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.