five children in the house, not just four. We’re reaching a crisis point here,” she said. Sue had heard about the new treatment for ADHD that was available at my practice.
Sue does not have children of her own. She met Pete two years after the death of his first wife and they were married shortly afterwards. “Pete can be so wonderful and funny,” Sue explains. “But after a few months of married life I began to feel I was living in a nightmare.”
Their life together was chaotic. The children had no routine and there were no proper rules. They wanted to watch television until they fell asleep at night and were very unwilling to eat balanced meals at regular times. Complaints from the school were a regular occurrence. Sue faithfully checked the children’s homework books, but their homework was often not done simply because it was not written down. Sue tackled the problems one by one, like a vegetable patch or flowerbed that you systematically clean and till. Soon the basic structures were in place: There were homework times, mealtimes, bedtimes and time for friends. There were fewer complaints from the school and Sue felt more in control.
Initially, Sue was not too concerned about the tantrums and other childish behaviour that Pete sometimes displayed. She was too overwhelmed by the adjustments that the children demanded of her. It was only with the benefit of hindsight that she realised that Pete’s unpredictability had been apparent from the beginning of their relationship.
As a child, Pete had hated school. He was always in trouble, being labelled “naughty”. He did not do his homework and got poor marks. He fell in with a bad crowd and even tried to burn down the school at one point. Pete explains that he now realises he simply accepted dares from his friends without considering the consequences. He feels as if he sometimes has tunnel vision and cannot see the bigger picture. He regularly finds himself overreacting and it makes no difference how unreasonable his actions are, he feels he cannot free himself from them. He feels powerless and trapped. It sometimes feels as if he is outside, looking in on himself and his behaviour.
The same thing happened on the day he tried to set the school alight. He broke into a classroom, egged on by his friends. He became caught up in the attention and the intensity of the emotions. That was the day they were going to teach their teacher a lesson. It was only after he had poured the petrol over the crumpled-up newspaper and put a match to it that he realised the seriousness of what he was doing and how bad the consequences could be. He desperately tried to put out the flames while his “friends” made a run for it. He says that it was never his intention to burn down the school. It was just that he got carried away. Fortunately Pete was able to quench the flames that day, but metaphorical flames that are lit by thoughtless actions can sometimes be much more difficult to extinguish.
Sue explains that Pete sometimes gets home when their youngest son is already in bed, storming into the bedroom while Sue is reading a bedtime story. He picks up the little boy and starts play wrestling him, after which the child is wide awake again. It often seems to Sue that Pete is only aware of his own needs and has no sense of responsibility. For instance, he might be in high sprits and start a game with the children at the dinner table that ends in tears because he fails to set boundaries or cry halt when things start getting out of hand. It has got to a point where she does not even feel comfortable leaving the children in his care when her attention is required elsewhere.
Pete runs his own business, which was often close to bankruptcy as a result of ill-considered decisions. Here too Sue has had to come to the rescue. The business is viable and has great potential. In the past, Pete has often tried to start up a second or even a third business while failing to give proper attention to his existing one.
After leaving school, Pete worked for a string of firms. Things usually started off well, but after a while he would become unreliable or get into a disagreement with another employee. Fortunately he inherited his father’s business. It flourished at times, but he was unable to apply sound principles consistently. For instance, sometimes he was very friendly to clients while at other times he was abrupt and even rude. Sue took over some of Pete’s responsibilities herself and delegated others in an effort to limit the inconsistency in their level of service.
Sue has reached the point where she is no longer prepared to assume all Pete’s responsibilities and do constant crisis management. She wanted a marriage in which responsibilities were shared and where she could rely on her husband’s guidance sometimes.
As a child, Pete was diagnosed with attention deficit disorder, specifically the type with hyperactivity. In his case the hyperactivity was associated with oppositional behaviour.
In some children and adults certain symptoms are more pronounced than in others. All people with ADHD do not necessarily present with all the symptoms of the condition. The behaviour patterns, weaknesses, strengths, personalities and abilities of people with ADHD differ. The “typical cases” that I describe are not intended to undermine anyone’s individuality in any way. I want to enable you to identify emotionally with the information in this book, and that is why I’m not merely providing you with factual information.
The initial interview
Various disciplines can shed light on the questions a therapist might ask at an initial interview. Through experience and personal preference the therapist will refine or change those questions until they become accurate searchlights that light up the relevant dark corners.
On page 32 there is an example of questions that might be asked in an introductory interview. I encourage you to go through the list and try to answer the questions as they pertain to your child or yourself as a child (if you have the relevant information). Teachers, therapists and students can use the questions as guidelines to help them sift through the relevant background information more easily.
I have included high-frequency responses, that is, answers that I hear most often from parents. I have not (yet) been able to determine response patterns when it comes to certain questions, although those questions do relate to certain aspects of ADHD. For example, one often hears that sleep disorders or problems are common among those with ADHD. But of the thousands of children with ADHD with whom I have worked intensively over the past twenty-three years, those with sleeping problems are in the minority. I have indicated the places where, according to my own observations and experience, there is no clear pattern of responses.
Questions are a vehicle of immeasurable importance to the therapist. But even more important is the therapist’s ability to listen. Regardless of how effective the questions we ask are, there is always the possibility that we might be overlooking an important component. The other danger is that a specific set of questions may shed light on a particular issue from one angle only. This can lead to prejudice on the part of the therapist. It is like when you begin focusing on red cars on the road: It will eventually seem to you that there has been a sudden increase in the number of red cars. And the longer, figuratively speaking, you look at someone through a particular lens or set of questions, the clearer certain aspects of that person become while others fade into the background, which could influence the type of intervention you decide on. That is why my opening statement is usually: “Tell me, I’m listening.” This important open question can offer you, the therapist, a perspective that your limiting lens or questions cannot.
As the reader, I ask that you do as follows: In your own words, state the problem as it is in your experience with your child (or with you or a child in your classroom). Awareness is an important step in treatment, and also in the decision-making that could lead to a positive change.
Professor Rudoph E. Tanzi of the department of neurology at Harvard University’s medical school says in Super Brain (2012), a book he co-wrote with medical doctor and author Deepak Chopra, that in every task we perform we are either unaware or aware or self-aware (aware of our own role in the situation rather than “shy”). When we are unaware, we are driven by our emotions and lower brain functions. The brain is then in an unbalanced state of functioning. Our decision-making functions are impaired and our behaviour is controlled by fear and anger, among others.
When we act consciously or are in an aware state, we can express how we feel about something. The emotions are then put in perspective by the higher brain