Dr. Richard Saul: ADHD Does Not Exist

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Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Raising a generation of children—and now adults—who can't live without stimulants is no solution.

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Today, the fifth edition of the DSM only requires one to fulfill five of eighteen possible symptoms to qualify for an ADHD diagnosis. If you haven’t seen the list yet, look it up. It will probably bother you. How many of us can claim we have difficulty with organization, or a tendency to lose things; that we are frequently forgetful, distracted, or fail to pay close attention to details? Under this subjective criteria, the entire U.S. population could potentially qualify. We’ve all had these moments, and in moderate amounts, it’s a normal part of the human condition.

However, there are some instances in which attention symptoms are severe enough that patients truly need help. Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Among these are sleep disorders, undiagnosed vision and hearing problems, substance abuse (marijuana and alcohol in particular), iron deficiency, allergies (especially airborne and gluten intolerance), bipolar and major depressive disorder, obsessive compulsive disorder, and even learning disabilities like dyslexia, to name a few. Anyone with these issues will fit the ADHD criteria outlined by the DSM, but stimulants are not the way to treat them.

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In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.

For my patients who are the former, I recommend that they eat right, exercise more often, get eight hours of quality sleep a night, minimize caffeine intake in the afternoon, monitor their cellphone use while they’re working, and most importantly, do something they’re passionate about. As with many children who act out because they are not being challenged enough in the classroom, adults who have work or class subjects that are not personally fulfilling, or who don’t engage in a meaningful hobby, will understandably become bored, depressed, and distracted. Similarly, today’s standards are pressuring children and adults to perform better and longer at school and at work. I too often see patients who hope to excel on four hours of sleep a night with help from stimulants, but this is a dangerous, unhealthy and unsustainable way of living long-term.

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