ADHD: Disease or Not?

There is an interesting article out today that concerns the exploding diagnosis of ADHD. We have all kinds of reasons to be concerned about the diagnosis of Attention Deficit Hyperactivity Disorder. The ones that bother me most as a physician have to do with the lack of any clear and certain way to make the diagnosis. To this day there is no laboratory, x-ray, or physical finding that can be used to make the diagnosis of ADHD certain. All that we have are the personal testimonies of parents, teachers, children, and now adults who are looking for solutions to the problems they face in life. And, that is the difficulty. No one would say that the children or their adult counterparts do not have problems. The question is do they have a disease? And, should that disease be treated with medicines that are habit forming with significant side effects?

Dr Richard Saul is a neurologist who spent his career helping patients who carried the label of ADHD. In the New York Post today Dr. Saul discussed his new book “ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder” due out in February.[i] To say the least he was not trying to be subtle. The Doctor says several things in the article with which I agree. The first is that the diagnosis of ADHD is entirely subjective and often incorrect. The best insight that Saul offered was that these children and adults do have problems. And, I think that is the most important part of all of it.

Right now in the US 11% of children are being diagnosed with ADHD. (14% of teenage boys in another study) Dr. Saul says that most of his time was spent finding out what problem the child or adult had and helping them deal with that instead of labeling them with ADHD and providing a prescription.  He gave examples of children with vision problems, students who were bored with their subject, and adults who struggled with caffeine use and sleep deprivation as many of the things incorrectly labeled as ADHD. “One by one, nearly all of Saul’s patients turned out to have some disease other than ADHD such as Tourette’s, OCD, fragile X syndrome, autism, fetal alcohol syndrome, learning disabilities,…substance abuse, or even giftedness.” Saul described the diagnosis of ADHD as “an easy to reach for crutch.”[ii]

A disease always has pathology or a change in the body at the cell level that causes the malfunction. We may not be able to describe it. We may not be able to find it, but it must exist. And most of the time we can demonstrate the change which allows us to create medications or surgical corrections to fix the problem. In medicine understanding the pathology has always been the key to good treatment. Since we do not have the pathology for ADHD defined, we do not have tests that can make the diagnosis. The result is that people with real problems are mislabeled and treated with medicine that can cause them more harm than good.

Instead of being pushed along by our current “tolerant” agree with everyone about everything culture, maybe children and adults would be better off if we took the time to help them find other solutions to behavior and attention struggles. That is the message that Dr. Saul expressed in the article. I look forward to reading his book.

[i]“ ADHD does not exist,” Kyle Smith. New York Post, January 4th, 2014

Dr. Saul’s book “ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder,” is to be released in February, 2014 by HarperWave publishing.

[ii] Ibid.

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