A lawsuit filed last month in Maui Second Circuit Court links the suicide of a 13-year-old boy to an attention-deficit hyperactivity disorder misdiagnosis.

The suit by Gaylene Louise Barron, the deceased boy’s mother, alleges a series of egregious errors that it says led to the boy’s death, including his doctor’s knowing use of an outdated diagnostic tool and failure to explain the risks of taking an ADHD stimulant drug.

It names Dr. Gabrielle Galler-Rimm, a board-certified pediatrician on Maui, and alleges medical battery, medical negligence and violation of the informed consent doctrine.

Kelvin Kaneshiro, Galler-Rimm’s attorney, said the accusations against her are “completely baseless and false.”

While Kaneshiro said the boy’s death is devastating, he emphasized Galler-Rimm’s expertise, compassion and good reputation garnered during almost three decades of practice.

The suit taps into a national debate over the jump in ADHD diagnoses in America. Does ADHD’s soaring prevalence reflect a growing awareness of the condition — or are we overmedicating our kids? 

With features that include lack of focus, severe restlessness and impulsive behavior, ADHD affects 5 percent of children, according to the American Psychiatric Association. But studies show more than twice that many school-age children receive the diagnosis.

There is no definitive test to prove whether a fidgety boy or an inattentive girl has ADHD. Muddying the line between a child with ADHD and one who chronically misbehaves or has some other syndrome is the fact that the diagnosis is inherently subjective.

When a child who does not have ADHD is prescribed a stimulant to treat the disorder as the result of a misdiagnosis, the drug (often Adderall, Ritalin, Concerta or Focalin) can be ineffective or even inflict harm. In rare cases, it can trigger dangerous side-effects, such as suicidal thoughts or psychosis.

Several lawsuits that pin violent or suicidal behavior on ADHD drugs have been filed nationwide.

A 2014 study found that two children diagnosed with ADHD developed suicidal ideation that abated after discontinuing the drug prescribed for treatment.

Troubling Behavior

In the Maui case, the suit contends that the patient developed hallucinations and a desire to hurt small animals over the course of his ADHD treatment.

It also alleges that the family discovered during the course of the boy’s treatment that he had been sexually abused four years prior to his ADHD diagnosis.

When Barron informed Galler-Rimm about the sexual abuse and told her that her son never hallucinated or exhibited a desire to harm animals until he started taking the ADHD stimulant Focalin, the doctor did not recommend stopping the boy’s treatment or reducing his dosage of the drug, according to the lawsuit.

At no point did Galler-Rimm advise Barron that the drug Focalin carries the risk of suicide, the lawsuit states. 

Barron found her son dead on Sept. 3, 2015 — almost two years after Galler-Rimm began treating him.

The boy is commonly identified in the suit by his initials.

MauiMedicalMalpractice (Text)

Barron, through her lawyer, declined to be interviewed for this story. She is seeking restitution for her and her son’s medical and psychological treatment, loss of income and general damages for pain and suffering.

“(The) mother is devastated, and this lawsuit is quite traumatic,” said Jason McFarlin, Barron’s attorney.

Out-Of-Date Assessment Tool?

The tool Galler-Rimm used to determine the ADHD diagnosis is the first edition of the Conners Comprehensive Behavior Rating Scales, a scoring card designed to assess a child’s emotional, behavioral or academic disorders, the suit states. The tool has been “out-of-date for approximately 30 years and (was) replaced because of multiple diagnostic problems,” according to the lawsuit.

The revised, third-edition Conners rating tool should have been used instead, the lawsuit contends.

The problem with using an outdated Conners tool, according to Hawaii ADHD expert Karen Tyson, is that it no longer reflects advances in treatment and research.

“It’s antiquated,” said Tyson, a clinical psychologist at LD-ADHD Center of Hawaii. “It no longer lines up with the gold standard.”

Max Wiznitzer, a Cleveland-based pediatric neurologist and the co-chair of the professional advisory board for the advocacy group Children and Adults with Attention-Deficit/Hyperactivity Disorder, said there are several mainstream assessment tools — Conners, Vanderbilt, SWAN — to help doctors make an ADHD diagnosis.

These tools require a doctor to gather a multiple-sourced history of the patient’s symptoms, which might range from bouncing off the walls to difficulty completing a task, from sources including school report cards and interviews with the patient, parent or teacher.

Some doctors rely wholly or heavily on the multiple-sourced history, which may reflect the bias of the reporter. Other doctors will also perform their own psychological evaluations of the patient.

“ADHD is a real diagnosis,” Wiznitzer said. “But it’s not black and white. You need some expertise in order to diagnose it.”

He added, “If you have an underlying anxiety disorder or a mood disorder, and not ADHD, but I put you on an ADHD stimulant medication, it might aggravate the anxiety or mood disorder and cause startling symptoms.”

The boy in the Maui case had previously been tested for ADHD at ages 9 and 11 by two different school psychologists using the third-edition Conners tool, according to McFarlin. He was not diagnosed with ADHD on either occasion, McFarlin said.

Even if Galler-Rimm had given the boy a correct ADHD diagnosis, she should have taken him off the stimulant Focalin when he began to display serious side-effects, according to Santo Triolo, a Maui-based clinical psychologist who is an expert witness in this case.

“On this medication, the child for the first time began to have hallucinations,” Triolo said. “So even if the diagnosis was correct, even if the treatment was appropriate, if someone presents with hallucinations you stop the medication.”

He described Galler-Rimm’s handling of her patient as cavalier and negligent.

“In this particular case there are a lot of problems,” Triolo said. “There was depression, there was apparent sexual abuse — all kinds of things. And all of these things can present themselves as being symptoms of ADHD, but they are not necessarily so.”

When Barron requested her son’s medical records, Galler-Rimm presented a partial record that excluded documents pertaining to the outdated testing tool she used to make the ADHD diagnosis, according to the lawsuit.

“As it turns out,” McFarlin said in an email, “if after treatment started, Galler-Rimm would have listened to Mom’s feedback and paid attention to the bad side effects of the ADHD drug, the drug simply could have been discontinued and the bad side effects would have went away.”

“In other words,” McFarlin added, “this situation was so tragic because it was avoidable.”

Expert: Moms Should Trust Their Gut

A $2 million lawsuit against a former Virginia Beach psychiatrist blamed the 2011 suicide of 24-year-old Richard Fee on the escalating doses of Adderall he had been prescribed to treat ADHD.

Fee’s parents said their son didn’t show any signs of ADHD as a child, and they questioned the diagnosis and the drugs he was prescribed, according to news reports in The Virginian Pilot.

The suit was settled out of court in 2015.

While scores of suits filed in recent decades name school districts and physicians, some accuse drug manufacturers with promoting the ADHD diagnosis.

A widely accepted contributor to the syndrome’s rising prevalence is the mass commercialization of ADHD, and its pill-form treatments, by pharmaceutical companies with big advertising budgets.

This marketing success has encouraged the misuse of ADHD drugs among high school and college students seeking a study aid to boost their alertness or maintain focus. One in six college students use ADHD stimulant drugs for non-medical purposes, according to a 2015 study.

Among male teens, suicides linked to misdiagnosis are not uncommon, said Tyson, the Hawaii-based clinical psychologist.

“You tend to hear a lot about suicides with kids who are diagnosed with ADHD or depression and they are actually on the autism spectrum,” Tyson said. “They feel left out and different than other kids and they feel very helpless. On the Conners III, there are questions that ask about helplessness. This is important because when kids feel overwhelmed and helpless and they don’t have any outlet, the risk of suicide goes up.”

Particularly dangerous is a misdiagnosis that results in a child with depression being treated with ADHD medication, Tyson said.

“A depressed person on medication is actually more dangerous than a non-depressed person,” Tyson said. “If you’re depressed and you’re put on ADHD medication, the ADHD medication acts like a stimulant. You can then increase the likelihood that a person will actually be more motivated to follow through with a suicide attempt because now they have more energy to do it.”

Whenever there is doubt about the veracity of a diagnosis, the best thing a parent can do is listen to their child and seek out a second or third opinion from a medical professional, Tyson said.

“I really believe in moms’ guts,” Tyson said. “I know when you go to your MD, you think, ‘This person has a whole lot more experience and expertise than I do.’ But if you are suspicious that your child may have any type of problem where there is a social issue or learning challenges, and there could have been a misdiagnosis, keep looking. Trust your gut.”

Thoughts on this or any other story? Write a Letter to the Editor. Send to news@civilbeat.org and put Letter in the subject line. 200 words max. You need to use your name and city and include a contact phone for verification purposes. And you can still comment on stories on our Facebook page.