By Ron Bashian, MD, Guest Contributor
On January 7, my web designer sent me two startling links. The first link was to information about a book titled ADHD Does Not Exist that was about to be published in the US. Its author is a neurologist, Dr. Richard Saul, MD, who is described by his publisher, Harper Collins as having impressive professional credentials. The second link was to a strongly approving essay in Psychology Today. My first reaction was shock and disbelief. My second reaction was outrage and a certainty that, as a pediatrician who serves and is inspired by those affected by ADHD, I could not let either of these stand unchallenged.
I first directed a repudiating reply to Psychology Today (you can read a copy of it here). Second, I reached out to various people whom I thought might help my mount my challenge to Dr. Saul and his book, and to a number of organizations including PEATC, our commonwealth’s federal and state sponsored education resource for parents, CHADD, and my local CHADD chapter. The result was a webinar titled Who Says ADHD Does Not EXIST – controversies and facts, which is now available online.
Before developing the webinar, in which I wanted to directly address the problems with ADHD Does Not Exist, it was obviously important to my own validity as a commentator that I first read Dr. Saul’s book. I wanted to be able to address his arguments factually and competently, so I needed to know what they were. As the book was not yet available (it became generally available on February 18, 2014), I first contacted the office of Dr. Saul. From there I was directed to his publishing agent at Harper Collins, who sent me an evaluation copy, overnight delivery.
In my reading, I confirmed that Dr. Saul is actually claiming that ADHD does not exist. Period. Citing abuses that have been described with some accuracy and much self-righteousness in the media, Dr. Saul came to his own diagnosis: a Neurochemical Distractibility Impulsivity Disorder. Its description sounded curiously similar to ADHD, but its diagnosis was based on unfounded, unpublished, and questionably relevant blood levels of epinephrine and norepinephrine.
Here’s the problem with Dr. Saul’s “new” diagnosis.
Conclusions in science are best derived from a group and not from an isolated observer. For objectivity’s sake, it is preferential that any group or individual should not profit financially from their opinion’s acceptance. A diagnosis (for instance Neurochemical Distractibility/Impulsivity) needs to first be cited in some peer-reviewed literature within PubMed before it can elicit any credibility. Any proponent of such a diagnosis owes the scientific community validating publication of some sort in the peer-reviewed literature. Any conclusion from an author who makes sweeping claims contradicting such literature and has not published in such literature is intrinsically suspect.
Changes in hypotheses and their accompanying proofs occur often – and some are radical. But it is a powerful scientific occurrence when many lines of evidence – from genetics through neurobiology, extending to neuroimaging and EEG, measurable in consistent changes of executive functions in affected individuals, and showing remarkable consistency over years – all point towards a unified coherence, a synergistic and complementary model. This confluence is the more powerfully demonstrated when peer-reviewed literature considers new concepts such as epigenetics, and dopamine transporter levels, and find that those too broaden, deepen, and amplify this same model.
What did I learn as I took up the challenge of toe-to-toe activism?
- When distorted and absolute statements emerge in science, they need to be challenged. Especially if they are radical.
- Regardless of the opinion from any “expert”, that expert’s opinion can be effectively challenged by anyone with a sound command of the pertinent science and relevant peer-reviewed literature. In this particular case, I believe my rebuttal was stronger as I, too, am a physician with comparable credentials.
- The most effective activism derives from a thorough knowledge of the topic, knowing which battles to choose, and how to engage both the opponent and the court of public opinion.
- Arguments are most compelling when stated objectively, with respect, and without rancor.
- There is no substitute for the truth, or any defense more powerful.
- Opinions of a scientific nature are best expressed in peer-reviewed journals. The scientific method is the gold standard for scientific evidence.
Finally, why did I bother?
At the bottom of all of this—foundationally—is the human experience of the many ways in which individuals affected by ADHD can better understand it and live lives of aspiration and dignity. It is about how they may confidently refute misinformation. And, not least, it is about how individuals with ADHD come to truthful validation of who they are in this world. It is about how and why they can reject shame and blame and guilt imposed by those who do not take the time to understand.
Those are the ultimate objectives that animate our work, which provide hope to those with ADHD, and which corroborate the dignity and purpose of all human beings.
Ron Bashian, MD, is both a pediatrician, who has worked for years with young people with ADHD, and an active ADHD coach. He has received 40 hours of specific ADHD training and is in the process of getting his International Coach Federation certification. You can contact him at firstname.lastname@example.org, his mobile phone, 703-403-5134, or his web site www.validationcoaching.com.