Attention Deficit Hyperactivity Disorder (ADHD) is a condition that more and more children are diagnosed with and treated with drugs for, every year. In this century alone cases of American children with ADHD have gone up by 40 percent. Yet does it even exist? A doctor from Chicago, Richard Saul, argues it does not. In his controversial new book ADHD Does Not Exist, he puts forward the case that not one single individual anywhere, is afflicted by this so-called disorder. Saul has now determined “There is no such thing as ADHD.”
Characterised by an inability to pay attention and sit still, a trait teachers worldwide have observed in many millions of pupils, ADHD is also associated with certain manic and impulsive behaviour patterns. Excessive chattering, fidgeting, dislike of waiting, and disorganization are also common. This level of exuberance is naturally present in many children, yet Dr Saul finds that ADHD is now frequently used as an “excuse” for those that are difficult to control. With the high media profile of ADHD, the tendency of doctors to diagnose it too readily, and the calming effects of the drugs used to suppress it, he suggests there is nothing short of an “epidemic of misdiagnosis.”
Figures are indeed high. In the US 11 percent of all children are diagnosed, and four percent of adults. It is also the most common mental health condition in the UK.
It is Saul’s belief that many underlying problems are being overlooked and left untreated as a result of the lemming-like rush to assume ADHD. He cites poor eyesight, lack of sleep and the strong possibility of learning difficulties or bi-polar. ADHD is only symptomatic of these, and once correctly diagnosed and treated, the ADHD invariably goes away.
Mood swings, hearing problems, substance abuse, giftedness, OCD and Asperger’s are all in Saul’s list of other probably underlying causes that are all too often put under the one umbrella label of ADHD.
These claims have rattled the medical community who have tagged Saul as a sensationalist and his proclamations as “dangerous.” A professor from the Sydney Children’s Hospital, Michael Kohn, who has worked with ADHD patients for twenty years says he is trying to be persuasive through the medium of fear. “Its manipulative rather than informative” he complains, and worries that it may prevent parents coming forward to seek help and advice.
Saul retaliates by saying that lumping all the signs together and calling them ADHD is like treating symptoms of heart attack with painkillers. The right thing to do is to tackle the cause. To treat ADHD as a condition, rather than an accumulation of symptoms, he says, is “a terrible and dangerous disservice.”
Dr Saul has many case histories to back up his theories. He has worked in the field of behavioural neurology and development for fifty years.
He cites seven-year old Aviva, who was causing problems in school, always fidgeting and asking to go to the bathroom. After being diagnosed with ADHD and put on the medication she reacted badly to it. Saul tested her sight and hearing, found she was near-sighted and got her some glasses. She improved immediately. Another boy, Bhavik, 9, was always bored in class. His teacher was convinced he was ADHD. After Dr Saul had his IQ tested he found he was in the top 2 percent. His boredom emanated from his giftedness and lack of stimulation.
In France, a 2004 study found 84 percent of children who had been diagnosed ADHD were in fact iron deficient. This caused physical tiredness, poor concentration and lack of memory – all traits easily put down to ADHD.
It is generally accepted that there is a debate about ADHD being a “standalone” condition or whether it is symptomatic of other illnesses, and this has occupied child health professionals over the years, however, no one has come out before like Saul to claim that ADHD does not exist at all. Sometimes, says child psychiatrist Florence Levy of the University of NSW, it is a delay in maturation that evens out as time goes by.
Back in 1937 it was discovered that stimulant drugs helped settle children who showed the signs of what is now called ADHD. The condition was not officially named until 1980. Since then, the number of cases has escalated rapidly. The diagnosis now extends to many adults. The drugs most used to treat ADHD are Ritalin and Adderall. They reduce impulsiveness and increase attention span. The spiralling rate of prescription of Ritalin is found in many countries. The British Medical Journal in a study found a 72 percent rise in Australia between 2000 and 2011.
Saul worries about so many children being on these drugs. He says they become tolerant to them, forcing the need to prescribe higher and higher doses. Parents who have seen radical improvements when their children go onto Ritalin are not so sure. Although many dislike the idea of having to manage their children by drugging them, they feel the benefits outweigh the issue of the medication.
Professor Levy thinks that parents do rush to look for explanation for any attitude in their child which is concerning, such as forgetfulness, chattering, boredom. They seek a medical explanation if the child is not performing well at school or having social acceptability problems. What once may have been absorbed as normal parts of growing and development now go under the microscope as parents seek the best for their offspring, and don’t want anything to diminish their academic progress. However, she does not agree that Australia is over-diagnosing ADHD. Children have to present symptoms for six months, according to their guidelines, to be considered for treatment and there must be “no better explanation.”
Saul was not always an ADHD disbeliever. In the seventies he saw it as a credible explanation for the many cases of affected children he saw. His concern is that it has grown to be diagnosed as a “knee jerk” reaction and that it does not in fact exist. It is covering for the underlying causes. Now the entire profession is stuck in a vicious cycle of misdiagnosis and prescription of stimulants.
In his clinic Dr Saul is often asked by students to be given the diagnosis of ADHD so they can access the drugs they believe will enhance their concentration. He turns them away, but many doctors do not. He blames this on the high awareness of the drug and the known effects. It is all too easy to fall into the “catch all” definition of ADHD to be prescribed. The definitions broaden all the time and many are subjective. How much talking is “talking too much?” How much messiness becomes “too disorganized?”
One adult patient who went to Saul, was told to resume her exercise program and cut down her working hours. Another doctor had given her Adderall. She followed his advice and now says, “I realised it wasn’t ADHD, it was just life.”
How to tackle the “epidemic of misdiagnosis” if Saul is right? He calls for a reduction in overreaction. On the basis that giving stimulants to children is “wrong and harmful” he reminds that children mature at different rates. Some coping strategies are just normal ways of dealing with regular anxieties. Improvements to diet, sleep and exercise can make huge differences.
“We must discard the decades-old diagnosis of ADHD that doctors, pharmaceutical companies, the media and even patients themselves still cling to.”
This radical voice for change is a challenge by Saul to the entire acceptance of ADHD as a condition. In his opinion,until real and underlying causes are detected and treated, many will suffer needlessly, and many of those, drugged and misdiagnosed, are children “failed and neglected by a dangerous myth.”
By Kate Henderson