Driven to Distraction (Revised) Page 7

  Where does the “more so” leave off and the neurological syndrome of ADD begin? How can we tell a spoiled child from an ADD child? How can we tell a child with emotional problems from a child with ADD? One must look carefully at the child’s individual history. The diagnosis rests primarily upon the history.

  There are also psychological tests that can provide additional evidence in making a diagnosis. Certain subtests of the WISC (Wechsler Intelligence Scale for Children)—a standard test for children—may suggest ADD. Typically, the subscores for digit span, arithmetic, and coding are low in ADD. Additionally, there is often a wide split between what is called the verbal subscore and what is called the performance subscore. There are other tests that attempt to assess attention and impulsivity, but it should be stressed there is no one definitive “test” for ADD. The most reliable diagnostic tool is the individual’s history as elicited from the child, from parents, and, very importantly, from teacher reports.

  There is no clear line of demarcation between ADD and normal behavior. Rather, one must make a judgment based on a comparison of the individual child to his or her peer group. If he or she stands out as markedly more distractible, impulsive, and restless, and if there is no other apparent cause for this behavior, such as a disruption of the family or substance abuse or depression or other medical condition, then the diagnosis of ADD can be entertained. However, only a professional who has experience in working with ADD should make the diagnosis.

  The two most common errors in the diagnostic process are missing the diagnosis or making the diagnosis too often.

  The most common reason for missing the diagnosis is not knowing about ADD in the first place. Not every teacher, not every psychologist, not every medical doctor knows about ADD.

  Even professionals who know about ADD can miss the diagnosis if they rely too heavily on psychological testing. While psychological testing can be very helpful, it is not definitive. Children who have ADD can appear not to have it when psychologically tested. This is because the structure, novelty, and motivation associated with the testing procedure can effectively, for the moment, “treat” the child’s ADD. The child may be focused by the one-on-one structure of the testing, focused by the novelty of the situation, and be so motivated to “do well” that the motivation overides the ADD. For these reasons, the clinical data—the teachers’ reports, the parents’ reports, the evidence of human eyes and ears over time—must take precedence over the data garnered through psychological testing.

  The second-most-common error in the diagnostic process is the reverse of the first. It is overcalling ADD, seeing it everywhere. A careful evaluation must take into account a number of conditions that can look just like ADD. Some of these, like hyperthyroidism, require testing by a physician in order to be ruled out.

  In addition to making sure that no other medical condition is causing the symptoms, one must recognize that ADD is a comparative diagnosis. It depends not just upon the presence of symptoms but upon the intensity and duration of those symptoms. Most children are distractible, impulsive, and restless some of the time. The vast majority of children do not have ADD, and one must be very careful not to make the diagnosis so easily that it loses meaning or becomes a fad.

  For those children who do, in fact, have ADD, it is of great importance that the diagnosis be made as early as possible so as to minimize the damage to self-esteem that usually occurs when these children are misunderstood and labeled lazy or defiant or odd or bad. The life of a child, and his or her family, with undiagnosed ADD is a life full of unnecessary struggle, accusation, guilt, recrimination, underachievement, and sadness. The sooner the diagnosis can be made, the sooner this unnecessary pain can cease. While diagnosis and treatment do not put an end to the difficulties ADD creates in the child’s life, they at least allow for those difficulties to be known for what they are.

  We all want our children to develop confidence, a solid sense of self-esteem that can sustain them over time. It is an invisible but decisive process, the weaving of self-esteem, drawing in threads of experience every day, threads that will last a lifetime. If those threads are made of humiliation, failure, and embarrassment, then the cloth will not be worn with much comfort. We should do everything we can to see to it that the threads are made of success, confidence, and a sense of the fairness of things. Understanding early on that a child has a learning disorder, such as ADD, is one way to help reach that goal.

  Throughout history there have been many great men and women who have had various learning disabilities that they managed to overcome. Although it can’t be proved he had it, Mozart would be a good example of a person with ADD: impatient, impulsive, distractible, energetic, emotionally needy, creative, innovative, irreverent, and a maverick. Structure is one of the hallmarks of the treatment of ADD, and the tight forms within which Mozart worked show how beautifully structure can capture the dart-here, dart-there genius of the ADD mind. In fact, there is a powerfully positive aspect to ADD, and learning disorders in general, a positive aspect that is as yet ill defined. You might describe many with ADD as having a “special something,” a hard-to-pin-down yet undeniable potential. If that potential can be tapped, the results can be spectacular. Albert Einstein, Edgar Allan Poe, George Bernard Shaw, and Salvador Dali were all expelled from school, and Thomas Edison was at the bottom of his class. Abraham Lincoln and Henry Ford were pronounced by their teachers to show no promise. The novelist John Irving nearly flunked out of high school because of an undiagnosed learning disability. There is a long, long list of people who achieved greatness in adult life after performing abysmally in school due to undiagnosed learning disabilities. Unfortunately, there is a longer list of those people whose spirits were broken in school, who therefore never got the chance to realize their potential.

  With that as introduction, let me take you now into the world of Maxwell McCarthy.

  When Maxwell was born, his mother held him in her arms and cried tears of joy. He was the son Sylvia and Patrick McCarthy had wished for after their two daughters. Maxwell stared up at his mom as his dad leaned across the pillows and drew little circles with his forefinger on Maxwell’s wrinkled forehead.

  “He looks like my father,” Patrick said.

  “You can’t tell this soon, silly.”

  “I just have a feeling,” Patrick replied. His father, Maxwell McCarthy, after whom this new Maxwell was named, had been a prominent Boston lawyer, the rod and staff of Patrick’s life, his hero and his guide. The values of intellectual achievement and rock-solid integrity combined with a hard-drinking, convivial bonhomie made the senior Maxwell an almost legendary figure. As Patrick looked down at his son now, he saw some of his old man in him. The large head size he concluded meant brains. The twinkle in the baby’s eyes meant joie de vivre. And the integrity would come from a disciplined upbringing. A gurgling, swaddled package now, Maxwell McCarthy was destined for great things.

  Sylvia’s fantasies drifted more toward the simple but boundless joy of holding this little baby. Oh, she had thought about his future before he was born. She hoped for him what she hoped for her other children, that he could have the advantages she hadn’t had when she was growing up. Her family had been torn apart by mental illness, depression, and alcoholism. She had worked her way through law school, where she met Patrick, and she was now juggling part-time legal work with being a mother of—now—three. In the process, she’d lost all contact with her family, and she was never far from the sadness of that. As she looked down at Maxwell, she thought, We will be good to you, beautiful one.

  As an infant and toddler, Max never liked to be left alone. He was gregarious and active. When he learned how to walk, it was almost impossible to childproof the house, Max was so fast. Cute as he was, it was exhausting to take care of him. As one of his babysitters said, somewhat vengefully, after a long night with Max, “You have a very high-maintenance baby.”

  By the time he was four, young Max had a nickname, “Mad Max.”


  “How shall I put it to you?” said Max’s day-care provider to Sylvia and Patrick. “He is very enthusiastic.”

  “You can be straight with us,” Patrick said sternly, for the moment forgetting he was surrounded by teddy bears, little bunnies, and storybooks, not leather-bound tomes.

  “Well, it’s just that he likes to do so many things, he’s all over the place. The minute he starts one thing he’s into another. He’s a bundle of joy, but he also can be very disruptive in the group.”

  In the car on the way home Patrick said, “What Miss Rebecca of Sunnybrook Farm was trying to tell us is that Max is a brat.”

  “She was not,” said Sylvia. “He’s just rambunctious, like you used to be.”

  “I was not. I had discipline. Standards. Max has no standards.”

  “He’s only four, for crying out loud,” Sylvia said. “Can’t you let him be a little boy?”

  “Sure. Just not a spoiled little boy.”

  “Oh. And I suppose his behavior is all my fault,” said Sylvia.

  “I didn’t say that,” Patrick replied.

  “No, you didn’t say that, but since I’m home twice as much as you, you’ve made it pretty clear to me who has primary responsibility for the kids. But Pat, boys need dads.”

  “Oh, so it’s my fault now. Clever way of turning it around.” They drove on in silence.

  At age six Max entered the first grade at Meadow Glen, a coed private school. Things went all right at first, but then one day, as the kids were on the floor doing projects in pairs, Max suddenly took his jar of paint, smashed it on the floor, kicked the project he and his partner were making across the room, and started punching himself in the face. His teacher took him outside to calm down while the co-teacher stayed with the other children. “What happened in there?” his teacher asked Max.

  “Everything I make breaks,” he said, tears beading down his cheeks.

  “That’s not true,” his teacher said. “Your project was looking very good.”

  “It was not,” Max said. “It sucked.”

  “Max, you know we can’t talk like that here.”

  “I know,” Max said sadly. “I need more discipline and better standards.”

  Later, at the request of the teacher, some testing was done on Max, but as it turned out it was only intelligence-testing. Max had a full-scale IQ of 145, with a ten-point split between performance and verbal. “You see? He’s plenty smart,” Max’s dad would say. “What he needs is to buckle down.”

  Through the early years Max’s grades were fine. The comments on his report cards, however, were upsetting, comments such as “Despite my best efforts, I cannot persuade Max to pay attention consistently,” or “Although he doesn’t mean to be, Max is a constant disruption in class,” or “His social adjustment lags behind,” or “He is so obviously bright—but he is a born daydreamer.”

  As for Max himself, he felt confused. He tried to do what he was told, like sit still or pay attention or keep his hands to himself, but he found that in spite of his best efforts he couldn’t do these things. So he kept getting into trouble. He hated his nickname at home, Mad Max, but whenever he complained about it, his sisters teased him, and when they teased him, he hit them, and when he hit them, he got in trouble. He didn’t know what to do.

  “I don’t know what to do with you,” his father said one day.

  “Why don’t you send me back to the dealership like you did with the Fiat? Maybe they have a lemon law for kids.” He had learned about the lemon law through listening to many conversations between his parents.

  “Oh, Max,” his father said, trying to give him a hug, “we wouldn’t trade you for anything. We love you.”

  “Then how come,” Max asked, pulling away, “how come you said to Mom that all the problems in this family are because of me?”

  “I never said that, Max.”

  “Yes, Dad, you did,” Max said softly.

  “Well, I didn’t mean it if I did. It’s just that we need a game plan for you, like when we watch the Patriots I tell you about the game plan. What kind of game plan can we come up with to keep you out of trouble?”

  “Well, Dad, you say it’s up to the coach to come up with a game plan that works, and if he can’t do that they should fire the coach. You’re the coach around here, aren’t you Dad, you and Mom?”

  “Yes, son, we are. But we can’t be fired. And we need your help.”

  “I’ll try harder,” Max said. He was nine years old at the time. That night he wrote on a piece of paper, “I wish I was dead,” then crumpled it up and threw it in the wastebasket.

  His life, however, was not all gloom. For one thing, he was, as his second-grade teacher put it, “chock full of spunk.” And, as that same teacher said, he was cute as a button. He was smart, no doubt about that, and he did love to get into things. He could turn a telephone booth into a playground and a telephone book into a novel. His father thought Max was more creative than just about anyone he’d ever met; he just wished he could help Max contain it.

  What Max couldn’t do was behave. Conform. Sit still. Raise his hand. And he didn’t know why he couldn’t. Because there was no explanation, he began to believe the worst: that he was bad, a spaceshot, a dingbat, a functional retard, all names he’d been called. When he asked his mother what a functional retard meant, she asked him where he’d heard the term.

  “I read it in a book,” Max said, lying.

  “What book?” his mother asked.

  “Just a book. What does it matter what book? Do you think I keep records?”

  “No, Max, I just wondered if maybe someone called you that and you don’t want to tell me who.” As soon as she said it, his mother realized her mistake, but the words were out and irretrievable. “Max, it doesn’t mean anything,” his mother hurried to add as she tried to hug him.

  “Let me go,” he said.

  “Max, it means nothing. Whoever said it is stupid.”

  “Like Dad?” Max said, staring into his mother’s eyes through tears.

  By the sixth grade, Max’s grades became erratic, ranging from the best in the class to barely passing. “How is it,” one of his teachers asked him, “that one week you can be one of the best students I’ve ever had and the next week act as if you weren’t even in the room?”

  “I don’t know,” said Max glumly, by now getting used to this line of questioning. “I guess I’ve got a funny brain.”

  “You’ve got a very good brain,” the teacher responded.

  “A brain is only a brain,” said Max philosophically, “but a good person is hard to find.”

  The teacher looked astonished at this precocious remark, astonished and perplexed, which Max picked up on. “Don’t try and figure me out,” Max said with resignation in his voice. “I just need more discipline. I’ll try harder.”

  Later, at a parent-teacher conference one of the teachers offered this description: “Watching Max sit at his desk in class is like watching a kind of ballet. A leg will come up, then an arm will arch around it, and then a foot will appear as the head disappears from sight. This is often followed by a crash. Then, often, a swear. You know, he’s so hard on himself it’s hard for me to come down on him.”

  Max’s parents listened, felt guilty, and sighed.

  Although Max thought quite poorly of himself by now, his spunk and pride kept him from talking with anyone about it. However, he did have conversations with himself. Sometimes he would beat up on himself. “You’re bad, bad, bad,” he would say. “Why don’t you change?” Then he would make a list of resolutions. “Study harder. Sit still. Get homework done on time. Don’t do things that make Mom and Dad worry. Keep your hands to yourself.”

  Brought up Catholic, sometimes he talked to God. “Why did you make me so different?” he would ask.

  And other times, the best times, he would wander unperturbed with his thoughts, from one image or idea to the next, so that big chunks of time could pass without his even noticing it. Often
this happened when he was reading a book. He would start on page 1, and by the time he was in the middle of page 3, he would be off in fantasy on a moonwalk or winning a football game with a rushing touchdown in the last minute. The daydream could go on for a half hour or so as Max sat staring at page 3. This was one of his greatest pleasures, but also a real obstacle to getting his homework in on time.

  Although Max had friends, he at times annoyed them by what they took to be his selfishness. As he got older, he found it hard to follow the conversation in a group of friends and so he stared off, blankly. “Hey, what’s with you, McCarthy?” his friends said. “You on drugs or something?”

  But because of his basically cheerful personality—he had learned how to put up a good front—and because his raw intelligence could carry him academically, Max avoided social or academic catastrophe.

  By ninth grade his family had grown accustomed to him as Mad Max; instead of fighting back, he took the teasing and added to it by making fun of himself, tripping over his feet intentionally or pointing to his head and saying, “Crazy.” His mother moved his room to the basement. “At least the mess can be contained in one place out of sight,” she said. “Since you’re constitutionally incapable of straightening your room, at least we can move you to the least offensive spot.” That suited Max just fine.

  In contrast to the time he drew circles on his son’s forehead when he looked at him as a baby in the hospital, Max’s father now just hoped and prayed that Max could survive in this cruel world, that he would find some niche for himself where his creativity and good nature were rewarded and his gargantuan carelessness and irresponsibility not get him fired. When his mother looked at him now, she thought of him as her lovable genius-goof. At times she felt very guilty at not having been able to straighten Max out, but after three children and more professional compromises than she cared to think of, she was trying to learn to go easy on herself. Indeed, she felt relief that the family had not been destroyed by the problems Max had caused earlier on.