Child’s Play
By Laurie Scarborough
Falling Towers
A tower of cutlery, toothpicks and scraps of paper partially masks the young boy and his mop of curly black hair. This is his newest masterpiece. He gathers the restaurant menus to add to the top of the tower.
“Bil, stop it.” The boy’s mother never did understand the tower-building business. Bill found restaurants boring and sitting still for longer than 15 minutes was a unique form of torture. So he made towers. He reaches a little higher to perch the menus atop his construction.
“Bill, I said stop it!” Bill slowly retracts his arm and slumps down in his seat. His hands find the paper wrapping of a straw. He places it flat on his leg and with both hands he pushes it forward. Rubbing it over and over again until it becomes a tight rope of paper. His hands need to be busy. He continues to roll the paper rope forwards and backwards and forwards and backwards. Until it breaks.
School
It is Senior Prize Giving Day at Westerford High School. The school is known locally in the wealthy Southern Suburbs of Cape Town for its academic success, but also for its esteemed art department. Three enormous studios enable the students to explore art extensively and the school prides itself on the high standard of art produced by the students. And so it is with great pride that Bill Sagan steps onto the stage to accept the Senior Art Prize. The hall is filled to capacity with parents dressed in smart clothes to watch their children walk across the wooden stage to accept their awards. The students are dressed for the occasion too in their best uniforms, neat hair and smart maroon blazers. All except for Bill, who as usual has a fairly unkempt look about him. He is short for his age, rather thin, has a mess of Tim Burton-esque black curls, scruffy uniform, and skew teeth. And as he lopes across the stage the audience begins to laugh.
At first he didn’t think much of it; he’s known as the class clown. He had spent most of his time at high school running around quoting Monty Python and generally being a bit strange. For almost two weeks that year he had stopped speaking altogether, including to his mother, which had delighted her. Instead, he’d communicated only by writing in a small spiral notebook. He’d eventually had to stop doing that though when he nearly caused a car crash while his mother was trying to read his notes at the wheel.
He had always found it difficult to stay in his seat in class. It was just so boring. So he would often find himself drawing on the chalkboard at the front of the class; a fight club quote with an accompanying picture, a drawing of the Pope in a noose. That sort of thing. And the teachers simply allowed him to do it. They all knew about his home life — a broken family, a sister with bipolar, a mother with delusions and numerous mental problems, and a mostly absent father. It hadn’t been an easy journey.
He’d moved schools so frequently it had been very hard to put down any roots. He’d eventually settled at Westerford for the final three years of high school, after being at five other institutions. The previous school he’d attended was utterly unthinkable. It had been populated largely by racist teenagers who aspired to being either accountants, or secretaries to their husbands, who were accountants. Although it was five years after the official abolishment of apartheid, during assembly they only sang Die Stem. The library was permanently closed because a fire-enthusiast had set some books alight. The building with all the books inside was still intact, but the only contact Bill had with the library was when he pressed his face against the burglar-barred window to look inside. It was like a ghost town for books.
The move to Westerford had therefore been a good one. The teachers were patient with him, which certainly was a change from his previous schools, although at most parent-teacher meetings Bill was described as “a daydreamer”, “lazy”, “lost in his own thoughts”, “aloof” and “erratic”. Although his behaviour became more pronounced in high school, Bill had always had problems.
He could never sit still, always seemed to be busy with more than one task at a time, and sometimes as many as five or six at one time. He never followed instructions, made careless mistakes, couldn’t concentrate on anything important, didn’t listen when spoken to, forgot to do his homework. He was disorganised, easily distracted, forgetful. He lost his belongings, had motor tics, could never keep quiet. He was restless, talked too much, interrupted lessons, couldn’t wait his turn. The list was seemingly never-ending. Everyone knew he was different, but no one knew what was wrong.
Which is why laughing seems appropriate. And there he is, standing on stage and accepting the Senior Art Prize with an entire a hall full of people laughing at him. He isn’t sure why it’s funny that he’s winning a prize, but he tries to hide his confusion. He walks off stage back to his seat next to his friend.
“Dude,” his friend said, “the back of your blazer is like, covered in white paint.”
A Change
“ADHD is divided into two subtypes,” Bill explains to me over a decade later. “You get someone who has ADD which is Attention Deficit Disorder or you have someone who’s hyperactive, which is Hyperactive Disorder. And then you get someone like me, who’s got a combined subtype which is Attention Deficit Hyperactivity Disorder.” We are sitting at the breakfast bar in Bill’s kitchen on a mild winter evening in Cape Town. The house is what you might call eclectically decorated, with bright blue kitchen cupboards, warmly varnished wooden floorboards, towering bookshelves and mismatched furniture. Nothing out of the ordinary though, for two artists. Although perhaps not to everybody’s taste, it has a homey feeling to it that makes you feel welcome, even as a stranger. Two shabby arm chairs are positioned around a fireplace that is surrounded by red textured wallpaper. I can imagine Bill and his wife settling there during cold evenings, reading together while their German Shepherd sleeps at their feet. A simple life.
But Bill’s life has been far from simple until quite recently.
“I’ve had the reverse story of having been diagnosed when I as 28, as opposed to being diagnosed when I was 12 or whatever.” One of the main reasons that he was diagnosed so late was because of his complicated family situation. Because of difficulties at home, he had been depressed as a teenager and had been admitted into a clinic for five days to treat severe depression. Most of his behaviour was attributed to depression, and the other “quirks” were put down to either a bad personality or laziness.
This was despite the fact that Bill displayed all 18 criteria for ADHD, when only 12 are required for a diagnosis.
He nearly failed matric, after walking out of one exam and submitting drawings instead of an essay for his history final. “It’s funny now. I’m glad I can laugh about it now. But I really had a very hard time laughing about it after that because I had to write supplementaries the following year.”
Bill struggled through most of his twenties. He got accepted into the University of Cape Town by the skin of his teeth to study at the Michaelis School of Fine Art. He passed all of his subjects, and, despite having a keen interest in art, he dropped out of the course after just one year. He then began a Bachelor of Arts undergraduate in Philosophy and Media Studies, but abandoned that after just a year too. He was a 20-year-old with no qualifications and no support system. His mother was hospitalised for her depression, so he couldn’t rely on her, and his father was married to a woman who neglected him. He was alone.
“A lot of my peers were able to finish their studies and have the normal 20-year-old experience. I was left out of it. I had to work to put a roof over my head from when I was 20.” He entered the workplace and began working as a graphic designer and animator. He couldn’t hold onto a job for very long before he either got bored and quit, or was fired for his erratic behaviour. He would spend 15 minutes working and then leave his seat and disturb other people in the office. He spent hours each day browsing the internet instead of doing tasks that were delegated to him, and when he did get work done, he was often completing drawings while watching a movie on VLC on his computer screen.
It wasn’t until he met Beatrice that things started turning around for Bill. Beatrice is Bill’s wife, a sunny-faced woman with flaming red hair that sways to her elbows, and very pale, freckly skin. As soon as the conversation turns to Beatrice, Bill’s eyes light up, his face softens and he is smiling for the first time in a while. Although Beatrice now works as a journalist, when they first met she was working at the German International School in Tamboerskloof. “Beatrice has some experience with teaching and with kids with learning disabilities. And she suggested that I maybe go and see a therapist and that I maybe go and check out what adult ADHD is.”
He read articles online about adult ADHD and then went to a psychologist to get a professional opinion. It took six months of therapy before he received a formal diagnosis. This can be quite typical in therapy, especially when a person seeks help many years after problems begin. A diagnosis can sometimes become more complex and difficult to pinpoint, which may have been the case with Bill. Furthermore, because many mental disorders do not have biological indicators, a diagnosis may take several weeks or months to confirm, and, as Bill says, “There’s no blood test for mental illness.”
Like Nothing on Earth
Ritalin is a medication that is famously used to treat ADHD, and is a very effective drug. But many parents are nervous to allow their children to start Ritalin because it’s a Schedule 6 stimulant. Medical schedules were introduced in South Africa 1965 to better control access to medication, with dangerous medications receiving a higher schedule. Schedule 1 medications can be bought freely in grocery stores, health shops or pharmacies. Schedule 2 to 4 can be distributed without a doctor’s script, but must be bought over the counter from a pharmacist. Schedule 5 medications need a doctor’s prescription, but the script can extend for several months. Schedule 6 drugs can only be prescribed with a monthly script. A new script must be collected in person from the doctor every month. Along with Ritalin, other Schedule 6 drugs include medical cocaine, opium, and morphine. Just one schedule up from Ritalin, is Schedule 7, which is only prescribed in exceptional circumstances. Medical heroin, cannabis, LSD, and amphetamine are just a few of the Schedule 7 medications. The final schedule, Schedule 8, contains just three drugs, which are available only for research purposes and medical analysis, but not for consumption.
One illegal stimulant which can have a similar chemical reaction in the body to Ritalin is the non-medical form of cocaine (a fact that elicits this reaction from Bill: “What? No fucking ways!”). It is perhaps for this reason, and because of the positive effects on concentration and focus, that Ritalin is a drug of choice for students at a university level. An article by journalist and former student, Amy Green, documents the use of the drug at the Rhodes University campus. Many students have become dependent on the drug to get through lectures, assignments and exams, but also use the drug recreationally. Green describes students crushing the pill into a white powder and snorting it to get the stimulant straight into the blood stream, a habit that seems to be common practice among students who abuse Ritalin.
When Bill was prescribed the medication he had to weigh it up. “I didn’t like the idea of taking Ritalin because it’s got a bad stigma.”
Despite his understandable apprehension he decided to give it a shot. “It made me feel in control. It made me feel better. And I realised what it felt like to be a normal, functioning person. It made me realise that I wasn’t functioning before. Because I think that before — and I think that a lot of people have this experience — is that you think you’re doing okay, you know? But really what you’re doing is white-knuckling it.” He has balled his hands into tight fists and he slowly pushes them through the air as if it is resisting his movement. His knuckles are a blotchy red and white colour.
“Before Ritalin I’d have four or five projects all going at the same time and so it used to be like band, woodwork, drawing, painting, oh ja and I have job, and some poetry, and this other thing, and this other thing. And sometimes it’s like I’d do all six or seven of those things but little bits and some at the same time and it all comes out like a big mush.”
He recognises though that it’s difficult for parents to take the leap. ADHD can often be genetic (Bill suspects that both his parents have ADHD) and so he may face this problem himself. “I think Ritalin’s good because it’s good for me. But I can understand that as a parent it must be terrifying to give your child a schedule 6 stimulant. But if it works, it works.” He shrugs. “I mean, with depression you take some pills and hopefully in three months those pills will kick in. And for some people they do really bad things. With ADHD you take a pill and half an hour later you feel it working. It’s like nothing on earth…there’s no mental illness like that. You take a pill and it goes away.”
Unfortunately, medical aid problems have meant that Ritalin has been a huge expense for Bill, who currently works as an animator, a job he rather bitterly jokes is like a “glorified waiter” in terms of salary. He pays R400 for 30 of the little white pills which lasts him one month. Because the medication is so tightly monitored, he cannot get a continual script, and so he has to go to the doctor each month to collect a new script. There is also no generic of Ritalin, thus the pharmaceutical companies involved in Ritalin hold the monopoly on ADHD medication. This has made treatment an expensive venture.
“My medical aid doesn’t cover it and I don’t get tax rebates for it. It means I have a chronic medical condition” — he lists the problems with his fingers, hammering home each one – “defined by the DSM, that I need medication for, every day, to function, that I can’t get the government to pay for, and I can’t get the medical aid to pay for.” His frustration is evident. “There’s a part of your brain that isn’t working or is missing. How can that not be a medical problem? It’s not like you got out of bed and like ‘Uuuh, I’m not feeling well’. It’s a real thing. A fucking problem.”
A Positive Thing
I’ve positioned myself in the corner of the coffee shop, facing the room, such that when Eshed Marcus arrives, he’ll have to sit with his back to rest of the room. I’ve done this purposefully because Eshed, like Bill, has adult ADHD, and I want him to have fewer distractions while we talk. He arrives straight from his office, where he works in digital branding. The first thing he tells me is that he’s had coffee today. And sorry. The caffeine buzz from a single cup has made his hand shake. “Caffeine is the absolute worst for someone with ADHD. Your mind cannot concentrate when you’re on caffeine. I’m all over the place. You will not keep me pinned down to my chair for more than an hour.” The interview might not go as planned.
Eshed was diagnosed with ADHD at the age of ten after teachers complained about his behaviour in school. He was being teased terribly by classmates because of his symptoms. Although his peers didn’t know that something was wrong, they knew he wasn’t like them. He often ran out of the classroom, and hid around the school until someone found him. On one occasion he became so overwhelmed he threw a desk across the room.
After being diagnosed, he trailed Ritalin for a month but went off it shortly after because it made him twitch. Once the other kids noticed him twitching, the teasing worsened and became unbearable. Eventually the guidance counsellor encouraged him to join a team sport so that he could socialise better. “That kind of turned everything around. Started making friends, started getting better. The class environment started getting better because I was seen as part of something.”
As we talk, Eshed often turns around in his seat to look at what’s happening behind him, which makes me think he’s either distracted or bored. “I can hear that conversation over there” — he gestures behind him to a loud waitress I hadn’t noticed several metres away — “but I’m trying not to.” Like Bill, he finds it difficult to block out conversations that are happening around him, a problem that was more pronounced at school. Teachers often complained that he didn’t listen to them. “I was actually paying attention. I was paying attention, just in my own way.” He explains that he passed all of his school exams without studying, because he couldn’t concentrate for long enough to study. So even though it looked like he wasn’t listening in class, he passed every exam based on what he’d heard in class.
“People always think that I’m not listening to them. But I’m listening to them and three other things at once. It takes a lot of effort for me to concentrate on one thing.”
Difficulty in focusing on one thing at a time is a common trait for people with ADHD, but he has learnt to adapt and use this to his benefit. “One of the biggest things I do is I have two computer screens at my desk.” He raises both his hands to show me the two computers. “I will watch a movie on my one screen” — he waves his left hand down the computer screen — “and I will do my work at the same time on the other screen.” He brings his right hand down the screen. While watching a movie and doing his work he will also be checking his email on his phone. “My work colleague doesn’t know how I do it. He calls it thinking fifth dimensionally.” He laughs. “I make more mistakes when I’m focusing on one thing than when I’m relaxed and doing more things.” A hyperactive brain needs to be overstimulated to feel functional.
One of the only things that he can do and focus completely on that one task is origami. “I realised it was because I was using my hands. As soon as it’s not just your brain that’s working but your hands as well, for me that’s something that got me concentrated on one thing.”
He’s also learnt to adapt to his fidgetiness. He works in digital branding so that he can use a computer all day. He enjoys computers because all ten of his fingers can be busy at once, which means he’s fiddling, but in a way that benefits him and other people. He’s found that people with ADHD have a very focused and possibly obsessive set of interests, and computers are one of these such interests for him. Although he can’t concentrate on most things for very long, he could spend hours a day breaking and fixing computers without getting distracted. “We’re very specific with things we’re good at. It’s almost like…they don’t say it is, but it’s almost like Asperger’s but with the ability to socialise.”
Asperger’s Disorder is an Autism Spectrum Disorder, in which people have repetitive behaviour and have significant impairment with social interactions, like communication, understanding non-verbal communication, sarcasm, and tone of voice. People with autism may not look people in the eye when they speak, will not make friends easily or even want to make friends at all. One of the key symptoms in Austism Spectrum Disorders though is the restrictive behaviours they display. They may spend hours just pushing a toy train up and down the carpet, or obsessively learn every fact they read about reptiles. Asperger’s has been described as “mild autism”, in which sufferers are always able to communicate verbally, but struggle with non-verbal communication and are described as “socially awkward”. People with Asperger’s frequently also have the immersive interests like the more severe autistic cases.
Although Eshed displays almost all of the 18 ADHD symptoms, which causes him to make frustrating mistakes (losing his phone once a week, forgetting to complete important forms), he thinks of ADHD as a special ability. “I’ve grown in to it. It’s part of me. I’m very happy to have it. I don’t think I’d enjoy concentrating on one thing…or reading.” He shakes his head in distaste. “No.”
He’s never tried Ritalin again since the trial in school. “I honestly don’t remember it helping at all.” Although he believes that in some cases it might be necessary to medicate children with ADHD, so that they can learn, he would discourage others from using it as a first call of treatment. “If my child had ADHD I would try everything in my power not to medicate them. Because when you’re medicated you’re not yourself. You’re not who you are. I’d rather have my child be different and have ADHD or ADD and try everything in my power to teach him how I grew up, how I managed things, than have him medicated and not feel like himself.” He credits a predictable routine to his functioning so well off medication. “Discipline is a thing that can help a child with ADHD. Getting them into a routine. A routine always helps.”
He’s also found that having more stimuli has helped him to concentrate, which might be why he functions better while multitasking. Many people with ADHD speak about a “white noise” that makes the brain feel “full”. He works best with headphones on, music playing, and in a dark room. “Most kids with ADD and ADHD will work with music on, with headphones on, with noise around them. Because otherwise your mind gets….lost.”
In the past, ADHD was thought to be a childhood disorder, one that people grow out of, but since the disorder has become so commonly diagnosed, researchers and psychologists have realised that most symptoms don’t disappear with age. What does happen though is that an adult can be more self-reflective than a child, and can exercise more control over the symptoms than a child. “After understanding what it is, I can use it to my benefit and not to my detriment. It got to the point in my life when I don’t see myself as having it anymore.”
Throughout the interview, one thing that Eshed keeps repeating is “positive”. He worries that ADHD has been given a bad name. “A lot of people don’t understand what it truly is. They think it’s a mental disorder when it’s not really. It’s just that the way we think is different. We think out of the box.”
“I am who I am. I can’t concentrate on one thing at a time. I’m happy that I can’t.”
A Professional Opinion
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Mareli Fischer is not what I expected. When she walks into our meeting room she is wearing a dark grey parka over a pale blue jersey, heavy black eyeliner and eye shadow, and ankle-high biker boots. If she were just carrying a half-full cardboard cup of coffee I would have been convinced she was a journalist herself. But she’s not a journalist; she’s a clinical psychologist who specialises in ADHD. She has a prominent nose and a warm, pleasant face that makes you believe anything she says. She works in private practice with a group of other psychologists, while working on her PhD in ADHD through the University of Cape Town.
She sits down, and takes out a notebook in which she has prepared some information about ADHD. Before we met, she asked me to send her the interview questions so that she could do some research to give me a useful interview. She flips her wavy shoulder-length hair to the side and begins by explaining the difference between childhood and adult ADHD. “When you’re a child at school you’re being watched by teachers and your parents. There are so many more people observing your development so people are very quick to pick it up. But then when you’re an adult a lot of these symptoms are privately experienced or not a lot of other people will understand why you do certain things.” She explains that one of the big differences is in the way that symptoms manifest in children and adults. While a child might have very obvious symptoms, adults are often able to repress their symptoms better than children because they are more concerned about social conformity. A child with lack of inhibition may interrupt people’s conversations or run around inappropriately, whereas an adult will want to do those things, but knows that they would get disciplined at work if they run around the office. Their lack of inhibition may be displayed in things like overly brash comments, or thrill-seeking behaviours like drag racing or extreme sports, which aren’t as recognisable as childhood ADHD symptoms. This could be why adults with ADHD are often misunderstood and wrongly labelled as childish or wild.
It is rare for someone to be diagnosed with ADHD for the first time as an adult, says Mareli, as symptoms are normally most recognisable in children, although it does happen to people. People like Bill, who had other difficulties compounding his ADHD symptoms, or people who don’t suffer academically often go through school unchecked.
Under the new DSM, ADHD is now categorised as a neurodevelopmental disorder, along with other conditions such as language disorders and autism spectrum disorders. Both Eshed and Bill mentioned the likeness between ADHD and Asperger’s Syndrome because of their hyper-focus in their areas of interest. Although this isn’t biologically accurate, there are behavioural similarities. “Whether it’s cars or computers or art or something, they will know more about that than any of us with our normally functioning brains.” Mareli smiles. You can tell she really cares about the children she treats.
“If they have severe ADHD they’ll be something that they’re interested in or they’ll have figured out what they’re gifted at. And they’ll be motivated to focus on that. Whereas a child is motivated by toys and sweets and things like that. Less productive stuff.” Adults are also able to reflect more on their symptoms, and find solutions that work for them. “With an adult it’s quite a personal thing. They are responsible for their own behaviour. Whereas with a child there’s the mom, the dad, the teacher, you deal with so many other people. With adults you usually have other things to consider. Things like self-esteem, relationship problems. So often people who struggle at school will internalise ‘I’m the problem, I struggle, my brain works different from other people’s.’ And then when you’re an adult those beliefs might already be ingrained. So in a psychotherapeutic way you must deal with hurt and issues from that.” Mareli rakes a hand through her hair and ruffles it over to the side again.
Treatment can differ from person to person, but the most effective treatment is usually stimulant medication, like Ritalin, alongside Cognitive Behavioural Therapy. “CBT addresses things like routine, how to monitor yourself, when you’re studying which study methods to use. It’s supposed to challenge your thoughts and help you internalise your ideas and routines and things like that to help you.” Children are often treated by a group of professionals, such as an Occupational Therapist for learning techniques, a Physiotherapist for muscle tone exercises that help attention span, and a Clinical Psychologist or Educational Psychologist to help with behavioural difficulties.
Consistent discipline is important for children with ADHD, so that they can predict when their behaviour will be punished. Mareli explains that rewarding good behaviour is just as important because children with ADHD can struggle with self-esteem. “It’s good to praise and recognise when they do try,” she says. “Even if it’s just doing something ‘normally’, like remembering a school book if they usually forget, then say ‘great job!’”
Despite the success of treatment with Ritalin, parents remain concerned about the drug. “A lot of people are negative about the medication. And there are other things you can try first. So, for example diet, a low GI diet. Cut out sugar, especially for kids. Things like consistent predictable routine, so kids can predict like ‘At 7 o’clock I eat dinner.’ The hope is that if you have this routined household the child with ADHD will be able to internalise some of these control structures and be able to monitor themselves as they grow older.” As she speaks, Mareli checks through her notes, careful to include everything she has prepared for our interview.
She explains that because ADHD medications are stimulants, they can sometimes aggravate underlying anxiety problems. On the other hand, if someone feels anxious because they can’t concentrate, then Ritalin may be very useful in reducing anxiety. Some children can’t learn basic things like reading and writing without Ritalin. The choice of therapy depends on the person and their needs. “People come to you with preconceived ideas about what ADHD is, and Ritalin has a really bad name, but it’s so useful to some children. They wouldn’t be able to learn, read or write, go to school, without it.”
Diagnostics in ADHD have come under scrutiny over the years, which has led to the existence of ADHD coming into question. There are two reasons for this scrutiny, the first of which is a significant gender bias in diagnosis, in which boys are up to nine times more likely to be diagnosed than girls. In Mareli’s PhD study, she’s had 80 children participants, and only four are girls. This may be because boys are socially allowed to be more boisterous, more physical and as children are developmentally less mature than girls. This could make hyperactivity a more “masculine” behaviour. Although Mareli disagrees with masculinity and hyperactivity being linked, she does agree that there is a sex association, and this could be explained by male and female attitudes to good behaviour. “Girls are often socially more motivated to do well in school, especially when you’re younger. Girls want to be good and boys aren’t really that concerned yet.” Even though boys are diagnosed more frequently than girls, their symptoms are the same, irrespective of sex. “The way that ADHD affects their lives…not different.”
The second reason for the ADHD diagnosis being discredited is that many people believe that ADHD is simply a result of bad discipline, differences in personality or immaturity. Children naturally have shorter attention spans than adults, and are much more physically active than the average adult. This, coupled with compulsory schooling that forces children to pay attention for long periods of time, sit still and be quiet, means that the modern world has forced children to behave more adult than they are developmentally able to. “They’re pushed into a system. They’re forced to do things in a certain way,” says Mareli.
Cynics argue that this has resulted in professionals pathologising developmentally normal behaviours for children. Diagnosis is also very often based on a subjective opinion of observable behaviour in children, because children are often not yet able to reflect on their experience with ADHD. This leads to inconsistent diagnosis, as every adult feels that they are an expert in ADHD and qualified to make diagnostic decisions. Parents, teachers, occupational therapists and psychologists all feel that they can identify ADHD in a child, and label them so.
Others argue that ADHD is just a label that parents and teachers use to excuse themselves from bad parenting, and exempt them from any blame. The blame is then transferred directly onto the small shoulders of their child, who is labelled “the problem”.
However, Mareli has several responses to the cynics. Although many of the ADHD symptoms could be put down to “naughtiness”, a child with ADHD is not doing these behaviours on purpose. They can’t help themselves. A part of their brain does not function like the child who can remain in their seat during a lesson on the water cycle. “We know that it has a neurological basis. It’s got to do with neurotransmitters, adrenalin, certain parts of the brain.”
She adds, “If ADHD is real, then it’s pervasive in all areas. The kid won’t just have attention problems at school. It’ll be at home, with friends, when playing. It won’t just be limited to one environment. So that’s a giveaway. If he’s only acting out at school, there’s something going on.”
One lesson to learn from the cynics of ADHD is the relevance of any diagnosis. Critical diagnostics is a growing field in psychology, where the importance of diagnosis is questioned. “Why do we diagnose things? It’s usually just to get medical aids benefits or to be able to communicate with another professional. So if you come to me and I diagnose you then they know exactly what I mean when I say some disorder. But for the person themselves, I mean what difference does it make to how they feel?”
As the interview comes to a close, I notice Mareli’s gold wedding band. She looks too young to be married. She sees me looking at it, and tells me she recently got married. She looks down as if trying to reconcile something, and then says, “My husband actually has ADHD.” They met while she was doing her Honours in psychology, with a thesis on ADHD. She was explaining her topic to him on their first date, only to discover the person sitting across the table knew only too well what she was describing. “He wakes up in the morning and he’s like BZZZZZZ,” she waves her hand in the air like an aeroplane in flight, “and then when he sleeps it’s like DOOOOSSSSHH.” The plane crashes. “There’s no in-between in energy levels.”
I ask her how she deals with it, and her response reminds me of Eshed. “A lot of people feel like it’s this really negative thing, but in a way it can be quite a creative gift. It’s not a death sentence. You can use it in a way that can add something to your life. If you have ADHD you have this childlike interest and energy that can be quite appealing to other people and if you can see the world in that way, like an adventure, that can be quite beneficial.”
A day in the life
It is 5.30 am when Bill’s alarm clock rings. He has 45 minutes to get ready for work. Exactly 45. If he takes longer than that then his whole routine, which he has spent a very long time trying to maintain, will be wrecked. The morning routine isn’t easy because when he wakes up, he’s not on Ritalin yet, so remembering something simple like his lunch becomes difficult.
He showers, brushes his teeth and walks down stairs. Once he’s downstairs, he doesn’t go back up. Everything he needs for the day is packed in his bag at the fireplace. He feeds his dog and then makes himself oats. He needs to eat a substantial breakfast because taking Ritalin on an empty stomach is not a good idea. Bill remembers the day he had only one piece of toast before taking his Ritalin. It wasn’t a good day. He had felt like an Energiser Bunny for about four hours, frantically doing everything with his heart racing like he’d just finished running The Comrades, only to have those energy levels take a sharp nosedive just before lunchtime. So oats it is.
Beatrice comes downstairs and Bill hands her a cup of tea he’s made for her. About 20 minutes later they pull out of the driveway in their blue Taz and head towards the train station. They travel six blocks until Bill feels something nagging him. “Beatrice, there’s something I’m forgetting.”
“Have you got your watch?”
“Got my watch.”
“Got your cellphone?”
“Ja.”
“Have you got your lunch?”
“Ja.”
“Have you taken your Ritalin?”
“Ggsk! No.”
Beatrice turns the steering wheel and heads back home.
***
When Bill remembers to take his Ritalin, he is able to lead a more “normal” life. He left his job because he realised his colleagues weren’t helping him stay healthy (they were a mix of drug-abusers and quite possibly psychotic people), and his boss was using ADHD to leverage a constructive dismissal. “Doing the same thing eight hours a day, I don’t understand how people can do it. It’s such a terrible feeling at the end of the day. Like that feeling you know when someone rubs the same spot on you over and over and over and if they do it long enough you’ll start sweating and you’ll get this…it’s not nice. That’s kind of like what the end of every day would feel like. It was like this endless repetition. And it was mind numbing.”
He joined a new company, and his new colleagues thinks he’s great and he’s even recently been promoted to Senior Graphic Designer. Even though he is now much happier, he wouldn’t want his new employer to find out about his ADHD, just in case. “It’s kind of really sad because it’s got a really negative stigma, but it’s the most treatable mental illness on the planet.”
When he forgets to take his Ritalin, his days are just lost. He is restless, fidgety, he chews his tongue, cracks his knuckles. He can’t stop talking, people get glazed looks when he speaks. He can see it, but he doesn’t stop talking. He interrupts people’s conversations from across the room. Any noise distracts him, and can make him very irritable. Getting any work done becomes impossible.
“At work our offices are above this loading area for a plastic company and they have these two forklifts that keep reversing all the time. And it’s like ‘doot doot doot’. And sometimes I just sit there and I’m frozen and I’m just listening. And, what I end up doing is that the fork lift will go ‘doot’ and then I go ‘doot’. And it goes ‘doot’ ‘doot’ ‘doot’ ‘doot’. And everyone will turn to me in the office and go,” he whispers, “‘Please don’t do that.’”
“I don’t believe that a person with ADHD can’t do something that a normal person can do to a certain extent. It’s just the amount of effort it takes me to do that is like four or five times more.” While the average person would find it easy to be on time for an appointment, Bill uses his smartphone to ensure his timeous arrival. His phone sends him a reminder two days before an event, then two hours before and event, and then 15 minutes before an event. He normally arrives at his destination half an hour early, so that he isn’t late. This over-compensation is the effort that Bill is talking about, and is part of the reason that he sought help.
Over the years he has frequented the offices of several healthcare professionals. He found psychologists by walking in to clinics in Cape Town, or asking friends for recommendations. He had to terminate therapy on many occasions because the cost of sessions became too much for him to pay without medical aid. Most recently though, with his promotion and a steady job, he is able to go to his new psychologist twice a month. “It’s helped me so much. It’s helped me advance my career. The amount of development I’ve seen in the last two years is probably more than the development I had from when I was 20 to 28.”
One of the biggest changes is that he is now able to plan for the future. “I have long-term goals now that I can work to and map out in my head.” He enrolled through UNISA to finish his art degree, and, without Ritalin he doesn’t think this would have been possible. “I can’t tell you how cool it is to, like, finish something.” He says it like he’s been longing for it for a long time. “I finished a painting the other day. And it took me a year to paint. That means that by myself I sat in a room for over a year doing one thing.” He holds up his index finger. One thing. “I wish I had the ability to do that when I was 18. I wouldn’t have gone back to try finish my degree if I wasn’t on Ritalin because I can’t finish books. And now I can, so it’s cool. It’s really rad.” The painting he is talking about is propped up against the wall in the corner of the lounge. It shows a fully clothed middle-eastern man lying in a bath tub with flowers floating on the surface of the water: “Brophelia”.
A technique that has helped him to stay focused is to have areas that are designated for only one task. Bill calls them purpose-driven spaces. “Upstairs I have study space and a bookshelf with some books on it. And sometimes I read downstairs but most of the time I’m upstairs reading ebooks. And I also have my desk. And it’s not a sitting desk. It’s a standing desk which I think helps me a lot. And then I’ve got a painting space in the garage which is really important.”
Because of the difficulties that Bill has had with ADHD, he resents it when people deny the existence of ADHD and put it down to naughtiness, or impulsivity. “They’re deluded. They’re obviously people saying that without having the disorder themselves. I unfriended a friend off Facebook last night for doing that. For saying the autism, ADHD and another disorder are all imaginary. Like a silent pandemic of some imaginary mental illness and it doesn’t exist. And, like, if you just open your mind,” he is whispering now, his eyes wide and mocking, “and accept who you truly are…Like, shut up. No really. It’s so stupid. People who say that are either parents of kids with ADHD and they really, really want to believe that their children are perfect. Or they’re people without medical degrees or ADHD. So they haven’t studied it and they haven’t experienced it.”
Bill has likened ADHD to both autism and Tourette Syndrome. In fact, although it is not widely discussed, about half of people with Tourette Syndrome will also have ADHD. The lack of inhibition and the tic-like impulsive need to perform certain behaviours are common to both disorders. Like Eshed, Bill likens ADHD to autism because of the extreme ability to concentrate on tasks that interest him for much longer than an average person. “When I was younger I would just draw for hours and hours and a lot of people call that order-focusing but that has to do with autism which is not ADHD. It’s more to do with you sort of doing something that’s really immersive.” Now when he paints he can’t paint without singing. Doing an extra task helps him to focus, which is common for ADHD sufferers.
There are some tasks that he can do without multitasking. “I have a theory about that. What I really like about woodwork is that you’re really busy with your hands all the time and there are like all these tools.” He splays out his hands, showing me the row of tools, his eyes are bright with excitement like a child in a candy store. “It’s like that immersive thing. You get drawn into something where, like, every part of you is busy with something essential. It’s the same thing with music and guitar. Each hand is doing something different.”
He has mixed feelings about ADHD now. Sometimes he even forgets he has it. “It doesn’t feel like the thing that defines me yet. Maybe it never will.” He knows that his personality has been shaped in reaction to his experience with ADHD, but he wishes his life would have been bit easier. “I definitely wish that someone picked it up earlier. Like in high school. That would have been awesome. I won the senior art prize but almost failed matric. You know? It would been cool to get the senior art prize and get a good report card and go to university and do well like any normal person would’ve been able to.”
***
Bill walks upstairs and switches the computer on. It’s time to do that essay.
Oh. His glasses are downstairs. He walks downstairs. He gets to the landing and looks around. What was he here for?
Coffee! He boils the kettle.
Oh. It’s break time. Computer games sound fun. He walks upstairs and sits down at the computer.
Oh. His glasses are downstairs. He walks downstairs. What was he here for again? The kettle clicks off in the kitchen.
Coffee!
Beatrice stands in the doorway, frowning as she watches the show. “Honey, did you take your Ritalin today?”
