroscience

Today, we see the frequent release of new and/or modified stimulants for treatment of young patients with attention deficit hyperactivity disorder (ADHD). These events often revive the controversies about both the diagnosis of ADHD and the appropriateness of the use of medications that are classified as controlled drugs in the treatment of young children. At a time when the media so often focuses on these questions, the availability of this well-documented new book is most welcome.

Drs. Solanto, Arnsten, and Castellanos and their 16 associates have provided us with a comprehensive volume that looks back to George Still’s 1901 description of a group of 20 overactive and inattentive children and forward to the need for ongoing research. The organization of the book in four parts—Phenomenology, Basic Neuroscience, Clinical Neuroscience, and Integration—increases the book’s usefulness.

Excellent introductions to each of the first three sections provide the reader with a preview of chapter contents. The references are extensive and will be of great value to those who wish to explore specific topics in greater depth. With the final chapter, the editors give us summaries of the current state of knowledge of the clinical presentation of ADHD and of the underlying deficits. They discuss stimulants as effective treatment.

In their evaluation of directions for future research in basic neuroscience, the editors point out the need “to render the behavioral phenotype more precise and to identify neurologically meaningful cognitive/behavioral subtypes that can be used to develop drug and other treatments…[for] the symptoms of these subtypes.” Specificity, even if only partial, would greatly improve clinical management of ADHD. Parents and educators would welcome better definition of the observed problems and availability of pharmacological means to modify the complicated neurohormonal balance.

The appendix, a reprint of Charles Bradley’s 1937 article, “The Behavior of Children Receiving Benzedrine,” makes the 65-year history of the use of stimulants to treat children very clear. By making Bradley’s article so easily accessible, the editors have provided another window on history.

This excellent book should be in the library of all psychiatrists who evaluate and treat patients with ADHD.