Richard Saul

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.… (más)

The title is the thing that screamed out at me in this case. Having been diagnosed with ADHD back in 1994 when I was eight years old, I suppose I have a bit of a personal opinion on whether or not ADHD exists. Through what Doctor Saul is saying, I can see that he is frustrated with the medical establishment and our society. Many cases in which someone said that they had ADHD in this book is instead a perfectly reasonable other thing that didn't have anything to do with ADHD. For instance, he had some fellow come in just so he could obtain a prescription for stimulant medication.

Doctor Saul bemoans the sad state of the modern medical practice; many doctors have less time and more patients than ever. So they follow a short checklist and automatically diagnose without being thorough about it. So through personal stories and testimonials, he relates the cases of some people that thought they had ADHD but did not actually have it. What they had were some of the symptoms. So I suppose he got what he wanted then, because this book follows a pretty standard formula. He introduces a new sort of possible explanation, Fetal Alcohol Syndrome say. Doctor Saul then relates some of the problems encountered by the patient and the tests that he ran to find the source of these issues. He talks about the actual thing that they had and then talks about how it can manifest itself as ADHD-like symptoms. Finally, Doctor Saul talks about the follow-up to all of this. How were they doing in the ensuing months and so on.

So this sort of style is pretty interesting, but once you read about the first few cases you start to notice a pattern about it. Case study, diagnosis, what is ___, how ___ is treated, prevalence of ___, follow-up. So once you read about the girl with vision problems you can see what you are in for.… (más)