Confused and Overcome with Bursts of Violence, It Sounds Like ADHD, But It's Not

“Then sundown comes around again, you find yourself alone
You wander through a sea of eyes but always on your own.” - Eric Anderson

At the end of my last post, I was about ready to leave my parents’ house in Delaware and head home to Georgia after spending a couple of weeks helping my mother and father deal with my dad’s recent traumatic brain injury. My father was temporarily settled in a residential rehab center, and my mom was getting over the shock of the accident and settling into her new, hopefully temporary, life at home alone. My wife, kids, mother-in-law, and dog were anxious for me to return home to Georgia and I was anxious to get there, but the night before I was going to leave my mother’s house, the rehab center called. My father had gotten violent. He’d injured some staff members.

As I run through the doors to his floor, I see Dad slumped in his wheelchair in front of the nursing station. He raises his head and watches me with a mixture of guilt and suspicion as Thomas, the charge nurse, pulls me aside. “Your father struck and kicked three aides today, hurting all of them," he says. "We sent one woman he kicked in the stomach to the emergency room. She’s home now and going to be all right, but this is a serious situation.”

I nod, dumbstruck, and tell Thomas my dad has never been violent before. Thomas says that many brain injury and dementia patients go through personality changes. They can get progressively agitated over time, especially in the evening hours when they become obsessed with getting out and going home. The condition is called sundown syndrome, and Dad is one of the most extreme cases Thomas has ever seen.

I tell Thomas that I understand that it’s serious and ask what we should do about it. He says tomorrow I’m to meet with the nursing director to discuss finding other accommodations that can handle my father, like a psychiatric institution. “Right now,” Thomas says, “We need to get him tranquilized with Ativan. He’s refused to take the pills, so we want you to help calm him, holding him if necessary, so we can give him a strong enough injection to turn this behavior off for tonight.” I nod and try to absorb what the nurse is saying without looking as horror-stricken and terrified as I actually am.

When I was a kid growing up in the '50s and '60s, attention deficit hyperactivity disorder (ADD/ADHD) wasn’t really known, but my parents knew that I was a little odd. Reports from school and neighbors confirmed that when I wasn’t distracted and lost in daydreams, I was given to unpredictable spells of energetic acting out, sometimes resulting in fights, stealing stuff, and accidentally setting fires. Over and over again during those years, my dad told me -- when everybody outside called me a crazy weirdo -- that what the rest of the world thought about me didn’t matter. What mattered was my family. Crazy weirdo or not, they loved me. In the end, he said, the people in your home were the only people you could trust. As I finish talking to Thomas and step toward my dad, I think about all those times he’d stood up and took my side against school principals, bullies, cops, and local store owners.

Like he’s reading my mind, he winks at me and gestures for me to get down close to him. “I need you to bring me a knife,” my dad hisses in an urgent whisper. “An 8-inch knife, no shorter than 6, but sharp, you hear me son? I mean razor sharp.” He leans forward from his wheelchair to me, crouched in front of him, our heads together like conspirators in the middle of the night in this bright hospital corridor.

“Why do you need a knife?” I ask, careful to keep the alarm out of my voice.

Dad squeezes my arm, his face 2 inches from mine, his clear eyes locked on mine. “Why do you think?” he says and letting go of my arm, stabs the air between us with an imagined blade. “To kill these people. Gut them. To get the hell out of here and go home.” He grins at me, his eyes sparkling with energy and purpose. I can’t help but smile back. Dad seems so happy. He’s stronger and much more alive than he was just two days ago. This would be great news if he weren't also spouting vicious, bloodthirsty nonsense and physically attacking the nursing staff.

“Dad,” I plead, my voice low and urgent, “could you just take the pills they want you to take?”

Dad’s eyes narrow. “No,” he says. “No way, no how.”

“But then they’ll have to use a needle...”

“Let them try,” he says, his grin flashing, “They’ve got to get past you and me first. And together we’re one helluva tough nut.”

Thomas steps up behind Dad, catching my eye. Dad senses the movement and grabs my arm again. “Don’t look at them!” he shouts. “They’ll trick you!”

I gather resolve in my shaking body and ignore Dad’s protests as Thomas steps forward with the hypodermic of Ativan. I lean forward, holding my father’s arms and restraining him with my weight. I tell him to stay calm, that it’ll be all right. But as the needle pierces his thigh and the plunger pushes the tranquillizer into his body, he can only stare at me with shocked disbelief. The spark that I saw dancing in his eyes just minutes before flickers and dies with the realization that his own son has betrayed him. And then, as the drug takes hold, he understands that now he is completely alone.