BOOK REVIEW

entitled Ordinary Families, Ordinary Children, regardlessof the limitations of the child.

ABBY L. WASSERMAN , M.D .Director of the Division of

Child and Adolescent PsychiatrySt. Luke's Hospital

Videotape:Why Won't My Child Pay Attention? 1989,76 minutes; color. Format: '12" videotape, $29.95.Lecturer: Sam Goldstein, Ph.D . Produced by NeurologyLearning and Behavior Center, 679 East 3900 South,Suite 100, Salt Lake City, Utah 84107-1973.

This videotape is aimed at educating and guiding parentsof children or adolescents with attention-deficit hyperactiv­ity disorder (ADHD). Even though the quality of the pr~­

duction (including lighting, setting , and camera work) IS

quite good, the format is a somewhat limited one; essenti~llya lecture given by Dr. Goldstein to a group of parents in astudio. The viewer 's attention is held by the lecturer 's an­imated and somewhat aggressive style of delivery and alsoby the judicious insertion of graphics . Even in a well-stagedlecture such as this, a certain amount of viewer monotonywould have ensued were it not for the inclusion at appro­priate points in the lecture of excerpts of comments froman interview with five members of a family in which twoteenage sons have had attention-deficit disorder. The re­marks of the parents , the sons, and their adolescent sisterprovide enriching and easily understandable interludes, awelcome change of pace form the lecturer 's (admittedly)kinetic delivery . This reviewer would have liked to haveseen scenes of these or other patients in home, school, orcommunity settings where examples of their behaviors, orof the management techniques suggested, could have beenbetter demonstrated. At the end of the lecture, a brief ques­tion and answer period between the audience and lectureris included.

The content is basically sound but is limited by the factthat a lecturer must generalize about each topic of the subjectat hand. Individual parents may thus find portions of thetape irrelevant, or, worse , may be misled to apply some ofthe conclusions or recommendations inappropriately to theirparticular situation. The lecturer does try to ~o~e~ this b.ysuggesting at several points how complex an mdlvld~a~ di­agnostic or treatment process can become. Notably rmssmg,however , is any suggestion that a child or adolescent psy­chiatrist might be one of the useful clinicians to tum to atthose times.

The latter part of the lecture is devoted to a descriptionof the treatment and management approaches. There is aheavy (and appropriate) emphasis in this section on under-

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standing the nature of the impulsivity and the difficulties inconcentration which create frustrations in dealing with achild or adolescent with ADHD. The lecturer advises thatif a child is showing unacceptable behavior the parent shouldfirst make a judgment as to whether the behavior is anexample of "incompetence" (i.e . , the child has acted im­pulsively and without thinking) or a~ ~xample . of " non-

. compliance" (i.e. , a more willful decision to misbehave).If it is the former , then the positive reinforcement approachshould be used. If the parent feels the child is willfullymisbehaving, then a more punitive approach is needed. Dr.Goldstein goes into some detail about management tech­niques.

Unfortunately , the lecture format cannot do much morethan introduce parents to the above issues, and it does beginto try to help them to understand the unusual subjectivestates, motivation , and behaviors of the children who havethis disorder. One potentially troubling aspect of the pres­entation is the lecturer ' s discussion of the role of medicationin treating ADHD patients. Dr. Goldstein implies that he"saves" the consideration of medication until after he hastried other methods of treatment. In this reviewer 's opinion ,this approach may unnecessaril y alarm some parents aboutthe legitimate role medication plays in management. Suchan approach to medication may have equally unfo~un.ate

consequences as the opposite philoso~hy t~a~ medlca~l~n

alone is all that is needed. The lecturer s positron on this IS

controverted later in the tape itself by the family membersinterviewed , who comment on the dramatic improvementbrought about by the use of medication. . .

The several questions asked by the parents in the audienceopen up areas that many families are concerned about: "Canthe condition be used as an 'excuse' for misbehavior?"" How do you answer criticism of others that you are ~ot

being a good parent?" "Should we expect an ADHD childto have the same responsibilities at home as his siblings?""How can parents who are 'worn out' learn to be 'calm'with their ADHD child?" "Would Boy Scouts be a goodactivity group for my son to join ?" .

In summary, a clinician who would like to use this tapeto help parents learn more about this disorder would do wellto alert them to the generalizations involved and to suggestthat they should additionally explore their individual con­cerns and questions with an appropriate professional. Theyshould be advised that the tape deserves more than oneviewing because it presents a complicate~ networ~ of in­terwoven factors which must be looked for many child whohas the ADHD.

PAUL N. GRAFFAGNINO, M.D.Clinical Professor of Psychiatry

Associate Clinical Professor of PediatricsUniversity of Connecticut School of Medicine

l.Am.Acad.Child Adolesc.Psychiatry, 29:4, luly 1990