E. Borba, 2015

ADHD

Things might get worse, before they can get better...

By Ewerton Borba

                                                                                                                                                

                                                                                                                                           

     Before I started my career in the healthcare business, right around a time when I was making plans about my educational pursuits, the debate over ADHD and its status as a real disorder was gaining power. Although I did not have a firm opinion about the issue, I recall that I was very skeptical about the existing treatment options back then. And I tried my best to duck out of sight when invited in hot discussions about the topic—I was too busy doing lots of things at once.

     One day, I could not avoid the discussion. My nephew had a full blown diagnosis (i.e. combined presentation), and as part of the treatment plan, about 5 mg of Ritalin a couple of times a day to get started; so, my sister wanted my opinion—I bet she regretted to have asked. I was not the one who had to deal with the energizer bunny (that’s how I humorously tried to capture his bunch of symptoms) 24/7, and I have never been very fond of medications. Therefore, it was easy for me to say: don’t do it, there other forms of treatment out there.

     At that point, I began to see how stressful her life had become and how she had become completely unable to manage the situation. Only then, I could see a clearer picture of the dynamics of my nephew's illness. Things were deteriorating fast; so he started with his Ritalin routine. A quick emergency measure helped to keep his bad behavior at bay in school: he started on an IEP (Individualized Educational Program). Sporadic visits of psychoeducators at home helped to minimize the hemorrhage.

       Last year, over six years after he was first diagnosed, I took him on a trip for the whole day. It was more difficult to convince my sister that he was going to be fine than to keep him under control. Up until last year, he had the habit of asking to come back home a bit after leaving. But this time, there was no way that I would respond to his demands. We were going to the Cape for the day and we would be several miles away from home. Of course, we both needed to have a mutual psychoeducation about the potential risks of that endeavor, but off we went.

      My sister recommended that I should bring a provisional dose of his meds in addition to the regular stuff, which I did without hesitation. But while I drove down diligently on 93 South that Sunday morning, I had a plan: I would not give him any medication. Instead, I would try different strategies to divert any of his attempts to spoil the day. First I played with him to exhaustion (at least that’s how I felt), gave him full attention, and even wasted a few bucks on some useless snacks. His mood started to change at the same time the sun began heading down south. But I still had a card up my sleeve, and I took him of a different type of trip: we had the coolest meditation exercise right on the beach.

     That little exercise was enough to extend our day at the beach. It also convinced me that no single approach can minimize the multifaceted nature of an illness like ADHD; most often, it requires dexterity yet simplicity to address its complicated etiology. In that scenario, I resorted to empathy and exercised patience while I ventured to see the world through the esurient eyes of an ADHD patient. Even though I was positive the entire time with my forecast for our afternoon, he surprised me more than I expected. (By the way, I returned the provisional Ritalin stuff to my sister.)

   A little over six months later, a referral landed on my desk, to eventually become the most complicated ADHD case I ever had. It was several months of an exhaustive psychological battle that involved a number of healthcare professionals, including my IHT (In Home Therapy) team, crisis teams, and the like. Several strategies were laid out, just to prove ineffective afterwards. Only after looking at the whole picture, flexing the context to distal environments, and retracting it back to the personal level, that we were able to have the client on board.

     One week, a week after the crisis intervention team was called in and we were beginning to have an overwhelming déjà vu feeling prior a visit, I remember that I had a card up my sleeve. In the midst of the initial tense moments of a play therapy, I suggested to the client that we went on a trip. To my surprise, he agreed. Then we had the most prolific session ever, with the coolest meditation/visualization exercise I could possibly have with this client. Things were never the same after that session...

References

 [Photographs of Ewerton S. Borba]. (ma. 2015). Ewerton S. Borba (Personal                                     Archive). Boston, MA.