It's Nobody's Fault (15 page)

Being the parent of a child with ADHD
is
a lot of work, perhaps more demanding and more challenging in terms of time and attention than any of the other disorders. When the kids are little, finding children for them to play with can be a full-time job; they tend not to be on anyone’s “A” list. As they get older, helping them with their schoolwork is usually extraordinarily time-and energy-consuming. The hard work usually pays off, though. The mother of one 13-year-old girl I’ve treated works closely with her daughter on her homework every night and helps her to prepare for tests, and the results have been spectacular. Last report card the girl came home with straight As. Her mother says that if any of the kids in the class have a question about the homework assignment, they always call Kelly. “Everybody knows that Kelly is the most organized child in her class,” she says. That’s because they work long and hard at it. Some nights after Kelly’s medication wears off, her mother sits in a chair next to Kelly and rubs her back while she studies. It’s the only thing that helps the girl concentrate.

Kelly’s parents think that they have the school situation pretty much under control, but as their daughter reaches puberty, they’re starting to have serious worries of a different kind. So far Kelly is not allowed to date, but they know that the day will come. “We’re a little nervous about her with boys,” her father told me. “She really needs her medicine. She’s the kind of kid who has terrible judgment and no impulse control without it. If somebody offered her a drink or a some marijuana, I could see her accepting if she hadn’t taken her medicine. She would think it was ‘neat.’ If some guy says, ‘Let’s go for a ride’ or ‘Let me put my hand there,’ I’m afraid she’ll do it. She knows the rules, but rules don’t really work for her if she’s not on her medicine.”

Parents of children with ADHD often drastically rearrange their lives, sometimes without even acknowledging that they’re doing it. “We don’t mind not eating together as a family,” one mother of a nine-year-old told me. “If we try to have dinner together, he just knocks everything
over. It’s better for everyone if I just stand and watch while he has his dinner.”

Before the parents of five-year-old Gary started their son on Ritalin, they had stopped taking him anywhere—no movies, no restaurants, nothing. Two weeks into the Ritalin treatment they took him to a puppet show at the local college, and he sat through the whole thing. “I had forgotten that these family outings could be fun,” Gary’s father told me.

Parents should understand that when they change their lives to suit the symptoms of their child’s disorder, they are not doing the child any favors. A kid who lives in a world in which everyone accommodates him is in for an extremely rude awakening. Parents can’t and shouldn’t shelter their kids forever. The sooner they teach their children to follow the rules of polite society, the better off everyone, especially the child, will be.

This disorder is tough on everyone in the family, including the other siblings. First of all, mothers and fathers of children with ADHD tend to be more short-tempered with
all
their kids, not just the one with the irritating symptoms. Second, kids with ADHD require and demand so much attention that there’s not always enough to go around for the others.

“Seth is so well behaved that I take him for granted,” a mother says about her son who
doesn’t
have ADHD. “When he does misbehave, I know I’m too hard on him. I count on him not to give me any trouble.”

Another mother feels similarly guilty about her ADHD-free son, who is a couple of years older than the child with ADHD. “The other day they both came home with grades. Casey got 100 percent on his test—which he always does—and Ben got 80. I’m sure I made much more of a fuss about Ben’s 80. Casey never complains. In fact, he’s a wonderful, caring older brother, and he really helps Ben. But I’m sure he feels slighted sometimes.” Family therapy can help a family deal with the child’s disorder and its impact on the whole family.

One of the biggest problems that parents of children with ADHD face is that the kids get labeled by the rest of the world. “Troublemaker” is the usual epithet they’re given, and it doesn’t take long for the word to spread. Fortunately a bad reputation is relatively easy to shake, at least as far as teachers are concerned. Kids who get treated for ADHD are almost always regarded as “new and improved” by their teachers, with
no hard feelings. Classmates tend to be less forgiving, however, and there are instances in which a kid with ADHD alienates his peers beyond redemption. When that is the case, it may be necessary to ask the school to place the child in a different class for the next academic year. A fresh start may be just the ticket for a child being treated for ADHD.

Teachers and other school officials, who should be part of a strong support system for these troubled children, sometimes make this problem worse. Kids with ADHD are disorganized and easily distracted, so remembering to take their medicine every day at school can be tricky. One of the children I treated set his watch so that it would beep, reminding him to take his medication at noon. The teacher complained that the beeper disrupted the class and wouldn’t let him use it. Another teacher routinely made fun of the fact that one of his students needed Ritalin. If the boy did anything out of the ordinary in class, the teacher would say, “I bet you forgot your medicine today, Tommy. Look how you’re acting.” I’ve encountered nurses who give a child his medicine if he remembers to come to their office but refuse to track him down to make sure he gets there.

Most schools will listen to reason, especially if parents enlist the help of the child’s psychiatrist, psychologist, or social worker to get their attention. High school guidance counselors are looking more favorably on the idea of untimed SAT tests—allowing kids with ADHD to complete the tests at their own speed—and many colleges feature special resource centers for their students with ADHD. The U.S. Office of Education has started a major campaign to inform school personnel about ADHD, including its identification, its treatment, and the special needs of children who have it. As more school systems become enlightened about this no-fault brain disorder, the same kinds of accommodations will be made for these kids as are made for children with any medical disorder.

The Age of Enlightenment may already be underway in the schools. I came to that conclusion when, quite recently, I evaluated a child with ADHD and faxed a letter to the school with instructions on how the medication was to be given. I was floored when, the very same day, the school nurse called to ask me how often I wanted the Conners questionnaire to be filled out by the child’s teacher. I told her that I’d like the form filled out every two weeks and that I would send her some forms. “No, don’t bother,” she told me. “We have our own supply right here.”

For sound practical advice about coping with ADHD many parents turn to ADHD support groups. The best known of them is CH.A.D.D.—Children and Adults with Attention Deficit Disorder—the largest organization of its kind in the country. The members of CH.A.D.D. have helped to identify ADHD as a real disability, forcing school districts and insurance companies, among others, to acknowledge its existence. They have enormous resources and can be helpful to parents who come up against teachers, camp counselors, or other authorities who are reluctant to cooperate with the treatment of a child with ADHD.

I said earlier in this chapter that ADHD is relatively easy to treat. I wish I could say that it’s easy to live with. Still, with active treatment and a lot of hard work, a child with ADHD can have a well-rounded, happy, productive life even if his symptoms never disappear entirely. He’ll probably have to make some allowances; he’ll do best to choose a profession that lets him move quickly from task to task rather than one requiring long periods of concentrating and sitting still. Theater critic is probably out, but he’d probably make a terrific stockbroker or salesman. I know one young man with ADHD who’s a physician. His specialty? Ears, nose, and throat. He told me he needed a practice with lots of action and quick results.

One mother whose child I’ve been treating for seven years is cautiously optimistic about the prospects of her 12-year-old son, more so than she ever thought possible. “When Max was first diagnosed with ADHD, I spent a month crying,” she told me. “I would drive to school with the tears rolling down my face, wondering what in the world we were all going to do. I just kept thinking that I wanted him to be like all the other kids. I wanted him to be treated like everyone else. It hasn’t been easy, but I think he really
is
treated like the others. He does all the things that the other kids do. It just takes a lot more effort.”

J
ames was 12 years old when he came to see me. Earlier that week he and his family had been on vacation, skiing in Colorado. One evening just before dinner James bolted out of the bathroom wrapped in a towel. Still wet from his shower, he stood in the middle of his parents’ bedroom and moved his head methodically from side to side, touching his chin to each shoulder over and over again. He said he couldn’t stop. The family, who’d never witnessed anything like this before, watched helplessly as he kept moving his head back and forth, sobbing. Soon the parents were crying too. Finally James’s older brother grabbed the bedspread off the hotel bed, wrapped his brother in it, and rocked him until he calmed down. A half-hour later they all went down to dinner, and James refused to talk about what had happened. During my first meeting with James I discovered that the chin-to-shoulder motion was only one of his inexplicable repetitive actions, things he did on a regular basis. He also tied his shoelaces repeatedly, checked his eyeglasses for cleanliness dozens of times a day, and kept on bending his fingers back, one by one, until he felt exactly the right amount of tension in each.

Five-year-old Mary likes to tear things. If the pictures she draws aren’t absolutely perfect—and they never are—she rips them into dozens of pieces. She also tears her clothing, particularly her underwear. If her parents don’t monitor her carefully, she’ll go to nursery school literally in rags. In the bathroom she constantly touches the walls and tightens the faucets. The barrettes in her hair have to be equally tight on each side. When her parents take her out to a restaurant, she checks for gum
under the table 20 or more times during a meal. Her parents say she’s been doing some of these things since she was two years old.

When I was in junior high school, a boy from my homeroom used to fascinate me in the school cafeteria every day. Like the rest of us, Norman would stand in line, fill his tray with food, and carry it back to the table. That’s when it got interesting. I would stare, mesmerized, as Norman proceeded to eat his lunch one quadrant at a time. He was incredibly precise about it; first he’d eat what was directly in front of him. Then he’d carefully rotate the plate 90 degrees and eat the contents of the second quarter. He went on like this until his plate was clean. Kids teased him about it, of course, but during the time I knew him he didn’t change his eating habits. Back then I thought Norman was weird. Today I’m reasonably sure that he had obsessive compulsive disorder, or OCD.

Childhood rituals and superstitions are perfectly normal. At about two and a half years of age children begin to follow and indeed expect a regular routine, especially at mealtimes or in preparation for bed. “Before I go to bed, I brush my teeth. Then Daddy reads me a story, and Mommy rubs my back,” a child might recite. Another kid says: “When I take a bath, I have six toys in the tub with me. Daddy sings Rubber Ducky’ while he washes my hair.” Any change in routine can create discomfort in a small child. Between five and six children develop group rituals, during which they play games. These games nearly always have rules, and most kids are as strict as Marine drill sergeants about them. Anyone who tries to circumvent or break the rules will face an extremely irate kindergartner. As children get older—from seven to 11 or so—they begin to take up hobbies and start collections: stamps, coins, baseball cards, dolls, and so on. They often appear overly preoccupied with their hobbies, but that too is normal. Obsessiveness is part of any hobby or collection.