Stop fidgeting while we jump to conclusions about your condition

SOLICITOR Gerald Kean was at some high profile dinner engagement, at a table with several other people, most of them new to him.

He wanted his water glass refilled. Then he needed his water glass refilled. He waved at the nearest busy waiter, who ignored him. Then he muttered to the woman next to him that the service was dire.

“No, it actually isn’t,” she told him. “You’ve gone through that carafe quicker than would be normal. And it’s the second one they’ve brought to this table.”

Kean, flummoxed by this crisp conversational redirection, said nothing, which, had the woman beside him only known it, is a rare happening.

She used the opportunity thus presented to her to tell him he needed to get to his GP and be checked out for type one diabetes. She was a doctor, she added, and his exigent thirst just might be a symptom of the disease. Or it might not be. One way or the other, no harm to check.

In the next few days, he sensibly followed her advice and had his health status checked. In due course, back came the diagnosis of insulin-dependent diabetes, requiring he inject himself every day and embark on a significant change in diet. All of which he did and does, and he remains suitably grateful to his observant fellow guest. Because she was a doctor, she didn’t make a definite diagnosis. Instead, noticing one florid symptom which might indicate a particular disease — but also could be indicative of an endless number of other possibilities — she properly directed him to his family doctor.

The rest of us don’t have to be so boringly rigorous. We can spot a symptom and go straight to diagnosis. The two favourite amateur diagnoses are of Asperger syndrome and ADHD. Strangely, even though Alzheimer’s is arguably more prevalent, with its symptoms manifest to family and friends, we are much less likely to decide someone we know has that form of dementia. Indeed, many of those close to an Alzheimer’s sufferer beat themselves up because of their insistence, sometimes over a period of years, on interpreting the symptoms of the sufferer as merely oddities.

When it comes to Asperger’s, however, particularly in relation to adults, we’re ready, willing and positively eager to diagnose it (never mind that the medical professional doesn’t really favour the diagnosis, preferring to talk of people being “on the Autism spectrum”). Anybody who, met in the course of business, is less than touchy- feely empathetic is likely to be dubbed “a bit Asperger’s” by others. In similar fashion, a colleague who doesn’t listen, who multi- tasks badly and who’s on to the next task before the current task is half-complete, is likely to get the ADHD label from amateur diagnosticians.

“There is something striking about the way we define this ‘illness’ — that is, by its symptoms, rather than its cause,” says Professor Richard Saul. “If we were to define a heart attack by the chest pain one feels while undergoing on, then the appropriate care would be painkillers, rather than ways of actually reviving the heart.”

Similarly, he points out, abdominal pain may be associated with appendicitis, gastroenteritis, cancer and other illnesses, but the stomach pain itself is not a diagnosis.

Dr Saul, who is a member of the American Academy of Pediatrics and the American Academy of Neurology, has just published a book, the title of which is a blunt statement: “ADHD Does Not Exist.”

And no, this is not another slightly alternative view of ADHD which suggests that it is overdiagnosed or that the drug companies producing Ritalin and the products which have succeeded it are pushing their product as a solution to a problem when better parenting, fewer sugary snacks or a commitment to regular exercise would take the restless edge off a child and greatly improve their attention-span.

Those who claim ADHD is diagnosed more frequently than is justified point out — as does Saul — that doctors short of time can, in the US, make the diagnosis inside two minutes. If a child has any five of a list of traits, they belong in the ADHD club, according to this approach.

The traits include fidgeting, blurting out answers in class, having difficulty awaiting their turn, interrupting or running around when sitting down is the preferred option.

Crazy, say the “over-diagnosis” people, who believe the two-minute approach lowers a medical diagnosis on normal children, which in turn leads to stuffing them with stimulants, which certainly have a beneficial effect on many of them, even if the benefit is most felt by their parents or teachers.

“Any one of us at any given time would fit at least a couple of ADHD criteria,” maintains neuroscientist Dr Bruce Perry. “A hundred years ago, someone would come to a doctor with chest pain and they would be sweating. And they would say: ‘Oh, you have a fever.’ They would label it, just like we label ADHD now. It’s a description rather than a real disease.”

That’s where Richard Saul is coming from, too, except that he believes that, even as a description, it’s wrong, and causes doctors, parents and teachers to miss the real diagnosis. He gives an instance of one little girl brought to him with what are regarded as the “classic signs” of ADHD.

This child, who had come from Argentina, was bright as the proverbial button, spoke two languages fluently at seven years of age, but was driving her teachers out of their tree. Not because she was obnoxious, but because she was restive. The child would leave her chair and move up in front of other children. She would not complete tasks set for the class by the teacher.

The paediatrician to whom her parents brought her immediately diagnosed ADHD and prescribed a stimulant. The only problem was that the stimulant drove her out of her tree, removing her appetite and her capacity to sleep. So they brought her to Saul, presumably having heard that he has reservations about the very existence of the condition, despite its phenomenal growth in children and adults, not to mention teenage students sold on the notion that the prescription stimulants sharpen their focus and help deliver stellar examination results.

SAUL started with the simplest possibility, testing the child’s hearing and eyesight.

“The vision test was positive for significant myopia (nearsightedness), which was likely the best explanation for her distractible and impulsive behaviour in school — the result of being unable to see the board, rendering her unable to do the in-class work required.”

Prescription? Spectacles. Outcome? Happiness all around. That’s Saul’s thesis: That at least 16 underlying conditions, ranging from hearing or sight problems to lack of sleep or Fragile X Syndrome, cause the symptoms so readily interpreted as signifying that the patient has ADHD or ADD (if they’re grown up). These underlying conditions, he believes, go undiagnosed, hidden under the easier but wrong diagnosis and the medication employed as a result.

Will Saul change the pattern of easy and often amateur diagnosis of ADHD? Not a chance.

* ADHD Does Not Exist by Richard Saul, MD is published by Harper Wave.