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ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder
In this groundbreaking and controversial book, behavioral neurologist Dr. Richard Saul draws on five decades of experience treating thousands of patients labeled with Attention Deficit and Hyperactivity Disorder—one of the fastest growing and widely diagnosed conditions today—to argue that ADHD is actually a cluster of symptoms stemming from over 20 other conditions and disorders. According to recent data from the Centers for Disease Control and Prevention, an estimated 6.4 million children between the ages of four and seventeen have been diagnosed with attention deficit hyperactivity disorder. While many skeptics believe that ADHD is a fabrication of drug companies and the medical establishment, the symptoms of attention-deficit and hyperactivity are all too real for millions of individuals who often cannot function without treatment. If ADHD does not exist, then what is causing these debilitating symptoms? Over the course of half a century, physician Richard Saul has worked with thousands of patients demonstrating symptoms of ADHD. Based on his experience, he offers a shocking ADHD is not a condition on its own, but rather a symptom complex caused by over twenty separate conditions—from poor eyesight and giftedness to bipolar disorder and depression—each requiring its own specific treatment. Drawing on in-depth scientific research and real-life stories from his numerous patients, ADHD Does not Exist synthesizes Dr. Saul's findings, and offers and clear advice for everyone seeking answers.
336 pages, Hardcover
First published February 18, 2014
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Displaying 1 - 30 of 106 reviews
October 3, 2013
Thank you to edelweiss, for the advanced copy!
I was really interested in this book as I've been diagnosed with ADHD for several years now, after being mis-diagnosed with an array of other things since I was a teenager. I'm very happy with the ADHD diagnosis, because it fits perfectly, and the medication and therapy help me immensely. But since I obviously have quite a bit of personal experience with being mis-diagnosed, I was willing to give this book a go and see what it had to say.
And this book was, frankly, not very good.
It wasn't even because of the content, which I found to be a little extreme. Come on now, gigantic blanket statements about things that can't possibly be proven (ADHD doesn't exist AT ALL. Period. There are NO exceptions!!!) have no place in science. So let's not pretend that it does, okay?
No, it wasn't the content that bothered me. It was the fact that this book about attention problems, written, I'm assuming, for people who have experience with this issue (like myself), is BORING AS HELL. Ironic, much? I mean, I could not believe how long some of the paragraphs were (break it up, please! My eyeballs are melting!) and it just went on and on and on and on and on and on and on and on and on and on about...have you lost me, yet? Puppies are adorable.
The more my mind wandered while reading this book, the more I was convinced that the author had absolutely no idea what he was talking about.
So, I'll just take my tiny attention span, with it's accompanying higher-than-average IQ (there's another reason those blanket statements don't work - we are not stupid Mr. Author, you said so yourself!), and go find myself a book that is actually interesting to read.
I was really interested in this book as I've been diagnosed with ADHD for several years now, after being mis-diagnosed with an array of other things since I was a teenager. I'm very happy with the ADHD diagnosis, because it fits perfectly, and the medication and therapy help me immensely. But since I obviously have quite a bit of personal experience with being mis-diagnosed, I was willing to give this book a go and see what it had to say.
And this book was, frankly, not very good.
It wasn't even because of the content, which I found to be a little extreme. Come on now, gigantic blanket statements about things that can't possibly be proven (ADHD doesn't exist AT ALL. Period. There are NO exceptions!!!) have no place in science. So let's not pretend that it does, okay?
No, it wasn't the content that bothered me. It was the fact that this book about attention problems, written, I'm assuming, for people who have experience with this issue (like myself), is BORING AS HELL. Ironic, much? I mean, I could not believe how long some of the paragraphs were (break it up, please! My eyeballs are melting!) and it just went on and on and on and on and on and on and on and on and on and on about...have you lost me, yet? Puppies are adorable.
The more my mind wandered while reading this book, the more I was convinced that the author had absolutely no idea what he was talking about.
So, I'll just take my tiny attention span, with it's accompanying higher-than-average IQ (there's another reason those blanket statements don't work - we are not stupid Mr. Author, you said so yourself!), and go find myself a book that is actually interesting to read.
June 9, 2014
ADHD Doesn’t Exist!
“But my self titled disorder NDI does!”
In some ways this book reminds me of those health magazines sold at whole foods. While at my short time there, I spotted an article with a name similar to, "the real cause of depression." I skimmed through the article about a correlation between inflammation and depression. It described inflammation as THE number one cause of depression and nothing else. Though this article never said what kind of inflammation-- there are several. The problem with these types of published works is that they do the same as the experts they're trying to disprove: pigeon-holing a disorder into one reason. In these cases it's saying that mental disorder is just a symptom.
I will jump to the main selling part of the book, the part that nearly had me laughing: His self created disorder that he named Neurochemical Distractibility/Impulsivity, which is also just as creative as the title of the book. The chapter is nestled in the middle, which I assume he intentionally placed there so he would not appear too arrogant. And to also avoid clashing with the title, and therefore destroying the main point of the book. He points out in this chapter that it's not a disorder in name of symptoms but proved by blood tests.
The blood tests he mentions, if I have made the correlation correctly, is still being tested. It's not out to the public. The very same blood test that is still being tested on lab rats as a future test to prove depression. (http://psychcentral.com/news/2014/04/...) While there are underlying theories of depression (see information about serotonin on any page such as wiki), there has yet been any physical test that a patient can take. Therapists and doctors alike go on a list of symptoms (like ADHD), while also interacting with the patient to make a diagnosis. Interacting with a patient... Who would have thought?
And like depression there are theories about how it works on the brain. There are two that I know of: the dopamine levels are significantly lower for those with ADHD; while the other is a developmental issue in the brain where one part of the brain is more underdeveloped. (http://psychcentral.com/news/2010/04/...) The reason why some people grow out of the disorder is because that part of the brain "catches up." So there is physical proof that ADHD does exist. However many patients are not able to go through with the testing that this author is suggesting. Because of affordability. Several of these tests he suggested to his patients are not covered by insurance and have to be paid to out of pocket. Many of these tests can reach up to a few thousand dollars.
The physical proof needed is way out of the affordability range-- which is why blood tests as described above are in the making. So, I would hope, testing would become financially reasonable and a patient can be treated accurately. Doctors forget that affordability is everything to human health.
Strangely, this doctor never mentions the benefits of medication for his version of ADHD, NDI-- those who take the drugs as prescribed, and who have "NDI", Adderall and other drugs, are said to help "improve" symptoms over time. (http://www.psychiatrictimes.com/adhd/...). When they're not abused. He also never mentions or addresses the strange fact of the patients who become sleepy when first taking the drug--fatigue when taking amphetamine salts, is sometimes described as physical proof of the disorder, though this is debated by doctors.
He also fails to mention the new types of medication coming out on the market: one that won't release amphetamines until it reaches the stomach (IE less abuse), and the other that doesn't have any speed, but like SSRI's takes a few weeks to kick in. (http://www.addvance.com/help/parents/...) He does mention one: stratta, but it's more in passing and he seems to fail to mention that it's a non-stimulant medication. But he seems more focused on sensationalizing ADHD as a ghost disorder and how all medications prescribed for these patients are 100% harmful and not effective.
The other hypocritical part of the book is the fact that he seems more okay with the high percentages of depression and anxiety, while completely washing ADHD--even though he touches on recent articles correlating five mental disorders to the same part of the brain, ADHD included. He describes the high percentages of physical symptoms such as vision problems but doesn't seem to make the connection that, yes, mental disorders can occur at just as high of rates. Even though you can't exactly see them. With blood tests.
It seems as though Saul wrote this book for the mainstreamer, and the terrified parent--riding on the popularity of ADHD and how well known it is. He sensationalizes the stigma. A lot of the facts are off (there is no blood test guys!), and if there are facts, they are used in black-and-white terms, as well as using them to spread stigma of mental health.
This guy should have his license pulled. When picking up the book, I did expect him to sensationalize the over diagnosis of ADHD. I have a subtype of the disorder among other things, so I like to track information (cures maybe?! a magic list of surefire things I can do to fix it?! secret affordable therapies?! surgeries I can do in my own bathroom?!) What I did not expect was straight up lies and misinformation. His bibliography is extensive, which kind of tells me that the misinformation was intentional and not otherwise. I believe if you are going to disprove something, you should write about it from all sides, but several of these books and articles use pathos disguised on the back of ethos. However I was amused by the science fiction he infused into how he diagnosed his "non-symptom related" NDI to "rare" patients.
He's lucky that I'm not willing to dig through his bibliography to see how he rephrased and reworded actual scholarly articles to his needs. The misinformation was found while skimming the book. My attention span can't hold up that well for that; I have ADHD. :)
“But my self titled disorder NDI does!”
In some ways this book reminds me of those health magazines sold at whole foods. While at my short time there, I spotted an article with a name similar to, "the real cause of depression." I skimmed through the article about a correlation between inflammation and depression. It described inflammation as THE number one cause of depression and nothing else. Though this article never said what kind of inflammation-- there are several. The problem with these types of published works is that they do the same as the experts they're trying to disprove: pigeon-holing a disorder into one reason. In these cases it's saying that mental disorder is just a symptom.
I will jump to the main selling part of the book, the part that nearly had me laughing: His self created disorder that he named Neurochemical Distractibility/Impulsivity, which is also just as creative as the title of the book. The chapter is nestled in the middle, which I assume he intentionally placed there so he would not appear too arrogant. And to also avoid clashing with the title, and therefore destroying the main point of the book. He points out in this chapter that it's not a disorder in name of symptoms but proved by blood tests.
The blood tests he mentions, if I have made the correlation correctly, is still being tested. It's not out to the public. The very same blood test that is still being tested on lab rats as a future test to prove depression. (http://psychcentral.com/news/2014/04/...) While there are underlying theories of depression (see information about serotonin on any page such as wiki), there has yet been any physical test that a patient can take. Therapists and doctors alike go on a list of symptoms (like ADHD), while also interacting with the patient to make a diagnosis. Interacting with a patient... Who would have thought?
And like depression there are theories about how it works on the brain. There are two that I know of: the dopamine levels are significantly lower for those with ADHD; while the other is a developmental issue in the brain where one part of the brain is more underdeveloped. (http://psychcentral.com/news/2010/04/...) The reason why some people grow out of the disorder is because that part of the brain "catches up." So there is physical proof that ADHD does exist. However many patients are not able to go through with the testing that this author is suggesting. Because of affordability. Several of these tests he suggested to his patients are not covered by insurance and have to be paid to out of pocket. Many of these tests can reach up to a few thousand dollars.
The physical proof needed is way out of the affordability range-- which is why blood tests as described above are in the making. So, I would hope, testing would become financially reasonable and a patient can be treated accurately. Doctors forget that affordability is everything to human health.
Strangely, this doctor never mentions the benefits of medication for his version of ADHD, NDI-- those who take the drugs as prescribed, and who have "NDI", Adderall and other drugs, are said to help "improve" symptoms over time. (http://www.psychiatrictimes.com/adhd/...). When they're not abused. He also never mentions or addresses the strange fact of the patients who become sleepy when first taking the drug--fatigue when taking amphetamine salts, is sometimes described as physical proof of the disorder, though this is debated by doctors.
He also fails to mention the new types of medication coming out on the market: one that won't release amphetamines until it reaches the stomach (IE less abuse), and the other that doesn't have any speed, but like SSRI's takes a few weeks to kick in. (http://www.addvance.com/help/parents/...) He does mention one: stratta, but it's more in passing and he seems to fail to mention that it's a non-stimulant medication. But he seems more focused on sensationalizing ADHD as a ghost disorder and how all medications prescribed for these patients are 100% harmful and not effective.
The other hypocritical part of the book is the fact that he seems more okay with the high percentages of depression and anxiety, while completely washing ADHD--even though he touches on recent articles correlating five mental disorders to the same part of the brain, ADHD included. He describes the high percentages of physical symptoms such as vision problems but doesn't seem to make the connection that, yes, mental disorders can occur at just as high of rates. Even though you can't exactly see them. With blood tests.
It seems as though Saul wrote this book for the mainstreamer, and the terrified parent--riding on the popularity of ADHD and how well known it is. He sensationalizes the stigma. A lot of the facts are off (there is no blood test guys!), and if there are facts, they are used in black-and-white terms, as well as using them to spread stigma of mental health.
This guy should have his license pulled. When picking up the book, I did expect him to sensationalize the over diagnosis of ADHD. I have a subtype of the disorder among other things, so I like to track information (cures maybe?! a magic list of surefire things I can do to fix it?! secret affordable therapies?! surgeries I can do in my own bathroom?!) What I did not expect was straight up lies and misinformation. His bibliography is extensive, which kind of tells me that the misinformation was intentional and not otherwise. I believe if you are going to disprove something, you should write about it from all sides, but several of these books and articles use pathos disguised on the back of ethos. However I was amused by the science fiction he infused into how he diagnosed his "non-symptom related" NDI to "rare" patients.
He's lucky that I'm not willing to dig through his bibliography to see how he rephrased and reworded actual scholarly articles to his needs. The misinformation was found while skimming the book. My attention span can't hold up that well for that; I have ADHD. :)
June 15, 2014
This book is a mess.
It starts out from a reasonable premise: ADHD describes a symptom cluster and that it is already known to overlap with other disorders. People may jump to the conclusion that ADHD is the problem and stimulant meds are the answer without fully investigating.
The problem is, he doesn't have any good answers. The bulk of the book is comprised of brief chapters listing disorders or conditions that may present similarly to ADHD. Many of these are reasonable things to consider, and I would certainly hope that a child is checked for vision or hearing problems before jumping to ADHD. They don't, however, explain enough cases--sure, Tourette's or schizophrenia might have similar symptoms, but how common are they? The diagnoses he chooses are not all solid. He devotes a section to sensory processing disorder, another condition that is viewed by many clinicians as a symptom cluster and which is not in the DSM. He includes an example of a child with bipolar disorder--another controversial diagnosis (and if we're going to rail against the side effects of stimulants, lithium is no picnic either).
Then he throws the real curveball. No, ADHD doesn't exist, but a new disorder, NDI, does. What's the difference? Ah! This is neurobiological! We can explain it through neurotransmitter levels, and this will also explain why some people do better with stimulants and some with SSRIs! But he doesn't explain how that all works, and you cannot just invent a new diagnosis in 10 pages and fail to explain it. This one chapter may undo the entire book.
I wavered between 1 and 2 stars--because he is correct that patients need to be fully evaluated, some patients may well have something else, and if his statistics are correct, there's much to wonder about in the number of ADHD diagnoses and the number of stimulant prescriptions being written. Our healthcare system, and even more so our mental health system, is prone to seeing a prescription as a quick fix. Unfortunately, he treats it only as a categorization problem, without recognizing the social factors that are also driving this.
It starts out from a reasonable premise: ADHD describes a symptom cluster and that it is already known to overlap with other disorders. People may jump to the conclusion that ADHD is the problem and stimulant meds are the answer without fully investigating.
The problem is, he doesn't have any good answers. The bulk of the book is comprised of brief chapters listing disorders or conditions that may present similarly to ADHD. Many of these are reasonable things to consider, and I would certainly hope that a child is checked for vision or hearing problems before jumping to ADHD. They don't, however, explain enough cases--sure, Tourette's or schizophrenia might have similar symptoms, but how common are they? The diagnoses he chooses are not all solid. He devotes a section to sensory processing disorder, another condition that is viewed by many clinicians as a symptom cluster and which is not in the DSM. He includes an example of a child with bipolar disorder--another controversial diagnosis (and if we're going to rail against the side effects of stimulants, lithium is no picnic either).
Then he throws the real curveball. No, ADHD doesn't exist, but a new disorder, NDI, does. What's the difference? Ah! This is neurobiological! We can explain it through neurotransmitter levels, and this will also explain why some people do better with stimulants and some with SSRIs! But he doesn't explain how that all works, and you cannot just invent a new diagnosis in 10 pages and fail to explain it. This one chapter may undo the entire book.
I wavered between 1 and 2 stars--because he is correct that patients need to be fully evaluated, some patients may well have something else, and if his statistics are correct, there's much to wonder about in the number of ADHD diagnoses and the number of stimulant prescriptions being written. Our healthcare system, and even more so our mental health system, is prone to seeing a prescription as a quick fix. Unfortunately, he treats it only as a categorization problem, without recognizing the social factors that are also driving this.
June 3, 2016
Many people in the review section are rating the book with one star and are saying things like, "He fails to recognize research that people with ADHD have a true attention deficit problem, and it's supported by brain imaging." This is such an ignorant quote to be deducted from the book. His thesis is that people that are diagnosed with ADHD/ADD DO have and attention problem, and DO experience hyperactivity. His point was that the "diagnosis" of ADHD is only listing symptoms, and it fails to answer what actually causes the problem.
June 12, 2022
Who’s afraid of the Big Bad Ritalin? Not me, but this guy is apparently. Get over yourself and stop undermining the lives of thousands of people who have benefited from ADHD diagnosis, especially women and girls who have been under-diagnosed since the beginning of humankind.
It doesn’t matter if ADHD “exists”; it matters if meds help tackle the cluster of symptoms, so that people can be better people/parents/employees, which they abso-fricken-lutely do.
It doesn’t matter if ADHD “exists”; it matters if meds help tackle the cluster of symptoms, so that people can be better people/parents/employees, which they abso-fricken-lutely do.
Read
February 6, 2019This book seriously angers me. Fortunately, my tiny attention span didn't make it to the end. Saul's thesis ("ADHD is a symptom cluster") was a reasonable premise, but he ends up being an outright ADHD-denier. Doctors like Saul contribute to stigmatize ADHD and just provide unsustained arguments to those calling us "character-flawed, disorganized, difficult-to-handle, lazy, undisciplined, over-emotional poseurs".
If a college student made such vague, pretentious claims, he would be facing an explosion of red ink. But Saul wavers on, tossing out a plethora of empty nonsense that can't possibly be proven. He starts promising, talks about the chemical imbalance that causes attention problems, but then goes on making up his own conclusions, thereby disregarding all modern insights. His claim that brain dopamine deficiency can be detected in (future!) blood tests is complete bogus. He sensationalizes the use of all medication, calling rilatin 100% not effective, even calling it "legalized speed".
Obviously, incorrect ADHD diagnoses can be harmful, and other causes should always be considered. But this is the kind of rhetoric that causes ADHD to go undiagnosed or misdiagnosed with an excess of other things. Too many doctors, pedagogues and psychologists are still doubting the mere existence of ADHD. Teachers, family, partners and friends have no understanding of attention deficit whatsoever. Ironically however, Saul manages to invent a brand new term (Neurochemical Distractibility/Impulsivity); which is basically how serious neurologists describe ADD/ADHD.
In conclusion, this book is a complete waste of time for those seeking guidance on ADHD. It's a mockery to intelligent people who were undiagnosed for years while trying to understand why normal things are so difficult. And it's an insult to anyone trying to break the stigma surrounding mental health. ADHD is not an excuse, it's a daily reality.
If a college student made such vague, pretentious claims, he would be facing an explosion of red ink. But Saul wavers on, tossing out a plethora of empty nonsense that can't possibly be proven. He starts promising, talks about the chemical imbalance that causes attention problems, but then goes on making up his own conclusions, thereby disregarding all modern insights. His claim that brain dopamine deficiency can be detected in (future!) blood tests is complete bogus. He sensationalizes the use of all medication, calling rilatin 100% not effective, even calling it "legalized speed".
Obviously, incorrect ADHD diagnoses can be harmful, and other causes should always be considered. But this is the kind of rhetoric that causes ADHD to go undiagnosed or misdiagnosed with an excess of other things. Too many doctors, pedagogues and psychologists are still doubting the mere existence of ADHD. Teachers, family, partners and friends have no understanding of attention deficit whatsoever. Ironically however, Saul manages to invent a brand new term (Neurochemical Distractibility/Impulsivity); which is basically how serious neurologists describe ADD/ADHD.
In conclusion, this book is a complete waste of time for those seeking guidance on ADHD. It's a mockery to intelligent people who were undiagnosed for years while trying to understand why normal things are so difficult. And it's an insult to anyone trying to break the stigma surrounding mental health. ADHD is not an excuse, it's a daily reality.
March 15, 2022
Ok listen - I really tried to give this man the benefit of the doubt. I enjoy reading books that challenge my perspectives and since I am diagnosed with ADHD I thought I would pick this one up and see how it went - maybe I would learn something...
Except I didn't really learn much at all and the author clickbaited me into picking up this book. ADHD Does Not Exist isn't actually about ADHD not existing at all - it's about how the author thinks it's overdiagnosed and wants to list out a bunch of other things that it could be instead. And yes, in the intro he admits he's trying to be provocative - and I would have no problem with that if it were honest.
He then goes on to give some good points. Yes, ADHD is really just a cluster of symptoms and those symptoms often do overlap with other disorders. Autism, for example, and anxiety, and PTSD. Sometimes other disorders (or combinations of disorders) can present similarly to ADHD and result in a misdiagnosis. I don't deny that it happens. Anyone who has ever seen anyone for mental health or neurodevelopmental disability has probably been misdiagnosed at one point - hell, anyone who has ever seen anyone for a health visit of any kind has probably been misdiagnosed.
But the author then gives a bunch of bogus reasons someone with ADHD might not actually have ADHD - like poor eyesight (myopia.) Excuse me, sir? This is easily solved by an eye exam, which happens in school regularly. If a child has issues with eyesight they're not going to get accidentally diagnosed with ADHD. And if this has actually happened I would call it extremely rare. Listing it in a book like this makes it sound like a regular occurrence that happens every day. This is made even more hilarious with a little bit of research because yes, there is a link between poor eyesight and ADHD, but also yes, the author is misrepresenting this to support his own anecdotal evidence as fact.
There is a trend whereby children with UNCORRECTABLE eyesight issues are twice as likely to be diagnosed with ADHD. The key term here being uncorrectable, which the study defined using the question "had a doctor told the parent that his or her child had a vision problem that couldn't be corrected by glasses or contacts?" Not one, but every single study I found on the link between poor eyesight and ADHD included this caveat that the study was done using participants whose vision is not correctable using glasses or contacts. This means we are not talking about myopia or simple nearsightedness or farsightedness.
And guess what? Saul doesn't cite a single study claiming otherwise. Actually, he doesn't cite one at all. He fails to properly clarify that these studies are done on children with "serious eye conditions" and instead cites anecdotal evidence for which he uses unrelated citations to support. And he gets away with it because nobody checks the citations.
Let's look at one example.
Saul cited a study by Soyeon Kim to support his claim that "children diagnosed with ADHD were significantly more likely to report vision difficulties than those without the diagnosis." However, this study was about color perception in adolescents with ADHD, not general vision trends in people diagnosed with ADHD. The study explicitly mentioned that it is not possible to generalize the findings due to small sample size and did not mention (except for one place) that people with ADHD are more likely to have vision issues.
Here is the exact quote from the introduction mentioning the link between ADHD and vision issues -
If you refer to Appendix A, you'd see it contains a literature study on vision problems with ADHD. Saul cited a study that was citing other literature for the claim. Why? Several studies have been done on the link between eyesight and ADHD so it should have been easy for him to link one of the ACTUAL studies on this, right?
Except they contain the caveat that the study is about uncorrectable vision problems.. right. Then he couldn't put myopia on his list of eye problems that get confused with ADHD, so instead of being honest he used a roundabout method to cite his information so that he could control what you do and don't see... Hmm... seems fishy.
The problem that I have with this isn't even the claim that poor eyesight and ADHD are linked. It's fact. There is a correlation. But correlation does not equal causation and this author is being sneaky with his citations in order to ignore many of these studies while also making it look like his anecdotal evidence is supported by science.
But don't take my word for it, all of the studies that I'm mentioning are linked below, including the study Saul linked in his book.
I found citation issues like this in other parts of his book as well, but for the sake of this review I will not go down that rabbit hole here.
I respect the premise of this book - laying out all of the (reasonable) alternative diagnoses someone could have instead of ADHD is a good idea. Having lists of things to go through and check off is important. When a parent has a child who is being referred out for an ADHD evaluation it can be useful for them to have resources on the alternatives - what else could be causing these symptoms that look like ADHD?
Someone being improperly diagnosed with ADHD and receiving the wrong treatment can be detrimental to their long-term mental health (and also finding the actual issue.) I am all for considering alternatives and other possibilities.
But this book is not only a lie, but it is harmful to people who actually do have ADHD because of the way it is set up and then... not well explained. There are too many people on this planet who actually believe that ADHD doesn't exist to be giving a book about alternate diagnoses a title like this. You're basically handing them the keys to get away with claiming 'it's not ADHD, it's one of these other things' using a doctor's authority. Because they read this book and it's written by a doctor then it must be true, right? Except it isn't. So much is either not cited at all or incorrectly cited and whether that is intentional or not I do not know - but it is irresponsible.
This issue is exacerbated by the lack of explanation in the book about what ADHD is and the fact that yes, it's a real thing. It is a neurodevelopmental disorder that does change the way our brains work (hence why medications like Adderall have the opposite effect on people with ADHD.) The part that gets me so much about it is that the author does briefly mention ADHD is a real thing and does exist but it's such a miniscule piece of the book (and is then followed up by chapter upon chapter of alternate diagnoses) that it may as well not be there at all. And the author ignored all of this in favor of a catchy title to sell more copies.
So in short, I am disgusted. 0.25 stars. I would give it a zero and report the author to the Dean's Office for violating academic integrity if I could.
SOURCES
DeCarlo, Dawn K et al. “ADHD and Vision Problems in the National Survey of Children's Health.” Optometry and vision science : official publication of the American Academy of Optometry vol. 93,5 (2016): 459-65. doi:10.1097/OPX.0000000000000823
https://www.ncbi.nlm.nih.gov/pmc/arti...
Kim, Soyeon et al. “Color vision in attention-deficit/hyperactivity disorder: a pilot visual evoked potential study.” Journal of optometry vol. 8,2 (2015): 116-30. doi:10.1016/j.optom.2014.10.002
https://www.ncbi.nlm.nih.gov/pmc/arti...
Fabian ID, Kinori M, Ancri O, Spierer A, Tsinman A, Ben Simon GJ. “The possible association of attention deficit hyperactivity disorder with undiagnosed refractive errors”. J AAPOS. 2013 Oct;17(5):507-11.
https://pubmed.ncbi.nlm.nih.gov/24160...
Granet DB1, Gomi CF, Ventura R, Miller-Scholte A. “The relationship between convergence insufficiency and ADHD.” Strabismus. 2005 Dec;13(4):163-8.
https://pubmed.ncbi.nlm.nih.gov/16361...
https://www.aoa.org/news/clinical-eye...
https://www.optometrists.org/vision-t...
Except I didn't really learn much at all and the author clickbaited me into picking up this book. ADHD Does Not Exist isn't actually about ADHD not existing at all - it's about how the author thinks it's overdiagnosed and wants to list out a bunch of other things that it could be instead. And yes, in the intro he admits he's trying to be provocative - and I would have no problem with that if it were honest.
He then goes on to give some good points. Yes, ADHD is really just a cluster of symptoms and those symptoms often do overlap with other disorders. Autism, for example, and anxiety, and PTSD. Sometimes other disorders (or combinations of disorders) can present similarly to ADHD and result in a misdiagnosis. I don't deny that it happens. Anyone who has ever seen anyone for mental health or neurodevelopmental disability has probably been misdiagnosed at one point - hell, anyone who has ever seen anyone for a health visit of any kind has probably been misdiagnosed.
But the author then gives a bunch of bogus reasons someone with ADHD might not actually have ADHD - like poor eyesight (myopia.) Excuse me, sir? This is easily solved by an eye exam, which happens in school regularly. If a child has issues with eyesight they're not going to get accidentally diagnosed with ADHD. And if this has actually happened I would call it extremely rare. Listing it in a book like this makes it sound like a regular occurrence that happens every day. This is made even more hilarious with a little bit of research because yes, there is a link between poor eyesight and ADHD, but also yes, the author is misrepresenting this to support his own anecdotal evidence as fact.
There is a trend whereby children with UNCORRECTABLE eyesight issues are twice as likely to be diagnosed with ADHD. The key term here being uncorrectable, which the study defined using the question "had a doctor told the parent that his or her child had a vision problem that couldn't be corrected by glasses or contacts?" Not one, but every single study I found on the link between poor eyesight and ADHD included this caveat that the study was done using participants whose vision is not correctable using glasses or contacts. This means we are not talking about myopia or simple nearsightedness or farsightedness.
And guess what? Saul doesn't cite a single study claiming otherwise. Actually, he doesn't cite one at all. He fails to properly clarify that these studies are done on children with "serious eye conditions" and instead cites anecdotal evidence for which he uses unrelated citations to support. And he gets away with it because nobody checks the citations.
Let's look at one example.
Saul cited a study by Soyeon Kim to support his claim that "children diagnosed with ADHD were significantly more likely to report vision difficulties than those without the diagnosis." However, this study was about color perception in adolescents with ADHD, not general vision trends in people diagnosed with ADHD. The study explicitly mentioned that it is not possible to generalize the findings due to small sample size and did not mention (except for one place) that people with ADHD are more likely to have vision issues.
Here is the exact quote from the introduction mentioning the link between ADHD and vision issues -
ADHD is also associated with visual perceptual problems that cannot be explained by executive dysfunction (appendix A).
If you refer to Appendix A, you'd see it contains a literature study on vision problems with ADHD. Saul cited a study that was citing other literature for the claim. Why? Several studies have been done on the link between eyesight and ADHD so it should have been easy for him to link one of the ACTUAL studies on this, right?
Except they contain the caveat that the study is about uncorrectable vision problems.. right. Then he couldn't put myopia on his list of eye problems that get confused with ADHD, so instead of being honest he used a roundabout method to cite his information so that he could control what you do and don't see... Hmm... seems fishy.
The problem that I have with this isn't even the claim that poor eyesight and ADHD are linked. It's fact. There is a correlation. But correlation does not equal causation and this author is being sneaky with his citations in order to ignore many of these studies while also making it look like his anecdotal evidence is supported by science.
But don't take my word for it, all of the studies that I'm mentioning are linked below, including the study Saul linked in his book.
I found citation issues like this in other parts of his book as well, but for the sake of this review I will not go down that rabbit hole here.
I respect the premise of this book - laying out all of the (reasonable) alternative diagnoses someone could have instead of ADHD is a good idea. Having lists of things to go through and check off is important. When a parent has a child who is being referred out for an ADHD evaluation it can be useful for them to have resources on the alternatives - what else could be causing these symptoms that look like ADHD?
Someone being improperly diagnosed with ADHD and receiving the wrong treatment can be detrimental to their long-term mental health (and also finding the actual issue.) I am all for considering alternatives and other possibilities.
But this book is not only a lie, but it is harmful to people who actually do have ADHD because of the way it is set up and then... not well explained. There are too many people on this planet who actually believe that ADHD doesn't exist to be giving a book about alternate diagnoses a title like this. You're basically handing them the keys to get away with claiming 'it's not ADHD, it's one of these other things' using a doctor's authority. Because they read this book and it's written by a doctor then it must be true, right? Except it isn't. So much is either not cited at all or incorrectly cited and whether that is intentional or not I do not know - but it is irresponsible.
This issue is exacerbated by the lack of explanation in the book about what ADHD is and the fact that yes, it's a real thing. It is a neurodevelopmental disorder that does change the way our brains work (hence why medications like Adderall have the opposite effect on people with ADHD.) The part that gets me so much about it is that the author does briefly mention ADHD is a real thing and does exist but it's such a miniscule piece of the book (and is then followed up by chapter upon chapter of alternate diagnoses) that it may as well not be there at all. And the author ignored all of this in favor of a catchy title to sell more copies.
So in short, I am disgusted. 0.25 stars. I would give it a zero and report the author to the Dean's Office for violating academic integrity if I could.
SOURCES
DeCarlo, Dawn K et al. “ADHD and Vision Problems in the National Survey of Children's Health.” Optometry and vision science : official publication of the American Academy of Optometry vol. 93,5 (2016): 459-65. doi:10.1097/OPX.0000000000000823
https://www.ncbi.nlm.nih.gov/pmc/arti...
Kim, Soyeon et al. “Color vision in attention-deficit/hyperactivity disorder: a pilot visual evoked potential study.” Journal of optometry vol. 8,2 (2015): 116-30. doi:10.1016/j.optom.2014.10.002
https://www.ncbi.nlm.nih.gov/pmc/arti...
Fabian ID, Kinori M, Ancri O, Spierer A, Tsinman A, Ben Simon GJ. “The possible association of attention deficit hyperactivity disorder with undiagnosed refractive errors”. J AAPOS. 2013 Oct;17(5):507-11.
https://pubmed.ncbi.nlm.nih.gov/24160...
Granet DB1, Gomi CF, Ventura R, Miller-Scholte A. “The relationship between convergence insufficiency and ADHD.” Strabismus. 2005 Dec;13(4):163-8.
https://pubmed.ncbi.nlm.nih.gov/16361...
https://www.aoa.org/news/clinical-eye...
https://www.optometrists.org/vision-t...
July 28, 2020
ADHD DOES exist.
An international team of researchers analyzed data from more than 55,000 individuals and identified 12 gene regions linked with ADHD.
The author essentially wrote a book about psychiatric disorders which are commonly confused for ADHD such as bipolar disorder - but the title and stance is harmful to the many people who truly have ADHD , and struggle in a world where their disability is treated as an excuse and a joke. ADHD affects every aspect of life, from longevity (ADHD people live an average of 5 years less) to mental health (around 50% of ADHD people experience depression from related stress) to employment (ADHD people are 60% more likely to be fired from a job and make on average $4,300 less per year than their peers.)
ADHD is a serious disorder, and erasing it with attention seeking titles harms people.
An international team of researchers analyzed data from more than 55,000 individuals and identified 12 gene regions linked with ADHD.
The author essentially wrote a book about psychiatric disorders which are commonly confused for ADHD such as bipolar disorder - but the title and stance is harmful to the many people who truly have ADHD , and struggle in a world where their disability is treated as an excuse and a joke. ADHD affects every aspect of life, from longevity (ADHD people live an average of 5 years less) to mental health (around 50% of ADHD people experience depression from related stress) to employment (ADHD people are 60% more likely to be fired from a job and make on average $4,300 less per year than their peers.)
ADHD is a serious disorder, and erasing it with attention seeking titles harms people.
July 5, 2014
Anybody who practices in the medical or mental health fields these days needs to know a lot about ADHD and the symptoms associated with it. Reading this book is a part of my efforts to be well-informed about the trends, latest research, and current thinking about this topic.
Dr. Saul's title is provocative, and he has aimed to provoke critical thinking with the book. While he does not exactly convince me that ADHD "does not exist," he does helpfully differentiate between ADHD and several other disorders that have overlapping symptoms. Included are detailed descriptions including case studies of patients with giftedness, sensory processing disorder, learning disabilities, substance use, vision and hearing problems, and more disorders that are often missed and untreated in favor of the quick easy ADHD label and treatment via stiumulant medication. The quick labeling and treating with meds has costs. Saul is very concerned about these missed conditions, saying "treatment delayed is treatment denied." His case studies all have happy endings. A critical reader might be skeptical about the rosy outcomes conveyed, once each person was properly diagnosed and (frequently) given the appropriate medication.
He also makes the case, perhaps not strongly enough, that some distractibility and impulsiveness are a part of NORMALCY and do not necessarily merit a diagnosis. "Not every set of symptoms is a diagnosis." These are points worth making to the general public. They are useful reminders for clinicians. Thoroughness in evaluation is certainly called for. There is nothing breathtakingly new here. However, the book is highly readable and neatly laid out. Dr. Saul's discussion of the trends of overdiagnosis and overmedication related to both consumer and provider behavior is concise and builds a good framework for the rest of his argument. He gives some pointers to those evaluating for ADHD and offers some lifestyle tips for those who struggle with ADHD symptoms but would not benefit from (or qualify for) diagnosis. The charts in the book make a good resource, quickly delineating the disorders addressed in the book and some of the main symptoms. He closes with a remark about the importance of mindset in dealing with these ADHD symptom-related challenges. If we think the worst and focus on what's wrong, it can become a self-fulfilling prophecy. It is always so important to think of the big picture and keep things in perspective.
Dr. Saul's title is provocative, and he has aimed to provoke critical thinking with the book. While he does not exactly convince me that ADHD "does not exist," he does helpfully differentiate between ADHD and several other disorders that have overlapping symptoms. Included are detailed descriptions including case studies of patients with giftedness, sensory processing disorder, learning disabilities, substance use, vision and hearing problems, and more disorders that are often missed and untreated in favor of the quick easy ADHD label and treatment via stiumulant medication. The quick labeling and treating with meds has costs. Saul is very concerned about these missed conditions, saying "treatment delayed is treatment denied." His case studies all have happy endings. A critical reader might be skeptical about the rosy outcomes conveyed, once each person was properly diagnosed and (frequently) given the appropriate medication.
He also makes the case, perhaps not strongly enough, that some distractibility and impulsiveness are a part of NORMALCY and do not necessarily merit a diagnosis. "Not every set of symptoms is a diagnosis." These are points worth making to the general public. They are useful reminders for clinicians. Thoroughness in evaluation is certainly called for. There is nothing breathtakingly new here. However, the book is highly readable and neatly laid out. Dr. Saul's discussion of the trends of overdiagnosis and overmedication related to both consumer and provider behavior is concise and builds a good framework for the rest of his argument. He gives some pointers to those evaluating for ADHD and offers some lifestyle tips for those who struggle with ADHD symptoms but would not benefit from (or qualify for) diagnosis. The charts in the book make a good resource, quickly delineating the disorders addressed in the book and some of the main symptoms. He closes with a remark about the importance of mindset in dealing with these ADHD symptom-related challenges. If we think the worst and focus on what's wrong, it can become a self-fulfilling prophecy. It is always so important to think of the big picture and keep things in perspective.
June 23, 2015
The book follows a template for every single chapter: "Here's disorder A. Patient B came in, misdiagnosed with ADHD, but it was actually disorder A that caused ADHD symptoms; by treating A and not giving the patient Adderall, I cured him. Disorder A co-occurs with ADHD in X% of ADHD cases; here are some genetic studies that find an overlap; here are the broader population statistics. It completely explains ADHD in this subset of cases."
While the book is a good reminder that ADHD can be misdiagnosed, the author fundamentally fails to provide evidence to support the titular claim. In fact, he identifies a purely neural condition (that he claims is unsupported by wider research, but that he "noticed" in his files): low blood serotonin or high blood norepinephrine, according to Saul, are the biological causes of ADHD symptoms. (But it is not proof of ADHD's existence, he insists, because ADHD is defined by DSM-V purely as a set of symptoms!) I don't even want to get into the problems with this statement, but it illustrates well the kind of logical leaps you'll have to put up with.
There is an inferential gap at the root of the book; bridging it will take much more than a clinician armed with a confirmation bias and a truckload of case studies.
While the book is a good reminder that ADHD can be misdiagnosed, the author fundamentally fails to provide evidence to support the titular claim. In fact, he identifies a purely neural condition (that he claims is unsupported by wider research, but that he "noticed" in his files): low blood serotonin or high blood norepinephrine, according to Saul, are the biological causes of ADHD symptoms. (But it is not proof of ADHD's existence, he insists, because ADHD is defined by DSM-V purely as a set of symptoms!) I don't even want to get into the problems with this statement, but it illustrates well the kind of logical leaps you'll have to put up with.
There is an inferential gap at the root of the book; bridging it will take much more than a clinician armed with a confirmation bias and a truckload of case studies.
September 3, 2015
I love the title and the concept of this book. Because it seemed to promise so much might account for the low rating, because it did not deliver. This author disagrees with ADHD as a diagnosis separate from any other issues. I agree with this premise, but halfway through the book I began to wonder whether the author was just renaming the same "syndrome" with a catchier phrase.
I have a personal stake in this issue. My son "tested" into a coveted gifted program in Chicago Public Schools; but it's not actually a gifted program. It's the same mainstream curriculum and methodology, just more and faster. By mid-second grade it became clear that the administration had a very specific goal: for us to obtain a diagnosis of some syndrome or deficiency -- they were definitely going for ADHD -- that would allow them, legally, to read the test to our child, or to disaggregate his test scores from mainstream scores. Many parents are just as enthusiastic about such a move, so that later their child will be granted accommodations like extended time on SATs. This diagnosis is rampant throughout the public school system.
What I wish this author had explored -- and I'm sure there is fodder for other aspiring writers to do so -- is the relationship between the increasing class sizes, testing demands, and other totally counterproductive educational decisions, such as eliminating art, on the number of ADHD diagnoses across public school systems.
I firmly believe that any ADHD "diagnosis" is at best a copout for school systems who don't have the resources -- financial or intellectual -- for smaller class sizes and a more engaging, authentic curriculum. At worst, it is part of the sinister underpinnings of the pharmaceutical-industrial complex, especially since the most recent version of the DSM-V has arbitrarily lowered its criteria for diagnosing a child with such an "illness." I picked up this book because I believe that ADHD does not exist, but ultimately I don't think that's what Saul's argument is. It's more about redefining the same exact "syndrome" with new words.
I have a personal stake in this issue. My son "tested" into a coveted gifted program in Chicago Public Schools; but it's not actually a gifted program. It's the same mainstream curriculum and methodology, just more and faster. By mid-second grade it became clear that the administration had a very specific goal: for us to obtain a diagnosis of some syndrome or deficiency -- they were definitely going for ADHD -- that would allow them, legally, to read the test to our child, or to disaggregate his test scores from mainstream scores. Many parents are just as enthusiastic about such a move, so that later their child will be granted accommodations like extended time on SATs. This diagnosis is rampant throughout the public school system.
What I wish this author had explored -- and I'm sure there is fodder for other aspiring writers to do so -- is the relationship between the increasing class sizes, testing demands, and other totally counterproductive educational decisions, such as eliminating art, on the number of ADHD diagnoses across public school systems.
I firmly believe that any ADHD "diagnosis" is at best a copout for school systems who don't have the resources -- financial or intellectual -- for smaller class sizes and a more engaging, authentic curriculum. At worst, it is part of the sinister underpinnings of the pharmaceutical-industrial complex, especially since the most recent version of the DSM-V has arbitrarily lowered its criteria for diagnosing a child with such an "illness." I picked up this book because I believe that ADHD does not exist, but ultimately I don't think that's what Saul's argument is. It's more about redefining the same exact "syndrome" with new words.
September 13, 2021
"ADHD isn't real. It must always be something else. Except sometimes it isn't something else: It's ADHD, but I don't like to call it that, so I made up an entirely new term that means the same thing. Also I know Asperger's isn't an accepted diagnosis anymore, but I'm going to keep using it anyway because I like it."
March 6, 2022
Who might find this book helpful?: ADHD-ers that have a phobia of themselves, ADHD-ers that wanna be further gaslit by some guy with an MD who made up his own diagnosis for you, also if you’d like a book about accounting he wrote one of those too.
People who would NOT find this book helpful: parents of recently diagnosed children, anyone questioning their diagnosis, anyone receiving treatment for their ADHD.
I went into this book with curiosity. I was recently diagnosed as an adult and there is no shortage of wacky & out there claims about ADHD, especially when it is diagnosed at an “older” or more like non adolescent stage. Just today I had a man explain to me that because I received my diagnosis later in life, I definitely have borderline personality disorder ???? (This man was a paramedic) Yeah no sir. Try again. Sometimes I think we all wonder whether or not medication is right for us and I suppose that was my main concern going in which I thought this book would address. He went on to say that “because adhd exists we have all these adults abusing stimulant medication so that they can do better in school and work!!” No sir. People need stimulant medication simply so that their brains can function on a level that might resemble your regular function. At least that’s my issue when I forget to take my meds, like today as I write this review 🤦🏻♀️
Anywho. Sir. Please stay in your lane, perhaps you’d do better to write another book about accounting, something that might actually help people.
People who would NOT find this book helpful: parents of recently diagnosed children, anyone questioning their diagnosis, anyone receiving treatment for their ADHD.
I went into this book with curiosity. I was recently diagnosed as an adult and there is no shortage of wacky & out there claims about ADHD, especially when it is diagnosed at an “older” or more like non adolescent stage. Just today I had a man explain to me that because I received my diagnosis later in life, I definitely have borderline personality disorder ???? (This man was a paramedic) Yeah no sir. Try again. Sometimes I think we all wonder whether or not medication is right for us and I suppose that was my main concern going in which I thought this book would address. He went on to say that “because adhd exists we have all these adults abusing stimulant medication so that they can do better in school and work!!” No sir. People need stimulant medication simply so that their brains can function on a level that might resemble your regular function. At least that’s my issue when I forget to take my meds, like today as I write this review 🤦🏻♀️
Anywho. Sir. Please stay in your lane, perhaps you’d do better to write another book about accounting, something that might actually help people.
March 13, 2019
Did not finish so take my review with a grain of salt. Do not hope you will find some truly enlightened reading on the over-diagnosis of mental illnesses and the like. You will find that our doctor has an issue with only one, ADHD, and that many ADHD cases can be explained by other so-called diseases like bipolar disorder, schizophrenia, sensory processing disorder, etc. He will tell you that the DSM is suspect and then use it to support his claims. He will then, according to our reviewers below, invent his OWN diagnosis of ADHD... which then kind of throws his whole thing into the garbage... so there is an ADHD-type disorder, it just has the wrong name? Omg. Anyway, not worth your time, no matter what side of the fence you are on.
March 20, 2017
I like debunking ADHD. The title ADHD Does Not Exist. The Truth About Attention Deficit and Hyperactivity Disorder by Richard Saul, M.D. certainly grabbed my attention. Forget about the bright yellow cover; look at the full stop before the subtitle. That's a way to make your point. And Saul definitely does, better so than another book on the topic, The ADD Myth: How to Cultivate the Unique Gifts of Intense Personalities by Martha Burge which I read four years ago. Saul is a doctor and neurologist who has decades of experience in the field of clinical diagnosis. What he has seen in his practice refutes the bandwagon pop psych misdiagnosis of the nonexistent ADHD:
"Working with referred patients over the next decade confirmed what I'd suspected for years: The symptoms of ADHD are better explained by other conditions. In other words, ADHD, as we currently define it, does not exist. The majority of patients who came to my office with a primary diagnosis of ADHD qualified for other diagnoses that explained their symptoms. Many other patients had no condition at all. For many of those patients who did qualify for other diagnoses, their previous physicians had diagnosed the other conditions as comorbid (occurring simultaneously) with ADHD. Once I treated what I saw as the primary diagnosis (the non-ADHD diagnosis), the attention-deficit and hyperactivity symptoms usually disappeared, leading me to believe that 'ADHD' was a product of other primary conditions, and not a condition on its own."
Saul wrote his book as an analysis of over twenty primary conditions that exhibit attention-deficit/hyperactivity symptoms. By getting to the bottom of a diagnosis, he can target the underlying condition and in so doing, "cure" the ADHD as well. Could one's ADHD be a symptom of poor vision? Or of not getting enough sleep? Obsessive-compulsive disorders, Tourette syndrome, Fetal alcohol syndrome or Asperger syndrome? Substance abuse or hearing problems? Even gifted children exhibit signs of ADHD if they are not stimulated enough in class because they are too advanced for the material. Saul described in detail how all of these primary conditions have attention-deficit/hyperactivity as a confirmed symptom.
When meeting with patients, Saul described how he conducts an examination. Instead of meeting with them for a rushed (yet altogether typical) seven-minute consultation--often with a prescription for Ritalin already pre-written--he does a full check, which may include: vision and hearing tests, blood tests, urinalysis, allergy tests, genetic tests, and even EKG's, EEG's and CT scans. The majority of these tests will not provide their results immediately. So many patients diagnose themselves with ADHD before they even set foot inside a doctor's office that many physicians find it difficult to contradict a patient intent on leaving with a specific prescription. Saul will have none of that. Prescription drugs are not placebos, and a drug prescribed unnecessarily will have deleterious effects:
"Stimulants are a Band-Aid solution to an underlying problem, but they are much worse than a bandage because they have the potential to create new problems for those who use them."
and:
"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. Many of the case examples we will consider in later chapters include children and adults who've lost appetite, sleep, and general well-being to stimulants they didn't need. Practitioners and the general public alike must be much more cautious with stimulants and the potential for addiction when using these drugs, regardless of an ADHD diagnosis."
Saul, like Allen Frances, M.D., ripped into the authors of the latest Diagnostic and Statistical Manual of Mental Disorders V (commonly known as the DSM-V). He pulled no punches among his peers:
"The motivations of the DSM-V authors, like with ADHD, are also questionable. Some have argued that the medical practitioners behind the DSM-IV depression criteria had financial ties to pharmaceutical companies, which motivated them to ensure a high rate of diagnosis for the disorder (ensuring, in turn, a larger number of customers for antidepressants)."
The solution to this epidemic of false ADHD diagnoses, thus, is to spend enough time with patients to provide a thorough and accurate diagnosis. ADHD sweeps all other conditions under the rug, but since an ADHD diagnosis provides a prescription as well, then, bonus, it has to be right. The patient believes that if he leaves with a prescription--particularly one that he in fact asked for--then all his woes will be healed. Far too many doctors fail to get down to the bottom of an accurate diagnosis in their rush to see as many patients as possible:
"As I've mentioned in detail in Part I of this book, there is an epidemic of ADHD misdiagnosis, and that's the result of the motivations and activities of several groups: medical practitioners, pharmaceutical companies, and patients themselves. Ongoing media attention devoted to ADHD has made it easy for people to 'diagnose' themselves with the disorder, and for physicians to diagnose ADHD too easily (as Justin's neighbor did) or prescribe stimulants after asking just a few questions (as Yvette's doctor did)."
Saul also describes in one chapter how often there is no diagnosis at all. "Not every set of symptoms is a diagnosis." and, like Allen Frances, we have to step back and look at what is normal in our lives and stop trying to medicalize what we are struggling with. Often these struggles are temporary. A minor roadblock or bump on the path of life does not need a prescription, just some confidence and perseverance. The hyper-stressed world of being constantly plugged in either on-line or at work is diverting as well as sapping our attention spans. No wonder children can no longer pay attention when they're checking their phones every twenty seconds for messages. This impatience is the new normal.
ADHD Does Not Exist. was a rapid read. Many times I looked down at the page I was on, surprising myself that I had advanced so far in so little time. Since Saul wrote about over twenty different primary conditions, with the intent perhaps that those who were not affected by any of the other conditions wouldn't bother reading any other chapter except the one that affected them, there was a lot of repetition, especially in the concluding remarks. His mantra, always in italics, drove home his point: As with any disorder mistaken for ADHD, treatment delayed is treatment denied. If you believe you or someone you know has ADHD, spend the time and effort to get a thorough diagnosis.
"Working with referred patients over the next decade confirmed what I'd suspected for years: The symptoms of ADHD are better explained by other conditions. In other words, ADHD, as we currently define it, does not exist. The majority of patients who came to my office with a primary diagnosis of ADHD qualified for other diagnoses that explained their symptoms. Many other patients had no condition at all. For many of those patients who did qualify for other diagnoses, their previous physicians had diagnosed the other conditions as comorbid (occurring simultaneously) with ADHD. Once I treated what I saw as the primary diagnosis (the non-ADHD diagnosis), the attention-deficit and hyperactivity symptoms usually disappeared, leading me to believe that 'ADHD' was a product of other primary conditions, and not a condition on its own."
Saul wrote his book as an analysis of over twenty primary conditions that exhibit attention-deficit/hyperactivity symptoms. By getting to the bottom of a diagnosis, he can target the underlying condition and in so doing, "cure" the ADHD as well. Could one's ADHD be a symptom of poor vision? Or of not getting enough sleep? Obsessive-compulsive disorders, Tourette syndrome, Fetal alcohol syndrome or Asperger syndrome? Substance abuse or hearing problems? Even gifted children exhibit signs of ADHD if they are not stimulated enough in class because they are too advanced for the material. Saul described in detail how all of these primary conditions have attention-deficit/hyperactivity as a confirmed symptom.
When meeting with patients, Saul described how he conducts an examination. Instead of meeting with them for a rushed (yet altogether typical) seven-minute consultation--often with a prescription for Ritalin already pre-written--he does a full check, which may include: vision and hearing tests, blood tests, urinalysis, allergy tests, genetic tests, and even EKG's, EEG's and CT scans. The majority of these tests will not provide their results immediately. So many patients diagnose themselves with ADHD before they even set foot inside a doctor's office that many physicians find it difficult to contradict a patient intent on leaving with a specific prescription. Saul will have none of that. Prescription drugs are not placebos, and a drug prescribed unnecessarily will have deleterious effects:
"Stimulants are a Band-Aid solution to an underlying problem, but they are much worse than a bandage because they have the potential to create new problems for those who use them."
and:
"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. Many of the case examples we will consider in later chapters include children and adults who've lost appetite, sleep, and general well-being to stimulants they didn't need. Practitioners and the general public alike must be much more cautious with stimulants and the potential for addiction when using these drugs, regardless of an ADHD diagnosis."
Saul, like Allen Frances, M.D., ripped into the authors of the latest Diagnostic and Statistical Manual of Mental Disorders V (commonly known as the DSM-V). He pulled no punches among his peers:
"The motivations of the DSM-V authors, like with ADHD, are also questionable. Some have argued that the medical practitioners behind the DSM-IV depression criteria had financial ties to pharmaceutical companies, which motivated them to ensure a high rate of diagnosis for the disorder (ensuring, in turn, a larger number of customers for antidepressants)."
The solution to this epidemic of false ADHD diagnoses, thus, is to spend enough time with patients to provide a thorough and accurate diagnosis. ADHD sweeps all other conditions under the rug, but since an ADHD diagnosis provides a prescription as well, then, bonus, it has to be right. The patient believes that if he leaves with a prescription--particularly one that he in fact asked for--then all his woes will be healed. Far too many doctors fail to get down to the bottom of an accurate diagnosis in their rush to see as many patients as possible:
"As I've mentioned in detail in Part I of this book, there is an epidemic of ADHD misdiagnosis, and that's the result of the motivations and activities of several groups: medical practitioners, pharmaceutical companies, and patients themselves. Ongoing media attention devoted to ADHD has made it easy for people to 'diagnose' themselves with the disorder, and for physicians to diagnose ADHD too easily (as Justin's neighbor did) or prescribe stimulants after asking just a few questions (as Yvette's doctor did)."
Saul also describes in one chapter how often there is no diagnosis at all. "Not every set of symptoms is a diagnosis." and, like Allen Frances, we have to step back and look at what is normal in our lives and stop trying to medicalize what we are struggling with. Often these struggles are temporary. A minor roadblock or bump on the path of life does not need a prescription, just some confidence and perseverance. The hyper-stressed world of being constantly plugged in either on-line or at work is diverting as well as sapping our attention spans. No wonder children can no longer pay attention when they're checking their phones every twenty seconds for messages. This impatience is the new normal.
ADHD Does Not Exist. was a rapid read. Many times I looked down at the page I was on, surprising myself that I had advanced so far in so little time. Since Saul wrote about over twenty different primary conditions, with the intent perhaps that those who were not affected by any of the other conditions wouldn't bother reading any other chapter except the one that affected them, there was a lot of repetition, especially in the concluding remarks. His mantra, always in italics, drove home his point: As with any disorder mistaken for ADHD, treatment delayed is treatment denied. If you believe you or someone you know has ADHD, spend the time and effort to get a thorough diagnosis.
September 7, 2018
Honestly, I'm conflicted about this book.
On the one hand, the author does touch on the very real problem of overprescribing stimulants for ADHD without going through adequate testing. It is a very real problem and I thought I could almost be convinced that ADHD is a disorder that manifests due to symptoms of an underlying disorder. However, it raises the question, what makes a disorder? Just because dozens of other disorders share similar symptoms doesn't seem to the negate the existence of ADHD.
Again, I could have been convinced. But right in the middle of the book he proposes this "newly named" disorder called Neurochemical Distractability/Impulsivity (NDI), a disorder in which levels of neurotransmitters in the brain are misbalanced leading to a distractable state which can be treated with SSRIs and stimulant. Does this sound familiar? Sounds a little like ADHD if you ask me.
When I saw the title and synopsis of this book I was interested and excited on a new take on the ADHD epidemic. However, the author has little novel research or facts and largely fills the book of patient anecdotes in which every patient lives happily ever after having been treated by him. The book had a lot of potential but definitely fell flat in the end, ending on a chapter that sounded more like a self-help book than a well-thought out research conclusion.
On the one hand, the author does touch on the very real problem of overprescribing stimulants for ADHD without going through adequate testing. It is a very real problem and I thought I could almost be convinced that ADHD is a disorder that manifests due to symptoms of an underlying disorder. However, it raises the question, what makes a disorder? Just because dozens of other disorders share similar symptoms doesn't seem to the negate the existence of ADHD.
Again, I could have been convinced. But right in the middle of the book he proposes this "newly named" disorder called Neurochemical Distractability/Impulsivity (NDI), a disorder in which levels of neurotransmitters in the brain are misbalanced leading to a distractable state which can be treated with SSRIs and stimulant. Does this sound familiar? Sounds a little like ADHD if you ask me.
When I saw the title and synopsis of this book I was interested and excited on a new take on the ADHD epidemic. However, the author has little novel research or facts and largely fills the book of patient anecdotes in which every patient lives happily ever after having been treated by him. The book had a lot of potential but definitely fell flat in the end, ending on a chapter that sounded more like a self-help book than a well-thought out research conclusion.
March 31, 2020
Most useful for medical students. This book is an extended differential diagnosis of ADHD. That is, Dr. Saul describes a litany of diseases which mimic ADHD and should be ruled out before making that diagnosis.
His approach to ADHD is consistent with what I saw practiced at the ADHD clinic in Seattle Children’s Hospital.
His approach to ADHD is consistent with what I saw practiced at the ADHD clinic in Seattle Children’s Hospital.
December 4, 2024
This book earned only a skim-read from me. I do not appreciate the inflammatory nature of the title, which is intended to be provocative.
I can support the author's proposed paradigm shift to viewing ADHD as a set of symptoms with many possible causes. In fact, I have found this way of thinking about ADHD to be very helpful! But I think there are more honorable ways to make this point.
This book also contains a significant amount of outdated terminology and misunderstandings about dyslexia and autism, etc.
I can support the author's proposed paradigm shift to viewing ADHD as a set of symptoms with many possible causes. In fact, I have found this way of thinking about ADHD to be very helpful! But I think there are more honorable ways to make this point.
This book also contains a significant amount of outdated terminology and misunderstandings about dyslexia and autism, etc.
June 17, 2021
The basic premise is that providers need to be better stewards of differential diagnosis especially as relates to behavioral health diagnosis, namely ADHD. I find that many providers have an air of maintaining the status quo when it comes to any sort of healthcare diagnostics (as someone who works in a non-behavioral setting). I can only imagine the unmitigated ability of behavioral providers to misdiagnose in behavioral settings. In any case, he makes the case that any number of reasons (16 that he dedicates substantial time to) could be what providers formally diagnose and treat as ADHD. I do agree with his basic premise. The reasons he names and expounds on with anecdote feel at times very redundant. I, too, agree with those that believe time should have been dedicated to speak to trauma.
As a Charlotte Mason enthusiast, I was eager to read this book's stance on attention up against the premise of Charlotte Mason that attention is habit that to a large extend can be (and ought to be) trained. I believe that there are many things that enable the habit of attention to be neglected. Medicating a child who is having academic troubles is easier and less time consuming that more holistic alternatives, I get it. In general, when providers thoughtfully consider the holistic and the personalized aspect to medicine, we can ideally move in the direction of medicating people who do not need to be medicated and creating plans based on what is sustainable for the family.
In general, this book in conjunction to what I know about Charlotte Mason leads me to believe that the family unit is powerful and many simple but complex lifestyle components can make for healthy outcomes in children.
As a Charlotte Mason enthusiast, I was eager to read this book's stance on attention up against the premise of Charlotte Mason that attention is habit that to a large extend can be (and ought to be) trained. I believe that there are many things that enable the habit of attention to be neglected. Medicating a child who is having academic troubles is easier and less time consuming that more holistic alternatives, I get it. In general, when providers thoughtfully consider the holistic and the personalized aspect to medicine, we can ideally move in the direction of medicating people who do not need to be medicated and creating plans based on what is sustainable for the family.
In general, this book in conjunction to what I know about Charlotte Mason leads me to believe that the family unit is powerful and many simple but complex lifestyle components can make for healthy outcomes in children.
December 7, 2019
I agree (as a pediatrician), with the author’s basic premise. I do think he is dismissive of true ADHD, and seems to manufacture a new clinical entity (without much to back it up) rather than simply admit it does exist, not just in the levels we’re seeing it diagnosed.
I also found it interesting he did not cover early childhood trauma as a major source of ADHD-like symptoms that are not recognized and addressed appropriately.
I also found it interesting he did not cover early childhood trauma as a major source of ADHD-like symptoms that are not recognized and addressed appropriately.
April 10, 2015
Great read for professionals and non-professionals
I was impressed with the writing style that adhered to the scientific community and general public alike. The anecdotal cases provided a closer look of the individuals dealing with such debilitating issues that also made for great supportive examples.
I was impressed with the writing style that adhered to the scientific community and general public alike. The anecdotal cases provided a closer look of the individuals dealing with such debilitating issues that also made for great supportive examples.
February 22, 2021
I like the idea that ADHD is over diagnosed and that you should rule things like vision and hearing out first. But come on, ADHD does not exist but my made up label does? Also the examples of other disorders were so clichéd that even a lay person would guess what the client "really has". In point of fact many disorders in the DSM are just symptom lists.
September 14, 2023
fascinating to read. a lot of helpful information but definitely not something to read by itself, just take into consideration.
December 8, 2017
I have a lot of thoughts about this book—most of which probably don't make sense. I've never been diagnose with ADHD, nor has anyone in my family, but I picked this up because I was hoping it would be something like Neurotribes (which I'm also currently reading) is turning out to be. Instead, I got this mess.
I feel like this was just one big bragging session so that Saul could be like 'look at me, helping all these patients'. Yes, well done, I'm happy for you. His apparent amazing doctor skills aside, maybe this would have been more persuasive if he wasn't just repeating the same thing over and over again. I swear, if I ever hear the words 'a treatment delayed is a treatment denied' again I might just punch a wall.
Okay, I need to step away from the review box before I get even more frustrated. Just, save yourselves.
I feel like this was just one big bragging session so that Saul could be like 'look at me, helping all these patients'. Yes, well done, I'm happy for you. His apparent amazing doctor skills aside, maybe this would have been more persuasive if he wasn't just repeating the same thing over and over again. I swear, if I ever hear the words 'a treatment delayed is a treatment denied' again I might just punch a wall.
Okay, I need to step away from the review box before I get even more frustrated. Just, save yourselves.
May 20, 2017
In "ADHD Does Not Exist", author Richard Saul examines ADHD from a medical perspective, with decades of experience in the field. Richard explores other medical conditions, and shows the overlaps of symptoms. Some explored conditions were schizophrenia, fetal alcohol syndrome, OCD, and vision or hearing problems. Saul also shows how some of these conditions can be confused into a disorder with, as he sees it, the symptoms hyperactivity and attention-deficit.
The author backs up his claim with professional studies and examples from his own experience. However, the author claims the DSM is an unreliable and outdated work in progress, but later refers to it for diagnosing other symptoms. Mr. Saul also seems arrogant, as he explains how his own disorder, NDI, is real and a cause of ADHD. It seems as if he created his own disorder to work around a possibility or reality of ADHD.
In the end, though the author backs up his claims, the book is boring in some parts, contradicting in others, and makes some outlandish claims. The author is clearly an expert in his field, despite some possible errors in his work. For these reasons, I rated this book as 3/5 stars.
The author backs up his claim with professional studies and examples from his own experience. However, the author claims the DSM is an unreliable and outdated work in progress, but later refers to it for diagnosing other symptoms. Mr. Saul also seems arrogant, as he explains how his own disorder, NDI, is real and a cause of ADHD. It seems as if he created his own disorder to work around a possibility or reality of ADHD.
In the end, though the author backs up his claims, the book is boring in some parts, contradicting in others, and makes some outlandish claims. The author is clearly an expert in his field, despite some possible errors in his work. For these reasons, I rated this book as 3/5 stars.
March 21, 2021
Before reading I'd like to remind you to not judge a book by its cover. This one especially so. It is intended to be provocative and may even turn some readers away with an initial glance. That being said, this book is a well-thought-out and scientifically sound documentation of the overdiagnosis of the disorder we know as ADHD. The Author, Dr. Richard Saul documents the epidemic that is resulting in the prescription of stimulant medication to children and adults who exhibit "ADHD" symptoms. The main problem is that with these symptoms they do fall under the umbrella of symptoms associated with ADHD but this umbrella is far too wide and imprecise. So many other disorders result in "attention and hyperactivity issues" that can be treated in a different way (and far more effectively) than what we call ADHD. A sad side of this misdiagnosis is that the normal ADHD treatment of stimulant education most of the time leads to exasperating the condition caused by the underlying disorder which can lead to permanent effects on the individual.
All in all a fascinating read and a great insight into the commonly misunderstood world of ADHD.
All in all a fascinating read and a great insight into the commonly misunderstood world of ADHD.
October 18, 2015
This book was awesome, interesting and excellent. It is not stating that attention deficit and hyperactivity do not exist; It is saying that they are probably the symptom of a different issue (not ADHD). For example, vision problems can often include the same symptoms that you'd see with ADHD but if you treat ADHD with medication, you will not be taking care of the underlying issue (the vision problem). There are many issues/syndromes that contain attention problems and/or hyperactivity and can mimic ADHD and are often misdiagnosed as ADHD. This book breaks it all down into terms that are easy to understand and includes what to look for as well as how to treat each issue/syndrome. Each chapter includes a story of a real patient. I'd recommend this book to anyone who has been diagnosed with ADHD/ADD or knows someone who has been diagnosed or if you're just interesting in reading about disorders, this book is perfect for you!
July 16, 2017
Read the book. Ignore the title. While I agree with the author's statements regarding the overdiagnosis of ADHD and the disappointingly common approach of the medical community to ignore other issues that can lead to the same set of symptoms, simply stating that ADHD does not exist is overreaching. Still, the author does an admirable job setting out many of the alternative diagnoses that present with the same symptom set and makes the very valid point that carelessness in diagnosis when the preferred form of treatment with medications that have long and short term negative side effects is rampant in our medical and educational systems. I would definitely say this is a book for someone with attentional difficulties to read before accepting an ADHD diagnosis for themselves or their child.
January 5, 2020
It is absolutely important to test for alternative or related causes to any symptoms, but just because a symptom can be caused by an alternate disorder, does not refute the existence of that disorder. And this logical fallacy seems to be the only argument offered in this book.
Also, while the author will cite sources and studies for many facts and figures given, he's more often only supporting his own arguments with anecdotes of this one person he treated this one time. This may aide the reader in understanding the concept, but lacks in scientific rigor. And again, just because it wasn't ADHD that time, does not follow that it can't ever be ADHD. It just highlights the importance of rigor with diagnosis.
Also, while the author will cite sources and studies for many facts and figures given, he's more often only supporting his own arguments with anecdotes of this one person he treated this one time. This may aide the reader in understanding the concept, but lacks in scientific rigor. And again, just because it wasn't ADHD that time, does not follow that it can't ever be ADHD. It just highlights the importance of rigor with diagnosis.
May 21, 2019
Although I am not qualified by any means as to whether ADHD is a condition on its own or is a blanket diagnosis for symptoms that could be caused by something else, I think this book is a good reminder to step back, slow down, and dig a little deeper when it comes to ADHD. We are a people who want and rely on "fast" and "quick" anything, yet sometimes slowing down and taking the time to truly observe, ask questions, and seek multiple (including educated, professional, experiential) opinions on matters such as ADHD would most likely be all-around more beneificial to all involved.
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