As an assistant psychologist in the UK working within a specialist service to assess, diagnose and treat Autism and ADHD, I find Dr Berezin’s comments regarding ADHD to be wholly offensive to both myself as a clinician and the client groups I help. I have helped to assess enough adhd clients to know that there is a common thread amongst all of their difficulties – Poor short term memory, poor planning and organisation, difficulties sustaining attention and concentration and impulsivity. ALL of the clients we assess have the difficulties listed above to a degree that has seriously impacted upon their ability to hold employment, sustain and maintain relationships etc – I am forgetful and get bored sometimes yes, but not to the detriment of losing my marriage/relationship or being fired frequently because I cannot sustain my attention long enough to complete tasks or frequently forget to pick up my children from school! I help to facilitate psycho-educational (CBT based, as this is where the evidence lies currently e.g. see Dr Ramsey/Dr Susan Young) courses for newly diagnosed adults with ADHD to help with symptom management and guess what, IT WORKS MORE RELIABLY than medication as it helps clients make a permanent change in the way they lead their lives which in turn reduces the overall impact of their adhd symptoms. We follow clients up months after a course to see how they are progressing using clinical interviews and measures such as WSAS to get a ‘snap shot’ of life after the course. If there was not some kind of difference in the neuro-development of these adults from childhood why would specific strategies based on the work of Ned Hallowell, Mary Solanto, Stephanie Sarkis and Russell Barkley all help to improve the lives of the clients I see? Surely I am wasting my time if Dr Berezin’s opinion is to be believed! It is precisely views like this that make a lot of our client group reject any support as they end up believing ‘it’s all in my head’ – how invalidating do you want to be towards another persons experience!? Dr Berezin states somewhere in his article that he has come to believe in the diagnosis of autism… why? It is just as fraught with diagnostic inconsistencies and can look a lot like personality disorders such as schizoid/schizotypal or psychosis. As an aside, as a service we are increasingly seeing more adults who would have been traditionally labelled as schizoid or schizotypal for autism assessments due to their lack of interest in others and as sensory differences in autism are so poorly recognised and understood by other professionals that this often gets labelled as ‘psychosis’. The way we describe these conditions to clients who come to our service is under the ‘umbrella’ term of neuro-developmental conditions – differences in wiring in which there have been numerous studies to illustrate – I would invite you to look at Dr Russell Barkley’s work on neurological differences in adhd to balance some of your skepticism.