A Fresh Look at ADHD

A Fresh Look at ADHD

“I love your haircut, Joel. It looks like a crown, or like one of those hats which Egyptian priests wore in ancient times.”

The young boy smiled as he passed by me and sat down on his chair. The notes in his file told me he was 12 years old, although he looked much older, on account of being very tall and muscular. He wore a gray hoodie sweater, with a quilted vest on top, dark comfortable pants, and hi-shaft basketball trainers. Indeed, his hair did remind me of an Egyptian priest. The curls were very tiny and grew straight upwards, with the sides and back of his head cut very short.

He was very grounded and graceful in his movements, he moved to the chair something like the way that a lion or a tiger moves, with slow deliberate movements: a little cool, with the bounce to his gait, as if he was walking to music that the rest of us could not hear.

He looked at the ground as he passed me, as though trying to hide his face. I could tell that something was going on within him that he did not want me to see. His body was full of energy, but he was containing it. He reminded me of a young puppy who has been well trained to sit, and heal, and lay down, and fetch; you can tell that the physical body is bubbling with frisky energy, but it has been contained within learned boundaries.

His father had a royal demeanor. I could see where Joel had got his disciplined energy from, his father was sitting upright, straight and tall. A first-generation immigrant from Ethiopia, his hair was cut very short into tiny curls, gripping tightly to his head like barnicles. It was also shaved short on the sides. Everything about him was new and shiny: the well polished brown leather shoes, the well pressed cotton pants, the freshly pressed brilliantly white shirt, with standup collar. He had clearly spent much time at the fitness center. Joel’s mother was Swiss: shoulder-length blonde hair and fair skin. She was also very tall. They were clearly very much in love with each other, and obviously delighted in the same values: clean, new, crisp. Everything about them announced their success. When I shook both of their hands, the grasp was firm and confident.

“How are you today, Joel?” I asked their son.

“Fine,” he replied. He turned towards me, but with his eyes still cast towards the floor.

“What was the best thing of last week?” I asked him.

He became visibly more bright and enthusiastic, like when you wake up a computer from sleep mode, and the screen suddenly bursts with light and color. “It was amazing, it was my birthday. All my best friends came over, and we played hide and seek in the woods all afternoon. Then somebody said, ‘Hey, let’s build a tree house.’ All my friends ran in different directions, and brought together fallen tree trunks and branches, and we built a huge tree house together. My mother prepared a scrumptuous birthday cake for me…” his mother beamed, and blushed a little, “… and we had a fantastic spread of food. We took everything into the treehouse, and ate it all there.”

When he had walked into the room, he struck me like a cool young rapper in a video for teenagers, much older than his real age. But now, as soon as he started to speak, he had the innocence, the playfulness and the eagerness of an eight-year-old boy.

I turned to the parents. “How can I help you?”

“We have an issue at school,” said his mother. “Joel is easily distractible, he loses things, and he is messy. His teacher complains that he doesn’t get things written down.”

“ We are worried he may fail the class…” interjected Joel’s father.

“ Joel,” I said to the boy. “I notice you’re a big guy. Do people often mistake you for being older than you really are?” The boy nodded, quietly.

“I have seen this very often,” I turned back to the parents. “When a child looks much older than he is, it can create an expectation to behave a certain way, for which there isn’t really the readiness internally. It can create a feeling of rebellion, like “I’m not ready to show up in the way you expect me to.”

“ Thank you doctor,” said his mother. “We have discussed the situation with Joel’s teacher as well as the school psychologist, and they asked us to get Joel tested for ADHD.”

“I see,” I said. “Tell me more about what happens at school.”

“ Whenever Joel is asked to read out loud, or when they are asked to write something, apparently he has difficulty to concentrate,” his mother explained. “His teacher feels that he is rebellious and disruptive.”

“I am concerned that he is getting a reputation as a troublemaker,” the father added.

“He is never like that at home,” said the mother. Her voice wavered, and her chin began to quiver. Her eyes moistened, just a little, and she dabbed them with her perfectly clean and pressed white linen handkerchief.

“Do they have sports at school?” I asked. “What about that?”

“No problem at all,” said Joel’s father. “My son is great at sports. Very respected and integrated in the team. He is completely in his element when they’re outdoors. Also, we go to a sport club together, and there’s no problem there, he is very disciplined and focused. This weekend, when he was playing with his friends in the forest, he was completely present and connected all the time. He just has to learn how to discipline himself when he’s sitting down and writing and reading. The only problem is in this class with his teacher.”

Now Joel was staring at the floor. He looked like he wanted to disappear. Being half African, his skin was dark, but I could still see that his face was flushed with emotion. His shoulders hunched forward, as if he was waiting for judgment to be passed.

“ Listen,” I said, “if a child has ADHD, they generally have it across the board, it’s not just in one activity. So I really doubt he suffers from this condition. But let me refer you to my colleagues in the developmental pediatric department, who can do a formal test and assessment.”

As they all stood to leave, Joel looked relaxed, and more open, as if he had been seen and recognized. He looked me directly in the eyes as he said goodbye

*

When they came back a month later, his father was out of town on business. So it was just Joel and his mother. Joel seemed much more relaxed, friendly and open.

“ Welcome back,” I said opening the file, and looking at the report. “I see that you have been to the developmental pediatrician. Looks like you were there three times, for two hours each. How was that for you, Joel?”

“Yeah, They were long meetings, but it was cool. We did a lot of stuff that was fun. They gave me tasks to do, and I had to complete them.”

“The doctor agreed with you,” said Joel’s mother. “She said that she did not feel that Joel had ADHD, but that it is simply an isolated weakness with his reading, and that he is trying to compensate. She suggested that we support Joel with his reading skills, but also that we speak to his teacher, and ask her to ease off the pressure on him. The doctor also suggested that Joel could read things that he feels interested in.”

“We agreed that it was a coping mechanism, a way for Joel to escape things he’s not good at. But then, last weekend Joel and his father went on a long hiking trip together, for the whole day. You see, my husband is very motivated and ambitious. He is a first generation immigrant, from Ethiopia. He has a ‘go go go’ attitude.  Actually,” she blushed, “that was why I fell in love with him. So he has the idea that you just have to want something enough, and you can achieve anything. He was trying to motivate Joel to know that if only he wants to write well and read well enough, then he can do it. This was the gift my husband wanted to pass on to his son. After they went hiking together, my husband told me that he understood that Joel was feeling under pressure, and that instead of feeling empowered, he had made him feel inadequate.”

As his mother spoke, Joel did not look down this time. He looked at his mother as she spoke, calmly and with a subtle air of assent.

“But now my husband understands that this kind of deep wanting has to come from within a person, it cannot be imposed from the outside.” She reached out and placed her hand on her son’s shoulder, and squeezed just a little. “He was just concerned to let his father down, because they love each other so much. But now they have come into a completely new understanding.”

When they rose to leave, I shook hands with both of them. Somehow I knew that I would probably not see them again, at least not for this issue. It was resolved.

*

Joel is just one of the many kids who are referred to me from the school or family for ADHD, who are actually perfectly healthy, simply compensating for a weakness in one area of their life. Not being good at something, and feeling ashamed about it, can easily look like distractibility. The problem is not actually within the child, it is one of social expectations.

Of course, ADHD clearly exists. But I would guess that it is only a real problem for a small fraction of the people who are diagnosed. Often these situations are treated with drugs, which can cause all kinds of other imbalances. It is much simpler to simply adjust the cultural expectations, and also to compassionately explore in what area the child may feel inadequate or ashamed. We all live within a medical system   as well as a society that does not adequately celebrate the uniqueness of each person. Consequently, when a child is simply being themselves, and then does not adequately display qualities that others would like them to have, we call it a pathology. It is in fact the expectation of someone being different than they are which is pathological.

This is why I founded Heart Based Medicine. It is an expression of my desire to let people be the way they are, andfor us to learn — as doctors — to love people as they are, to celebrate them as they are, rather than diagnosing them as aberrant from some expectation of normal.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of the Heart Based Medicine organization.  They are not intended to diagnose, treat, cure or prevent any disease. They are the expressed opinion of the author for the sole purpose of educating the public regarding their health and wellbeing. Individual results may vary. Seek the advice of a competent health care professional for your specific health concerns. Photo credits:
  • Photo 01: © anastasianess via Adobestock.com
  • Photo 02: © fizkes via Adobestock.com
  • Photo 03: © thinglass via Adobestock.com
 

Steffi Is Afraid of the Jab

“Steffi and Peter Meyer, please.”

A family, who had been sitting in the corner of the waiting room, all stood up together. The father was tall, with short gray hair, and a three day beard. His wide open eyes conveyed a simple warmth. The mother was shorter than her husband, wearing leather boots, stylish jeans and a nice blouse, dressed as though she might have come directly from an administrative job in an office. Peter, their son, was close to 2 meters tall, with a very strong broad back. He was probably 95 kilos. He reminded me of a Canadian ice hockey player, with strong arms, strong legs, and a chiseled clean-cut face. He wore black jeans and a green hoodie.

As they walked towards me, I realized that Peter’s little sister had been hidden behind him. She looked about nine years old, with brown hair cascading onto her shoulders. She was strong for her age, with long arms, and long slim fingers, like a pianist.

Stephanie’s face was covered in tears, such that her hair was stuck to her face.

Her eyes were full of fear. She glanced briefly at me, and then right again looked away at the floor. Immediately, my heart shrank. I crouched down, so our eyes were at the same level.

“Hey, Steffi,” I said, “What is going on with you? I’m so sorry. Here, let’s go into my office and you can tell me all about it.”


Once we got settled in my office, Steffi didn’t want anything to do with it. She sat on her father’s lap, and hid her face in his shoulder. I spoke to both the parents. “How are you all doing?” I asked.

“Previously, you saw my colleague. This is my first time meeting your family.”

“Oh, we are all just fine,” the mother replied. “We are here for the third injection of the encephalitis vaccine, but Steffi has a sore throat and a headache and joint pain, and she feels really bad today. We were wondering if this is the right time to give the injection?” “Probably not,” I said. “How long has she been sick?” “ Just a few days,” the mother replied. “She’s been sleeping badly. In fact, we are all very sleep deprived right now.” “Steffi,” I said, turning to the little girl.

“I get the sense there might be something else going on?”

She shook her head and hid her face again. “I was wondering, do you have any concerns about the immunization we were planning today?”

“Well,” said the girl very shyly, still not looking out from buried into her father’s chest, “perhaps just a little bit.” Behind her, her father, mother and brother were all nodding vigorously, as if to say “Yep, doctor, you nailed it. That is precisely why she’s crying.” “Okay, Steffi,” I said. “Let’s do this.

Today we are not going to do anything. We will leave you in peace to get better.”

At this point, Steffi started to speak freely. “I really have a bad headache, doctor, my throat is so so sore, I feel so weak, and I can’t get to sleep. I want to go home to bed now.” “I do have a question, doctor,” her mother said. “She has had quite a high fever. One day it went to 40°. Some people tell us we should lower the temperature with medicine, and other people say it is good. What is really true?” “It’s good that you ask.

Almost always, fever is a good thing. It’s something that the body does to fight disease. Fever on its own is really not dangerous.

We simply have to know the cause of the fever. In this case, it seems that it is primarily a cold, and I’m not worried about it. “We want to be able to hold a space for the fever to do its work, and to go through this as a valuable experience. Steffi, when you feel kind of shaky and that everything hurts, the best medicine is to let your mommy hold you and cuddle you and protect you.

I’m going to write a prescription for you to sit on mommy’s lap as much as possible, or cuddle up in the bed together.”

I turned to Steffi’s mother again. “This is one of the most beautiful and fundamental experiences that you can give your child: when she feels down, to know that there is somebody there to hold her, to support her, to love her and take care of her, so that she knows she is not alone.

This may be fundamentally much more healing than to lower the fever by taking a tablet.

Now Steffi turned towards me, and I saw an openness and trust in her eyes. I recommended a little ointment to rub on her chest for her cough, and then we talked about eucalyptus oil, and where it comes from, and that it smells quite nice. “Next time, when you feel much better, it would be a good time to catch up on your immunizations. Tickborne encephalitis is a big thing here in Switzerland. For athletic girls like you who like to go out in the woods, it’s a good idea to be protected.” She nodded, solemnly. It was clear that she was not very enthusiastic.

“This is the first time I have seen you as a patient,” I reminded her. “We have not met before. Please, give me a moment to check through your medical history. I turned to the computer screen, and started scrolling through notes from previous office visits.

“How strange,” I said, looking back at her. “I don’t see any record here of whether or not you are proficient in magic.”

Steffi suddenly sat up straight from her father’s lap, and looked at me with big eyes. “What?” She asked. I looked back at the screen and continued scrolling. “It’s very strange, I’m looking through all the notes and I don’t see any record of whether or not you are able to perform magic tricks.” “Of course not,” she said. “Well,” I said, “Are you absolutely sure? Since there’s nothing in the notes, you may be a magician and not know it.” “I don’t think so,” she said.

“Would you like to learn how to perform magic tricks?” I asked her, with the look of a somber and serious doctor. She frowned at me, unsure if I was joking or not. “If you like,” I went on, like this was standard office visit protocol, “I could show you some magic tricks next time you come in. But only if you’re really interested, of course.” “What kind of tricks?” she asked. “Well,” I said, “I see that you’re concerned about immunizations. You don’t like injections. There is a very particular magic trick that can help with that. It’s a spell that you can cast, so that you don’t feel any pain.” “That’s not possible,” she said confidently. “Oh yes,” I corrected her, “Actually it is. You will see. I will show you next time, if you are sincerely interested. I poised my pen above a form on the desk.

“Should I make a note here that next time, before we do the immunization, I should teach you to cast a spell to make the pain go away?”


Now Steffi was looking quite bright and excited. She nodded firmly. “Okay,” I smiled closing her file. “I will see to it.” We immunized her brother that day, with Steffi watching. For him, it was not a big deal at all. She watched with curiosity. “You see,” I said. “It was fine for him, and you can learn to have exactly the same thing too. With the right spell.” “What will I have to do to cast a spell to make the pain go away?” she asked me, cautiously. “That is an important part of becoming a magician,” I explained.

“You have to develop the patience to wait until the right time to learn the trick.”

Steffi left the office looking quite happy, holding her father’s hand. All of the family was laughing together now. Sure enough, a week later they all came back. “Okay,” I said, “Are you ready to learn the trick?” She nodded very enthusiastically. She was quite keen. Her cough was all gone and she had no more fever. “Alright,” I said. “Do you see this little pinwheel here?” I held up a pinwheel. “When you blow on it, it starts to spin. Try it.” She did as I suggested. “We have several different kinds here in the office. They are very carefully color coded, according to their effect. I went over to a cupboard, and came back with three different pinwheels, of different colors.

“You need to be very very careful, because this is powerful magic. Make sure you choose wisely.

As you can see, there are three different colors of pinwheels: Blue, red, and silver. You have to choose which experience you want to create when you have the immunization. If you blow the red pinwheel, the injection will be very painful. Some people prefer that. If you want it to be just mildly painful, you can choose the silver one. And then, if you’d like to have no pain at all, you can choose the blue one. Which experience would you like to have? Steffi did not hesitate.

“I would like the blue one please. I don’t want to feel anything.”

“Alright,” I said. “Then we are ready to cast the spell. Please focus all your attention on this blue pinwheel. The harder you blow, the less you will feel. Try it now.” She started to blow. “All right, you need to blow a little bit harder. That’s right, a little bit harder. Blow harder. Even harder.” By now she was blowing with all her might. As she was causing the pinwheel to rotate at high speed with her breath, I casually disinfected her arm. She was blowing, blowing, blowing. I performed the injection. Then I said to her, “Alright, you can stop blowing now, well done.” I put a little Band-Aid on the site of injection. Steffi looked at me in amazement. She did not understand. How is it possible that she had just had an injection, her absolutely worst nightmare in the whole world, and she didn’t feel anything at all? The family thanked me, and we completed our office visit.


Something like this happens very often in my work as a heart-based pediatric physician.

I love to give children the experience, early on in life, that they are fully in control of the healing process.

Steffi had been viewing an immunization injection through the lens of fear. By asking her a question about magic, it helped her to detach from this story. I showed her that there was a possibility to learn, to take responsibility for her own state, and to become an active participant, rather than a victim of the experience. This was the first step for her in learning to take an active part in taking care of her health.

She learned that day that pain is an evaluation of an experience, and that she has full control over the evaluation she places on things.

Also, by offering her a choice of three different pinwheels, she realized that she had the capacity to influence the situation. It was empowering; it put her in the drivers seat, allowing her to choose the level of pain she wanted. By blowing very hard, it activated her energy, and put her attention on something else rather than the sensation of the injection in her arm. As a doctor, it is always my intention to perform the duties I have been trained in at medical school, but also to encourage my patients, of all ages, to practice magic.

The story above is based on personal experiences. Places and names are fictional.