Jeremy, age 12, sits in my office flanked by his mother and father. We have concluded our intake stage of his ADHD evaluation — meaning that we have pinpointed Jeremy's symptoms, struggles, and triumphs through his words, and we have noted the observations of his parents and teachers. We are gathered for the all-important diagnostic feedback session, in which I will tell Jeremy and his parents what my team and I have gleaned from these "history lessons."
Jeremy and his parents seem tense. Jeremy, his baseball cap on backward, stares at a spot on the floor, as if he wants to be somewhere else. Mom and Dad lean forward, looking at me with anticipation and fear written on their faces.
I get to the point. "I have great news for you. We've learned a lot about you, Jeremy, and guess what? You have an amazing brain. Your brain is incredible."
Jeremy looks up, and Mom and Dad lean back a bit. "Your brain is like a Ferrari. Do you know what a Ferrari is?" Jeremy nods, smiling. "Well, your brain is like a Ferrari race-car engine. It is very powerful. With the right care, you will win many races in your life."
I pause. “But there is one problem.” Parents and son shoot looks at me. “You have bicycle brakes. Your brakes are not strong enough to control the powerful brain you’ve got. So, sometimes, you race past places where you mean to stop, or you ignore instructions you mean to hear. But don’t worry. I am a brake specialist. I will help you strengthen your brakes, so you can become the champion you are.” For the next 15 minutes, we discuss the race-car brain outfitted with bicycle brakes.
Russell Barkley, Ph.D., has described the neurological underpinning of ADHD as a relative state of disinhibition, giving rise to three negative symptoms: distractibility, impulsivity, and hyperactivity. A person with ADHD can't inhibit incoming stimuli, which causes him to be distractible, and he can’t inhibit outgoing impulses, which causes him to be impulsive or hyperactive.
In other words, a child with ADHD has weak brakes. The aim of treatment is to strengthen those brakes. While Jeremy, his parents, and I discuss this idea, the fear in the room subsides, as if an approaching high pushes a nasty storm out to sea.
Gradually, the sun shines through, filling the room. Worry and fear melt into relief and enthusiasm. Jeremy’s parents start sharing stories. "Let me tell you about when Jeremy's brakes failed him last week," says Jeremy's dad, and all three of them start to laugh. A potentially tense meeting turns into a fear-free discussion, as we brainstorm strategies for winning life's races.