books book reviews

Psychopharmacology books

reviewed by T.J. Nelson


ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder

by Richard Saul, MD
Harper, 2014, 313 pages

I f you look through the medical literature, you will find over 27,000 articles on ADHD. But ADHD is defined by purely behavioral criteria. There's good reason to believe that, if ADHD exists at all as a nosological entity, it's not a single disorder, but a grab-bag of different stuff. That's also the theory promoted in this book.

What everyone else calls ADHD, Saul calls Neurochemical Distractibility / Impulsivity Disorder. He says it's caused by an excess in norepinephrine and serotonin. Just like ADHD, it's treatable with stimulants like Ritalin and Adderall. Diagnosis is behavioral, since it's hard to measure any increase in neurotransmitter levels. In other words: it is ADHD, and ADHD does in fact exist. But too late, you bought the book already.

Saul also says that ADHD symptoms can be caused by a variety of other problems, including vision or hearing problems, substance abuse, giftedness, sensory processing disorder, absence seizures, OCD, schizophrenia, or autism. Parents and doctors need to do more than check off the list of symptoms in the DSM before making a diagnosis.

That's fairly reasonable, though it's not what the reader might expect. If you tell a patient they don't have ADHD, often their reaction is not relief as it would be for a real disease, but outrage. This doesn't mean there's nothing wrong with the patient. But ADHD is often just an excuse for bad behavior or bad teaching skills.

In that regard, it's like Asperger's syndrome, the symptoms of which were said to be above-average IQ and deficient social skills. So the patient got an excuse for messing up their social life and was labeled as smart. No wonder it was so popular; alas, the DSM-5 has dropped it. It no longer officially exists. We have to go back to being geeks.

This book is written for a general audience, and it gives parents some valuable advice on what to do if their child is having behavioral problems. But it doesn't help us understand the medical issues or the social and political issues that overdiagnosis of ADHD has created. It won't convince anyone that ADHD doesn't exist. But if you're a parent of someone diagnosed with ADHD, it could be the most important book you'll ever read.

jun 27, 2015