ADHD and Swine Flu: Similarities at Home and Abroad

"The main problem in Egypt is follow-up. A decision is taken, there is follow-up for a period of time, but after that, they get busy with something else and forget about it."
-- Chief of Infectious Disease, Department of Agriculture, Cairo, Egypt?

I’m pretty sure that the Egyptian medical expert who made that statement last month had no idea he was exactly describing ADHD symptoms. He was merely explaining why there is now a terrible pile-up of rotting garbage in Egypt’s cities after the government-ordered slaughter of every hog in the country.

It was a well-intentioned act. Egyptian officials were trying to prevent an outbreak of the flu formerly-known-as-swine-flu. But someone, somewhere, forgot that the pigs functioned as environmentally friendly garbage processors, roaming free, noshing on leftovers that are routinely tossed onto the streets.

Now, the leftovers are literally left over, turning the cities’ streets into giant compost piles. It’s smelly and people are understandably angry. And the whole snafu sounds like an ADHD moment to me. But it probably doesn’t wear the ADHD name tag.

In Egypt, as in many Middle Eastern countries, attention deficit hyperactivity disorder is barely acknowledged as a medical diagnosis. Researchers are aware of the disorder; I found a substantial research study on school-age ADHD children in the Delta region of Egypt. More often, however, ADHD symptoms tend to blame the victim for being “naughty, misbehaved” or even mentally challenged.

Although the prevalence of ADHD in the Middle East is considered to be about the same as the rest of the world -- 5 percent of the general population -- there are far fewer ADHD diagnoses. And there are no ADHD accommodations for students in the public schools.

The good news is that in April 2009, the Egyptian Parliament enacted a long-overdue law that substantially alters mental health treatment. The Egyptian Initiative for Personal Rights (EIPR) vigorously advocates for the rights of people with mental health disabilities. The progress is slow, but significant.

As I learn more about ADHD abroad, I have a new appreciation for the mental health services available in the United States. The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), as out-of-date as its ADHD criteria seem to be in 2009, is pure gold when used for appropriate diagnoses and treatment.

In the final analysis, it makes no difference if that unnamed decision-maker in Egypt has a diagnosis of ADHD. It is equally unimportant whether the statement about lack of follow through within Egypt’s leadership is accurate. The lesson is that ADD-ish behavior -- impulsive choices, lack of forethought, single-minded adherence to a goal, even a laudable one -- can create an ADD-ish nightmare that affects hundreds of thousands of people.

I often bristle at ADHD treatment that entices me to behave in a more linear fashion, to think in logical sequence. I am more comfortable when my wild and erratic ADHD brain is allowed to skip and play at will. But this incident draws me up short, forcing me to look at the serious effects of ADD-ish behavior. It’s not funny. It’s not whimsical. And it needs to be addressed effectively.

On a lighter note, I must say that Egypt is at the top of my list of “Must See” countries. I want to stand in the shadow of the Great Pyramids and float down the Nile. After careful consideration, I think I may wait until the flu pandemic runs its course...and the pigs, like the swallows of Capistrano, return to Cairo.