'WHEN A FOUR-YEAR-OLD girl behaves so badly she is kicked out of three day-care facilities, babysitters refuse to look after her and the mother has to give up full-time work as a result then parents may suspect something is wrong. When she takes the car keys from her mother's purse and drives the family vehicle through the garage doors it is obvious there is a serious problem.'
Yet the real difficulty, according to Dr Thomas Brown is not with obvious cases he describes such as this, but with diagnosing and treating people who have attention deficit disorder (ADD) without the behavioural problems associated with hyperactivity.
Dr Brown, 63, associate director of Yale Clinic for Attention and Related Disorders, was recently in Hong Kong as the guest of local group FOCUS, which organises events to support parents of children with the whole spectrum of conditions that inhibit personal and educational development.
Although a leader in the field of ADD, Dr Brown accepts his views can be controversial. He has to contend with opposition. At the extreme end there are those who deny that there is any such thing. There are also sceptics who think that the condition is over diagnosed and over treated and that good parenting and behaviour modification will remove the symptoms. This, he says, is ignorance of the complexity and debilitating effects of a hidden danger.
'The trouble is that folks with ADD do some things very well and teachers and parents can mistake this as a problem of will power. It is not. Bright girls can sit at the back of the class and be called daydreamers, for example. Boys can be brilliant at sports but be unable to focus well enough to do even basic assignments. ADD does not discriminate against age, intelligence or socioeconomic status.' He tells the story of a boy who was the best ice hockey goalkeeper observers had ever seen, who was able to follow the puck around the rink every second of the game but was having enormous difficulty in school.
Stories are central to Dr Brown's work. Trained as a clinical psychoanalyst he first became sensitised to students who were struggling with ADD when he conducted a series of interviews with two intelligent high school students who told him of their own and their parents' frustration caused by chronic underachievement at school. 'Their descriptions of their experiences and not being able to focus, difficulties with organisation and regulating sleep, helped me realise that here were cases of 'can't' rather than 'won't'.'
