Driven to Distraction (Revised) Page 3

  And this is the case with so many people who have ADD. They are very likable, although they get into the most difficult of patches. They can be exasperating in the extreme—one mother called me about her son, who had ADD and had just inadvertently almost set fire to his school, and asked me if she could run over him in her truck—but they can also be unusually empathic, intuitive, and compassionate, as if in that tangled brain circuitry there is a special capacity to see into people and situations.

  Jim’s story took us through many twists and turns. There was the time he had a job as a bus driver: one dreamy afternoon doing his regular run he made what he thought was his last stop and headed home for the bus yard only to pull into the lot with a bus half-full of confused and angry customers. He had forgotten to make the actual final stop on the line. “Where are we?” the passengers demanded. “Where have you taken us?” It was Jim’s last ride for that bus company. Or there was the time in conversation with a female colleague when he referred to his boss as a “pinhead,” only to realize almost as he was saying it that the female colleague was his boss’s wife. “I don’t do it on purpose,” he said. “I just put my foot in my mouth. I don’t think about who I’m talking to or where I am. Is it my unconscious wish to fail?”

  “It could be,” I said. “That sort of thing has been known to happen. On the other hand, it could be something completely different.” I began to tell Jim about ADD. “You see, it might be that you’re not a screw-up or a loser at all, and that you do not have an unconscious wish to sabotage yourself. It might be, and it is beginning to sound to me as if this is very much the case, that you have a neurological condition called attention deficit disorder. It’s no more a thing to be ashamed of than being nearsighted is. In fact, it’s sort of like being nearsighted. You don’t focus very well. You have to strain to see clearly. People with ADD have trouble attending to one task at a time. You’ve probably heard of hyperactive children, and that was how this syndrome was originally described—hyperactivity in kids. We now know that the symptoms include more than just hyperactivity and that it affects adults as well as children. The hallmark symptoms of ADD are easy distractibility, impulsivity, and sometimes, but not always, hyperactivity or excess energy. These people are on the go. Type A personalities. Thrill seekers. High-energy–, action-oriented–, bottom-line–, gotta-run–type people. They have lots of projects going simultaneously. They’re always scrambling. They procrastinate a lot and they have trouble finishing things. Their moods can be quite unstable, going from high to low in the bat of an eye for no apparent reason. They can be irritable, even rageful, especially when interrupted or when making transitions. Their memories are porous. They daydream a lot. They love high-stimulus situations. They love action and novelty. Just as this kind of problem can get in the way at work, it can also interfere with close relationships. Your girlfriend can get the wrong impression if you’re constantly tuning out or going for fast action.”

  As I explained to Jim what attention deficit disorder was, I watched him. He leaned forward in his chair and looked right at me. He began to nod his head at the mention of each new symptom. An excited look came over the face that had been so harried when we first met. “When I was a kid,” he broke in, “it was always ‘Earth to Jim!’ or ‘Where’s Jim?’ or ‘Jim, why don’t you just shape up?’ My parents and my teachers just thought I was lazy. So I would get punished or yelled at. For a while I yelled back, but then I just sort of began to agree with them. I mean, what can you do? My dad had a way of smacking me across the side of my head if I talked back. It was kind of brutal, come to think of it. So I don’t think of it much. I have to wonder, though, what kept me going. I mean, I never lost my spunk. I remember a teacher in the sixth grade making me copy pages out of a geography textbook because I had lost my homework. She said if I would admit I just hadn’t done the homework instead of lying and saying I’d lost it, she wouldn’t make me copy the pages. Well, I had done the damn homework, so I was not about to say I hadn’t. Well, she got ticked off and really lost it. She got into this thing where she kept upping the ante, assuming I would back down. She kept adding on pages for me to copy. When she reached a hundred pages, she stopped. I stayed up all night copying those pages, and I would have reached the hundred pages if my mother hadn’t found me in the middle of the night. She made me stop. Plus she went into school the next day and raised a big stink. Old Miss Willmott had to apologize to me. To me! It was the most satisfying moment of my entire educational career, bar none, and I’ll always love my mother for it.”

  “But I wish they had known then what you are telling me now,” Jim went on. “There were so many stories. My whole ninth-grade year was like one long war with my parents. They got into the same thing Miss Willmott did, always upping the ante. Their basic idea was that I wasn’t trying hard enough, so they kept coming up with more and more punishments, none of which worked. It makes me kind of sick to think back on it. It wasn’t my parents’ fault. They didn’t know what was going on. Why didn’t anybody tell me about this before?” Jim finally asked me in exasperation.

  “People haven’t really known about it very much until fairly recently,” I answered.

  It can’t be said when ADD came into existence. The fidgety, overactive child has been around, one may presume, for as long as children have been around. And they have not been treated well.

  The treatment of children has been terrible throughout history, one of the consistent but little-mentioned black marks in almost every epoch of human civilization; people have seldom differentiated much when it comes to children who behaved “badly.” Too often, it was simply recommended that these children be beaten, or in some cases, killed. There is something in the most inhumane part of human nature that enjoys hurting smaller and weaker beings, particularly if they annoy us or make demands on us. It is beyond the scope of this book to document the abuse of children that mars human history; I bring it up in connection with ADD because it has often been the overactive children, the ADD kids, who have been subjected to the worst abuse. It is only recently that we have conferred upon children rights beyond those of animals and decided to look upon their “misbehavior” as possibly signifying something other than satanic possession or a moral infirmity deserving punishment.

  So it is not surprising that although the syndrome we now call ADD has been around for centuries, it was simply lumped together with all other “bad behaviors.” It was not until this century that it began to be recognized as a medical condition. Although it is hard to say who first defined the syndrome, credit usually goes to British pediatrician George Frederic Still, who, in a series of lectures to the Royal College of Physicians in 1902, described some children in his medical practice who were difficult to control, showing signs of “lawlessness,” lacking “inhibitory volition,” and in general being obstreperous, dishonest, and willful. He hypothesized that the condition was not the result of bad parenting or moral turpitude, but rather was biologically inherited or due to injury at birth.

  The theme of injury at birth and brain damage continued in the thirties and forties in the idea of the “brain-injured child.” Even when no actual evidence of neurological impairment could be found, “brain damage” was invoked to explain uncontrollable behavior. It was during these decades that stimulant medication (amphetamine) was first tried, successfully, to help contain the behavior of some of these children.

  Other terms began to appear, some quite descriptive, such as “organic drivenness,” others rather amorphous and bleak, like “minimal brain dysfunction.” One had to wonder whether the brain itself was minimal or the dysfunction was minimal or perhaps whether the understanding of what was happening in the first place was minimal.

  Separating the symptom of hyperactivity from any notion of brain damage, Stella Chess in 1960 and others around the same time began to write about the “hyperactive child syndrome.” Chess saw the symptoms as part of a “physiologic hyperactivity,” whose causes were rooted in biology rat
her than the environment.

  By the 1970s many major researchers were investigating the syndrome of hyperactivity. Virginia Douglas, in Canada, began to look broadly at the symptoms associated with hyperactivity and found four major traits to account for the clinical picture: (1) deficits in attention and effort, (2) impulsivity, (3) problems in regulating one’s level of arousal, and (4) the need for immediate reinforcement. In large part due to her work, in 1980 the syndrome was renamed attention deficit disorder.

  In the decades since that time, research has ballooned. Probably the most up-to-date and definitive account of the history and current state of the field is to be found in a book written by one of the great researchers in the area, Russell Barkley; currently in its third edition, his book is entitled, simply, Attention Deficit Hyperactivity Disorder.

  “So what does it mean, exactly?” Jim asked me. “Does it mean I’m stupid?”

  “Not at all. But don’t let me tell you. You tell me. Are you stupid?” I asked.

  “No, I’m not. I know I’m not,” he said emphatically. “I’ve just had this trouble all my life of getting out what’s inside.”

  “Exactly,” I said. “That can be due to a lot of different things in different people, but in your case I think it’s due to ADD.”

  “Is it common?” he asked.

  “Probably fifteen million people in this country have it, both children and adults. It affects males more than females, probably in a ratio of about three to one. We don’t know what causes it exactly, but the best evidence is genetic. Other factors may contribute, like problems at birth, but genetics is the main cause. Environmental factors can make it a lot worse, but they don’t cause it.”

  “You mean my mother didn’t screw me up?” he asked ironically.

  “Not in this case. Maybe in other ways, who knows. Do you want to blame her?”

  “No, no. But I want to blame someone. Not blame someone, I just want to get mad. It really pisses me off that no one told me about this before. If this is just the way I’m wired—”

  “Then,” I interrupted, “you don’t have to blame yourself.”

  “Who is, of course, the person I’ve been blaming all along. But it is my fault, isn’t it? I mean it doesn’t matter whether I’ve got ADD or XYZ—if I’ve messed up, I’ve messed up and at my age there’s no one but me to take the heat. Right?”

  “In a way, I guess,” I said, rubbing my shoulder as if his words had activated an old ache. “But what’s to gain in all the blame? I want to give you a framework to understand yourself in such a way you can forgive yourself and move on.”

  “OK,” Jim said, “I get what you’re saying. What’s the bottom line, though? Is there anything you can do for this?”

  “ADD people love bottom lines,” I answered, laughing. “It’s always, ‘Get to the point’; ‘What’s the next show?’; ‘Where’s the beef?’ ”

  “Yeah, you’re right,” he said. “I’m not big on scenery. I want to get there. Is that bad?”

  “I didn’t mean to put you on the defensive. I have ADD myself. I know how it feels.”

  “You have ADD?” Jim asked, apparently taken aback. “You seem so calm.”

  “Practice,” I said, smiling. “Actually, I’m sure for you there are times when you can be quite focused and relaxed. For me, doing this kind of work is one of those times. But the practice part is true also, and we’ll get into that.”

  From this point Jim’s treatment began. Actually, it had begun already. Just finding out about the syndrome, finding at last that there is a name for it, constitutes a large part of the treatment for most people.

  “What is it with me?” he asked in one session. “I don’t mean to be rude. But this guy calls me up and he starts to tell me the materials I sent him were the wrong ones, when I knew perfectly well they were the right ones, he just didn’t know why they were the right ones, and so he thought they were the wrong ones, and so immediately that started to annoy me, but it wasn’t even that that got to me, it was his tone of voice. Can you believe it? I knew from the first second he started on the phone that I wanted to hang up on him or punch him.”

  “You had like a rage reaction,” I offered.

  “Damn straight. And when I think about it now, I get mad all over again. So I tried to do what you said. Pause. Think of the consequences. This was a good customer. I didn’t want to lose him and I didn’t want him bad-mouthing me to his friends. So I paused. But the more I paused, the more he talked on, in this really slow, dumb voice, on and on, and I wanted to scream at him, ‘Get to the point!’ So instead, I just cleared my throat. But then he said to me, ‘Don’t interrupt me, I’m not finished.’ Well, I lost it. I told him I thought we could be on the phone until next Christmas and he still wouldn’t be finished and I had better things to do and I hung up. Can you believe that?”

  I laughed. “I think you did very well. At least up until you lost it. The guy was pushing your buttons. And let’s face it, there are going to be times where you’re going to get annoyed and you’re going to lose it. Treatment for ADD won’t take that away completely, and you wouldn’t want it to, would you?”

  “I guess not. But is this part of ADD, this rage reaction, as you call it?”

  “Yes,” I said. “It’s part of the impulsivity. If you think of ADD as a basic problem with inhibition, it helps explain how ADD people get angry quicker. They don’t inhibit their impulses as well as other people. They lack the little pause between impulse and action that allows most people to be able to stop and think. Treatment helps with that but it doesn’t cure it completely.”

  “You know what the funny thing was?” he asked. “The guy called me back the next day and said he was sorry we had developed a communication problem between us the day before and maybe we could start over. A communication problem, can you believe that? I said sure, only let me start this time. I explained to him in ten seconds why what I had sent him was what he needed, he said he understood and said thank you, I said, ‘No, it is me who should thank you, I’m sorry for our communication problem yesterday,’ and we said goodbye, best of friends.” Jim slapped his knee.

  “How do you like that?” I said. “Your guardian angel must have been on duty.”

  “But where does it come from, this anger?”

  “Can you tell me?” I asked.

  “I think it’s built up over the years. When I was a little kid, I was all over the place, but I wasn’t angry. I think it built up, in school. All the failures. All the frustration.” Jim clenched his fists without knowing it as he talked about his feelings. “It got so I knew before I started something it wasn’t going to work out. So all I had left was tenacity. I wouldn’t give up. But, damn, why didn’t I, with all the screw-ups I had to show for my efforts?”

  Jim was beginning to get into what is a large and very important part of ADD, although, strictly speaking, it is not part of the neurological syndrome itself. He was starting to talk about the secondary psychological problems that typically develop in the wake of the primary neurological problem of ADD.

  Due to repeated failures, misunderstandings, mislabelings, and all manner of other emotional mishaps, children with ADD usually develop problems with their self-image and self-esteem. Throughout childhood, at home and at school they are told they are defective. They are called dumb, stupid, lazy, stubborn, willful, or obnoxious. They hear terms like “spaceshot” or “daydreamer” or “out in left field” all the time. They are blamed for the chaos of family mealtimes or the disaster of family vacations. They are reprimanded for classroom disturbances of all sorts and they are easily scapegoated at school. They are the subject of numerous parent-teacher conferences. Time and again, an exasperated teacher meets a frustrated parent in a meeting that later explodes all over the child who isn’t there. He feels the shock waves afterward. “Do you know what your teacher said? Do you know how embarrassed your mother and I were?” Or, from the teacher, “I understand you have no greater control of yours
elf at home than you do in school. We must work on this, mustn’t we?”

  Month after month, year after year, the tapes of negativity play over and over again until they become the voice the child knows best. “You’re bad,” they say in many different ways. “You’re dumb. You just don’t get it. You’re so out of it. You really are pathetic.” This voice pulls the child’s self-esteem down and down, out of the reach of the helping hands that might be extended, into the private world of adolescent self-reproach. Liking yourself in adolescence is hard enough work for any child. But for the child with ADD it is especially difficult.

  “You kept up your efforts, but it must have been tough,” I said to Jim.

  “It sure was,” he responded with a kind of ruefulness in his voice that said to me, You don’t know the half of it.”

  “Tell me about it,” I said.

  “It’s just that I wouldn’t know where to begin. By high school they almost had me convinced I was just plain stupid. I mean, I couldn’t figure it out. I could understand the stuff in class. I could follow what was said. I could even jump ahead in my mind. But when it came to writing the papers or getting the assignments organized or taking tests, everything just went out the window. I would try. Believe me, I would try. I got lectures all the time on how I didn’t try, but I did try. It’s just that the bigger sledgehammer didn’t work. I’d lock myself in my room and before you knew it I was gone. Doing something else. Reading. Listening to music. Then I’d catch myself and try and get to studying again, but goddamn it, it just didn’t work.” Jim’s voice got harsh and his face turned red.

  “It all comes back, huh,” I said.