ADHD Does not Exist

December 16, 2013
Saul, a behavioral neurologist with 50 years of clinical practice, isn’t joking around; after noting that 11% of American children are diagnosed with attention-deficit hyperactivity disorder—a 40% increase in a decade—he makes the provocative claim that, “among the millions of people diagnosed, not one of them actually has ADHD.” This matters for many reasons, particularly in that treatment for real disorders is delayed when ADHD is diagnosed and two-thirds of children diagnosed with ADHD take powerful stimulants with potentially debilitating side effects. Saul takes readers—parents, teachers, physicians—on a fascinating tour of conditions that share symptoms with ADHD. Children with Tourette’s disorder misdiagnosed as ADHD can experience amplified tics on ADHD stimulants. Other conditions with ADHD-like symptoms include undiagnosed hearing, sight, and sleep problems; undiagnosed giftedness, learning disabilities, mood and sensory processing disorders—even allergies. While few would argue with Saul’s contention that overdiagnosis is rampant, his uncompromising main theme will concern clinicians who regularly deal with the condition, whose criteria in the (much fought over) industry bible, the Diagnostic and Statistical Manual of Mental Disorders, were recently loosened. Nevertheless, parents will be better armed to ask more of the right questions after reading Saul’s book, which should spark much debate.

December 1, 2013

Behavioral neurologist Saul emphasizes a thorough approach to the diagnosis of attention deficit/hyperactivity disorder (ADHD), asserting that it is overdiagnosed, that correlating stimulant use has reached epidemic proportions, and that the name itself is a symptom descriptor, not a disorder. Saul maintains that knowledge and understanding of the conditions that are often misdiagnosed as ADHD are essential for appropriate and responsible treatment. More than 20 medical conditions and disorders that might be responsible for ADHD symptoms are presented, from hearing and vision problems, learning disabilities, mood disorders, and neurological problems to inherited genetic flaws and environmental factors such as allergies and toxin poisoning. Each chapter is constructed similarly, with an introductory case history, diagnostic clues, prevalence statistics, and treatment approaches. The largest section of the book, "The Conditions and Disorders Responsible for ADHD Symptoms," is an accessible, detailed, and well-documented list of rule-outs for those who are exploring an ADHD diagnosis. VERDICT Essential for parents and teachers.--Kellie Benson, Oakton Community Coll. Libs., Des Plaines, IL

Copyright 2013 Library Journal, LLC Used with permission.

January 15, 2014
Respected American Academy of Pediatrics and American Academy of Neurology fellow Saul makes the controversial claim that attention deficit hyperactivity disorder is routinely misdiagnosed. The author challenges the definition of ADHD as a fundamentally flawed catchall based solely on "symptoms of distractibility and impulsivity [that] are all too real" but may be attributable to "more than twenty medical diagnoses." Using the analogy of common ailments--e.g., abdominal pain, which may be the result of a variety of problems ranging from indigestion to appendicitis or cancer--Saul makes the point that many different factors can explain a child's disruptive behavior. He makes a convincing case that a diagnosis of ADHD followed by a prescription for a stimulant, such as Ritalin, has become a routine option for pediatricians at the urging of school authorities and parents. Too often, an overlooked, underlying condition is left untreated while the hapless patient suffers from side effects such as insomnia, weight loss and anxiety. The author illustrates his contention with anecdotal material, using case histories accumulated from his more than 50 years of medical practice. He explains that he routinely administers a series of tests before making any recommendations, beginning with a blood work-up in order to eliminate problems such as hyperthyroidism, iron deficiency or hormone imbalance. He describes instances in which a routine eye examination revealed that a child was unable to see the chalkboard and a similar instance of how a hearing problem was the root of a student's inability to follow instructions properly. If none of these are at issue, Saul looks for stress-related psychological problems. Other possibilities range from dyslexia, substance abuse, 20-second epileptic seizures and major psychiatric disorders such as depression. None of these benefit from amphetamine-based medications such as Ritalin. A provocative, valuable guide for parents, school personnel and medical practitioners who deal with individuals showing symptoms routinely attributed to ADHD.

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February 15, 2014
Roughly 11 percent of children and 4 percent of adults in America have been labeled with attention-deficit/hyperactivity disorder (ADHD). But is ADHD even an illness? Physician Saul proposes that ADHD is actually a collection of symptoms caused by other medical conditions: mood disorders (major depression or bipolar disorder), hearing loss, vision problems, substance abuse, hyperthyroidism, sleep problems, absence seizures, learning disabilities, and OCD. According to Saul, a false diagnosis of ADHD delays or prevents initiating appropriate treatment of the actual cause of symptoms like impulsivity and distractibility. Additionally, incorrect diagnoses of ADHD subjects individuals to unnecessary utilization of stimulants. Drugs like Ritalin and Adderall can produce side effects (notably sleep disturbance and decreased appetite) and be abused. Saul believes that medical practitioners, pharmaceutical companies, the media, and patients themselves have engendered an epidemic of misdiagnosed ADHD with serious consequences, including overuse of prescription medication. He writes that ADHD is too often a rushed, careless diagnosis or an excuse for behavior. Sure to ruffle some feathers, ADHD Does Not Exist is provocative and pensive.(Reprinted with permission of Booklist, copyright 2014, American Library Association.)