For years I have been troubled by the many problems associated with the misdiagnosis of attention deficit hyperactivity disorder, or ADHD.
Attention related symptoms are absolutely real and can cause severe consequences for both children and adults; it’s our outdated definition of ADHD that has been so detrimental. Despite decades of advancements in neuroscience, the core definition of the disorder has remained essentially unchanged since its introduction in the Diagnostic and Statistical Manual of Mental Disorders, in 1980.
As a member of the medical community, I have seen so many physicians who too easily rely on the ADHD diagnosis. And why shouldn’t they? A patient comes to them complaining that they (or their child) are distracted and impulsive, and there’s an easy answer: Attention-deficit and hyperactivity disorder. The symptoms are right there in its name. What’s more? The disorder is reinforced by the millions of patients already taking medication for this common “condition.”
But this is exactly the problem. Diagnosing a medical condition based on symptoms alone can be a treacherous cycle. What if someone were complaining about abdominal pains; should s/he be prescribed a pain killer? That would be silly. Abdominal pains have a myriad of potential causes. So, for an organ as complex as the brain, “treating” the surface issue is also dangerously shortsighted.
Here and in later posts, I will argue that distraction and impulsivity can arise from a variety of causes, each of which require separate treatment. Furthermore, while masking attention symptoms with stimulants may appear to help in the short run, it delays proper treatment in the long run, and can have drastic consequences for patients, families, teachers, and society at large.
My experience with the symptoms related to ADHD began in the early seventies. As a clinical professor, my assignment was to evaluate children with learning and behavior issues to determine if there were possible medical reasons behind them. My thinking about ADHD first started to evolve when I noticed that many children with undiagnosed vision and hearing problems were naturally feeling distracted when their teachers were lecturing and writing on blackboards. Then, in the eighties, I was awarded a multi-year federal grant to teach physicians how to better evaluate ADHD and other conditions that may inhibit learning. Together with the Director of Special Education, I spent five years meeting with family pediatricians, physicians, and internists all over Illinois. But, frustratingly, we saw little change in the way patients were being evaluated and treated for ADHD. The principal reason why this diagnostic trend continued was a lack of knowledge of how to do a full evaluation. There was also an economic factor; the reimbursement was not equal to the time involved. Diagnosing someone with ADHD takes as little as 15 minutes, and provides the same co-pay.
Over the years, I gradually discovered more and more conditions that could lead to distraction and impulsivity. Sleep disorders, major depressive and bipolar disorder, learning disabilities, and even boredom in the classroom. After 50 years of clinical research, I have determined over 20 conditions that are responsible for attention-deficit and impulsivity symptoms.
These conditions are found regularly enough, so why are so many cases overwhelmed by ADHD diagnoses? In addition to the role that doctors play in this vicious cycle, another issue is that stronger attention-deficit symptoms can put a veil over the underlying condition. In subsequent posts I will describe some of the more common conditions associated with attention deficit, and I will explore how to find their often hidden causes.
Richard C. Saul, M.D., is the author of ADHD Does Not Exist.
Copyright Richard Saul, M.D., Behavioral Neurologist