Maybe it isn’t ADHD. But it doesn’t have to be a single other thing

This article by Daniela Drake had been widely shared, off the back of the new York Times’ critical coverage of the marketing of ADHD.
Dr Drake’s son was diagnosed with ADHD by an ADHD specialist. She alleges that this was wrong, because the boy actually has auditory processing disorder (APD), a somewhat mysterious condition in which the conversion of sound into units of linguistic meaning is impaired.
She then goes on to say that ADHD has been aggressively marketed (true) and therefore is the first thing on people’s mind when a child is experiencing difficulties in class (that may be true in the US, I don’t know). Other diagnoses are therefore missed. I would add that if you go to an ADHD specialist, who advertises as such, over-diagnosis is always a risk.
So it’s a valuable contribution to the debate.
The problem is that Dr Drake stays within the medical paradigm that a child’s difficulties are due to a single diagnosis. That is, it needs to be something else. The conditions she cites as under-diagnosed, APD, sensory processing disorder, and developmental visual disorder, are all of dubious validity as distinct diagnostic entities. They didn’t even make it into Dsm 5, that well known over-diagnosers charter. These “conditions” probably represent aspects of developmental dysfunction that co exist and interact with other aspects of the child’s strengths and difficulties, but are never the answer.
This matters, because claiming one diagnosis over another sets up an unnecessary confrontation between professionals and families, leads to over-simplification of the child’s difficulties, and encourages families to place their faith exclusively in whichever professional had offered the preferred diagnosis; so a child diagnosed with developmental visual disorder may be managed single handedly by a developmental optometrist. This in turn is a worry, because there is usually a lot of non-eye stuff that needs addressing, and the evidence base underlying developmental optometry is… well, it isn’t good.
So yes, attack ADHD drug peddling, I’ll be right beside you on the barricades (when I’ve finished clinic). But if you replace the clammy hands of big Pharma with the simplistic and unscientific diagnoses of enthusiasts, I’m not sure you’re exactly better off.
I would prefer that we moved away from the idea of finding the diagnostic holy grail, and concentrate on finding out what kids are struggling with, then find ways to help. If a diagnosis is required to access evidence-based intervention, then use it, but not all children need or benefit from one.


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