Books and journal articles are key sources for continuing education among professionals. However, not all publications are created equal. While journal articles are reviewed by peers and approved by professionals before publication, books are not. This leads to a vast spectrum in the quality of literature in the field of developmental disabilities. Catchy titles and bold claims can lead people to draw the wrong conclusions, as is the case with the book ADHD Does Not Exist by Richard Saul, M.D.
Dr. Saul’s book is intriguing. Attention Deficit-Hyperactivity Disorder (ADHD) seems to be increasing in prevalence among elementary age children. Many adults blame their lack of focus, ambition, and quality of performance on their ADHD – whether they have the disorder or not. Due to the rise in diagnosis – as well as the public’s view of the symptoms – many individuals criticize the disorder as being invalid, or made up. Dr. Saul seeks to validate this thought by stating that the disorder does not exist – at least, not in the current definition, symptoms and understanding.
The main idea in Dr. Saul’s book is that ADHD is too easily diagnosed, thereby overlooking other disorders that present similar symptoms (e.g. anxiety and hearing disorders). He dismisses the idea of comorbid disorders with ADHD, stating ADHD can not exist alongside another disorder that presents similar symptoms to ADHD. Dr. Saul repeatedly emphasizes that a person needs only five (5) checked symptoms to qualify for an ADHD diagnosis. He spends the rest of the book discussing various disorders that present similar symptoms to ADHD, which could serve as the real disorder a child has instead of ADHD.
Let’s look at the diagnostic criteria for ADHD according to the Diagnostic and Statistical Manuel for Mental Disorders, 5th Edition (DSM-5), which can be found on the Attention Deficit-Hyperactivity Disorder page on this site. You will notice that you need six (6) or more checked symptoms in attention deficit and six (6) or more in hyperactivity and impulsivity. Furthermore, the individual must have those symptoms prior to age 12 and show them in more than one setting. DSM-5 also states that the symptoms cannot occur exclusively along side a psychotic disorder, and if the symptoms are better explained by another disorder (e.g. anxiety or depressive disorder) then ADHD is not considered for diagnosis. However, that does not necessarily mean that ADHD cannot be comorbid with other neurodevelopmental or mental disorders. Even if Dr. Saul was using DSM-IV as his source, the information on diagnostic criterion would be almost the same.
Dr. Saul ignores the full diagnostic criteria for an ADHD diagnosis, and falsely claims you need only five (5) checked boxes total to qualify as having the disorder. He may be right in believing that some doctors rush to give the diagnosis without first ruling out other disorders that may better explain the symptoms. However, he does not supply evidence that the disorder does not exist. For example, Dr. Saul highlights the similar symptoms between ADHD and hearing disorders. However, he does not supply evidence that ADHD can not exist after a hearing disorder has been properly managed. He also states that sleep disorders can be the cause for symptoms instead of ADHD. Yet, he fails to address the subject of how ADHD can at times disrupt the sleep habits of individuals with the disorder.
More research needs to be done on ADHD and dual diagnosis with other disorders. Furthermore, more research should be done in the diagnostic practices of doctors to ensure full compliance with diagnostic criteria. However, the research needs in better understanding ADHD does not prove it is a fictional disorder. Dr. Saul’s book is a good read to understand alternate view points, but it the views expressed are full of holes and not valid. ADHD does exist.