Cite
Saul, Richard. ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder. First edition. New York, NY: HarperWave, 2014.
Jeremy
Synth
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FirstAuthor:: Saul, Richard
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Title:: ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder
Year:: 2014
Citekey:: saulAdhdDoesNot2014
itemType:: book
Publisher:: HarperWave
Location:: New York, NY
ISBN:: 978-0-06-226673-6
LINK
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Abstract
“Few mental disorders have been met with more controversy in recent years than Attention deficit-hyperactivity disorder. An estimated 4.7% of adults, and up to 16% of children are living with ADHD in the US. However, some allege that doctors are handing out prescriptions indiscriminately. Thousands of patients respond poorly to stimulant medication, which is at times prescribed to individuals without the condition. There have been countless reports of students and professionals abusing Adderall or Ritalin to enhance their performance in the classroom and at work. Meanwhile, pharmaceutical companies have found a goldmine. Yet the symptoms of attention-deficit and hyperactivity are all-too-real for many individuals who are frequently unable to function without treatment. The controversy surrounding the medication has left these patients and their families at a frustrating standstill, with no alternative options available to them. In ADHD Does Not Exist Dr. Richard Saul offers a groundbreaking solution. After thousands of clinical trials, he has determined that ADHD is not an entity on its own, but in fact a cluster of symptoms stemming from 12 other conditions, each of which requires a separate treatment. The comprehensive list ranges from harmless conditions (poor eyesight and giftedness) to more severe illnesses (bipolar disorder). Dr. Saul takes the reader through clinical examples in which he alters peoples’ lives by diagnosing the underlying cause of their attention-deficit symptoms. ADHD Does Not Exist will serve as a handbook for doctors, practitioners, educators, and individuals who are seeking an honest approach to treating ADHD. The book will also be of cultural importance, as it aims to deconstruct one of the most elusive medical conditions of our time”— Provided by publisher .
Notes
# Jeremy’s Review
This book is written to be controversial. It’s main premise is that any symptom of ADHD may be understood through the lens of a myriad of other disorders. The mere fact that ADHD has symptoms of other disorders means that it does not exist on it’s own. Some of those other disorders may be treated with stimulants, but often times it is not necessary. The author is a long practicing physician but his conclusions seem to be at odds with more leading researchers in ADHD study.
# Reading Notes
Preface
“For example, it became clear that physicians weren’t performing comprehensive examinations of children with attention/learning deficits, even though that was suggested by the American Academy of Pediatrics and other leading medical organizations. There were multiple reasons for this. Among them were knowledge gaps (doctors just didn’t know how to examine these patients) and economics (securing full reimbursement for such evaluations was becoming increasingly difficult).” (Saul, 2014, p. xvi)
Introduction
“Over 4 percent of all adults and 11 percent of U.S. children are diagnosed with ADHD —more than a 40 percent jump in the last decade. Two-thirds of these children are prescribed stimulants such as Adderall or Ritalin. Think about that for a second… That means many adults and teens are abusing these medications as well for better performance at school and work.” (Saul, 2014, p. 1)
“Nevertheless, there is something striking about the way we define this “illness”-that is, by its symptoms, rather than its cause. If we were to define a heart attack by the chest pain one feels while undergoing one, then the appropriate cure would be painkillers, rather than ways of actually reviving and repairing the heart.” (Saul, 2014, p. 2)
- Perhaps the way we define ADHD is incorrect in it’s titling, but the affects are the same on the person diagnosed with ADHD.
Chapter 1
“Symptoms associated with ADHD have likely been part of the human experience since before recorded history.” (Saul, 2014, p. 11)
“Nevertheless, this long and varied history of ADHD highlights the persistent ambiguity and controversy around the symptoms and their sources, a pattern that has continued into the present day.” (Saul, 2014, p. 13)
- We are still learning about ADHD, probably not out of the realm of possibility that it still hasn’t been nailed down yet.
“The point is that while the DSM provides useful guidelines for assessing and diagnosing a range of conditions, it’s always important for practitioners to use their own experience and judgment in making diagnoses.” (Saul, 2014, p. 15)
- I do not disagree here. Nerenberg would agree that the DSM is a collection of symptoms that is ever evolving.
“I see this stunning growth rate for ADHD and stimulant use not as a true rise in the number of people deserving diagnosis, but a reflection of the multiple trends that make diagnosis and the use and abuse of stimulants more likely.” (Saul, 2014, p. 16)
- It is irresponsible to default to the idea of more people being prescribed stimulants as akin to abuse. It must be weighed against the opioid epidemic, but not necessarily associated with it.
“Smaller, more specific studies have also shown costs associated with an ADHD diagnosis in a variety of areas. For example, families of children diagnosed with ADHD are more likely to experience conflict and stress, including divorce. Why exactly this happens is unclear, but it is an important finding nonetheless.” (Saul, 2014, p.17) (ref. 20)
- Not sure why a bunch of conclusions can be drawn through out this essay, but not here.
“Unlike other diagnoses that include attention-related and hyperactivity symptoms, ADHD has those signs right there in its name: attention-deficit/hyperactivity disorder. Human nature is to choose the simplest explanation for an observed pattern, and what could be simpler than a diagnosis that spells out its major symptoms so clearly? What’s more, teachers and parents are busier than ever, and thus more likely to place a low-performing or disruptive child into the easiest category possible. Most teachers and parents aren’t health professionals, so that makes their application of the ADHD label even easier. Unfortunately, these and other biases lead to a vast amount of ADHD misdiagnoses.” (Saul, 2014, p. 19)
- Again, not sure why it’s a hindrance to ADHD that the title of the disorder are the symptoms itself.
- Personal story: my diagnosis was a rule out diagnosis, not the misdiagnosis
Chapter 2
“Adult cases of ADHD are believed to have started in childhood, even if the disorder wasn’t formally diagnosed. Again we face the issues of subjectivity and bias, as it’s easy for adults to “remember” childhood attention difficulties (before age twelve) and to exaggerate current ones, once they’re convinced they have “ADD."" (Saul, 2014, p. 20)
- I think it’s relatively hard to misremember childhood instances of ADHD. Barkley writes about this.
“Medical practitioners lack time and incentive for full evaluations, and sometimes knowingly misuse the ADHD diagnosis. “I think I have ADHD.” That’s a common complaint in medical offices across the United States, including mine. Adults will come in having self-diagnosed themselves with the disorder. Parents will bring their child saying, “I think he has ADHD” or “Her teacher says she may have ADHD.” As physicians, it is our responsibility to do a full evaluation before assigning a clinical diagnosis.” (Saul, 2014, p. 22)
- Physicians should always be striving for the best diagnosis that is well researched and in the best interest of treating the patient. The lazy of doctors does not preclude the existence of ADHD.
“ADHD makes a great excuse. Among “useful” diagnoses to have, ADHD is better than most, especially for adults. Why? Because it can be a good excuse.” (Saul, 2014, p. 23)
- Yikes
Chapter 3
“As mentioned earlier, rates of stimulant use have risen dramatically and show few signs of slowing. Misdiagnosis of ADHD is a big part of this trend, but equally guilty is the increase in stimulant-seeking behavior.” (Saul, 2014, p. 26)
- Again, people seeking to abuse the medicine that is used to treat ADHD does not preclude ADHD from existing
“The worst part about the use of stimulants for those diagnosed with “ADHD” is that had they been diagnosed correctly in the first place, they wouldn’t have wound up with the prescription and all the potentially negative consequences.” (Saul, 2014, p. 32)
- Treating ADHD with a stimulant doesn’t result in many consequences, except perhaps in better focus and a few side effects that can be addressed with other types of medication.
Chapter 23
“One of the simplest indications of the need for intervention is the degree to which symptoms affect your functioning at school, work, and with family and other relationships. In other words, medical treatment is probably unnecessary if your symptoms aren’t disrupting your life in a meaningful way. Many people who are convinced they have ADHD or some other diagnosable condition are simply dealing with a normal level of stress in a faster-paced world.” (Saul, 2014, p. 271)
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The world certainly has changed in terms of being able to focus. Redefining focus and abilities to function in society will evolve, but so does medicine around the culture.