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Is ADHD Real?

By Camille Noe Pagán
WebMD Feature

Do you know someone who questions whether ADHD exists? To understand where they’re coming from, it helps to take a step back and look at the big picture.

All the major medical groups -- including the American Academy of Pediatrics, American Medical Association, American Psychiatric Association, and National Institutes of Health -- recognize attention-deficit hyperactivity disorder (ADHD) as a valid condition that should be treated.

But there are some people, and even some doctors and therapists, who disagree. Type “Is ADHD fake?” or “ADHD critics” into a search engine, and you’ll get pages of articles saying it’s a “controversy.” These include books and articles in mainstream media. Some even say the diagnosis should be eliminated.

For example, Richard Saul, MD, who wrote ADHD Does Not Exist, is a member of the American Academy of Pediatrics and the American Academy of Neurology. In the preface to his book, he says he wrote it to be “provocative” because he’s concerned “about the multifaceted problems caused by the misdiagnosis” of ADHD.  

He argues that “not a single individual -– not even the person who finds it close to impossible to pay attention or sit still -- is afflicted by the disorder called ADHD as we call it today.”

It’s not that he disagrees with the symptoms. He writes that “distractibility and impulsivity are all too real.” Instead, he writes that doctors are “using an outdated, invalid definition of ADHD.”  

In another recent book, A Disease of Childhood, author Marilyn Wedge, PhD, writes that “ADHD certainly ‘exists,’ in the sense that many children exhibit behaviors that parents and teachers can see and doctors can measure. But in my view, ADHD is neither an unnatural condition of childhood nor an illness that requires medication.”

The Diagnosis Issue

One possible reason for the different views: “Psychologists and psychiatrists don’t use lab tests to diagnose people with ADHD,” says Imad Alsakaf, MD, an assistant professor of psychiatry at Creighton University in Omaha, NE.

Instead, a doctor or therapist considers your health history, the symptoms you tell him about, the ones he might notice while observing you, and what other people who know you well (usually your family and your child’s school teachers) say. He may use the “Conners’ Teacher Rating Scale” or the “Vanderbilt questionnaire” to rate how often certain behaviors happen and how much of a problem they are, such as:

  • Doesn’t seem to listen when spoken to directly
  • Has trouble organizing tasks and activities
  • Has trouble waiting in line

There are clear standards for what it takes for a doctor to decide someone has ADHD. But because the process isn’t clear cut the way a brain scan or blood test would be, some people doubt the diagnosis, Alsakaf says.

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