Children who have learning difficulties, hearing problems and short-sightedness are all regularly misdiagnosed with attention deficit hyperactivity disorder (ADHD) and prescribed drugs they do not need, according to a new book.
Its author, Chicago-based behavioural neurologist Richard Saul, believes that the diagnosis of ADHD has become a handy catch-all solution for overworked teachers but fails to identify the root cause of children's problems.
"Teachers have 30 students in the class," he told TES. "It's difficult to spend enough time with the outliers. Then these people are often distracted, have a short attention span. `Attention deficit', that's the magic word. Take some medicine.
"The referral to the doctor is from the educational system. I'm not saying every teacher does it, but it's certainly something that does happen."
In his new book, ADHD Does Not Exist, Dr Saul insists that the condition is often nothing but a set of symptoms. By resorting to medication, teachers and doctors risk overlooking the underlying conditions that cause the symptoms, he believes.
ADHD is treated with stimulants, designed to stimulate those parts of the brain believed not to be working properly. In the US, there were 1 million new prescriptions for stimulants last year, Dr Saul said. In the UK, prescriptions for drugs such as Ritalin are increasing each year.
One patient told Dr Saul that her doctor had diagnosed ADHD over the phone and offered to send her some stimulants in the post. "To treat this so-called condition with stimulants is like treating the symptoms of a heart attack - such as severe chest pain - with painkillers, rather than tackling the cause of them by repairing the heart," Dr Saul writes in his book.
Speaking to TES, he pointed out that there could be many reasons for behavioural or impulse-control problems in children. "Depression, anxiety, bipolar disorder," he said. "Are you sleeping enough? Are you having trouble seeing the blackboard? Can you hear clearly? It goes on and on.
"Are you a gifted child who's just not getting enough stimulation and is bored sitting around? If the school doesn't pick that up, you've got a child who's more impulsive and distracted because you're talking about something they already know.
"Ninety per cent of the people I see don't require a stimulant. They have the symptoms, but you have to look for why."
This attitude has angered some of his readers. "People are mailing me these nasty notes saying, `I have ADHD'," he said. "But they also say, `and I have anger and all these other issues'. That's not ADHD the disease, that's ADHD the symptom. When you start adding in all those other symptoms, you have a completely different diagnosis."
Dr Saul, who spent 14 years providing medical evaluations for schoolchildren with learning difficulties, recommends that teachers with distracted, impulsive students first test them for physical problems. "Vision, hearing, all these things, are easily tested in schools," he said. "Some kids have home problems - they're not treated well. Some kids are hungry.
"There are a lot of problems - maybe a third of them - that schools can help with," he added. "They could find that children need glasses, or the wax cleaned out their ears, or something simple that will dramatically help them. It's important to get these things tested before getting a medical referral."
But Fintan O'Regan, a behaviour consultant and former chair of the European ADHD taskforce, said: "[ADHD is] a recognised disability. If this gentleman says it doesn't exist, a lot more people think it does exist. It's a lot like the people who say that depression doesn't exist, because everyone's sad sometimes. All these things are on a spectrum."
Use this mini presentation in staff training or to build awareness of ADHD.
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