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, and for 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.
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.