Ron Wall, the chairman of an international marketing firm based in Nevada,
could be a pin-up boy for attention deficit disorder (ADD). Sil-ver-haired,
Wall is a lanky six feet two and sounds a lot like James Bond. He has the
same British vowels and sartorial style, the same impeccable manners, and a
gleaming European sports car he uses to tool around town.
What’s missing is British reserve. Wall never hesitates. He strides into a
room with confidence and zeal. After meeting me, he immediately wants to
tell me about his latest idea, reaching out warmly as if we’re old chums.
When I met him he bounded up the stairs two at a time with his poodle, Loki,
in tow. He talked steadily to me as we headed towards his office, pausing to
engage with every staff member we walked past, his cell phone against his
ear.
“I can’t cut myself off from ideas,” he said, turning back to me, then a
moment later: “I don’t want to be outside myself.”
Forty years ago Wall thought up linking freebies to credit cards – now called
loyalty cards. Having amassed a small fortune, he is now considering
philanthropy as his next new thing.
I wanted to know how a British boy with ADD and a truncated education had got
to this point – head of a multi-million-dollar enterprise with franchises on
several continents.
During 20 years of clinical practice and teaching as a child psychologist, I
had seen mostly male patients. Boys and men with learning problems,
attention problems, aggressive or antisocial boys, those with autistic
features, those who didn’t sleep well or make friends, or couldn’t sit
still, dominated my practice – and that of every other developmental
psychologist I knew.
Research confirmed the gender breakdown of my waiting room. Learning problems,
ADD and autism spectrum disorders are four to 10 times as common in boys;
anxiety and depression twice as common in girls. From the point of view of
learning and self-control, boys are simply more vulnerable. Tests from a
huge sample of 15-year-olds from 30 OECD countries show that girls do vastly
better than boys in reading and writing and are neck and neck with boys in
maths.
Defining boys’ strengths and weak-nesses, and teaching others how to, had been
the focus of the first half of my working life. I had been at it so long
that many of my first charges were now adults, and to my surprise, I began
to see some of them featured as success stories.
One had become a designer of international renown. Another had made money as a
financial analyst and was leapfrogging from one investment bank to another.
A third had become an electrical engineer who had pioneered an invention. A
fourth was a chef on his way up. And there were more.
These apparently fragile boys had overcome their early difficulties. In some,
there seemed to be a flip side to early male vulnerability. Many of these
initially fragile boys continued to have obsessive interests or an appetite
for risk that set the stage for their careers.
Meanwhile, many of the girls their age who had been light years ahead of them
in classroom learning, language, social skills and self-control had opted
for paths that would not necessarily lead them to the highest status or the
most lucrative careers. So even if being male made childhood a bumpier road,
as adults at work, the situation was reversed.
Wall is a grown version of many boys I have assessed with ADD – restless,
distractible, voluble, quick to react. As he fidgeted with his phone, he
began to review his career, beginning with the car washing business he
started as a teenager, on to a stint as an underage croupier in a London
casino, followed by a gig developing advertising for a condom company and
eventually, hopping across vast landscapes of time and place, landing up as
CEO of this marketing enterprise.
Suddenly he segued to his family history, his parents’ postwar immigration to
London, interweaving his own and his son’s personal stories with references
to his ex-wife and his personal philosophy. I struggled to keep up with the
thematic changes and phone interruptions. He couldn’t keep to one topic and
I couldn’t keep up.
Research on men with ADD attests to their fragility – their frequent job
changes, sleep disorders and marital problems. We expect those with this
condition to struggle and perhaps fail, and many do.
But the ones who succeed often do so in a spectacular way, raising two
interesting questions: are there features of the disorder that are catalysts
for success? And as there are at least three times as many males as females
with ADD, is the disorder an exaggeration of more common male traits?
There is a phenomenon known as “increased male variability” that shows up in
school tests: girls’ results tend to cluster in the middle ground while boys
invariably turn in the best and worst performances. There are “more male
geniuses and more male idiots,” as the political scientist James Wilson
bluntly put it.
But their extreme male traits also boost them forwards, violating our
expectations of how fragile boys should turn out. They become extreme men:
athletes, criminals, inventors and multi-millionaires.
So, what is ADD? It is mainly characterised by inattention, especially in
repetitive situations where there’s little chance of novelty. “Dreamy,”
“forgetful,” and “not on the ball” are expressions often used to describe
those with the disorder, who also tend to be restless and impulsive –
blurting out unedited thoughts or taking untested risks.
Those with ADD often feel incapable of waiting. Nor can they easily and
patiently listen to others for very long, execute elaborate plans, inhibit
their urges or ideas indefinitely or be cool-headed about boredom. Often
hyperac-tivity goes along with these symptoms, creating a maelstrom of
energy and disorganisation that’s hard to ignore.
Affecting from 7% to 12% of children worldwide and 4.4% of adults, ADD is –
along with depression – one of the most common psychological disorders in
the world. But whereas depression is primarily a female disorder, men are
three times as likely as women to have ADD, and boys are up to ten times as
likely to have it as girls.
One reason why ADD is controversial is that its symptoms shade into
run-of-the-mill dreaminess and reck-lessness. And as diagnosis rates vary
widely among countries and even among regions within countries, there’s
continuing suspicion that ADD is just an artefact of culture, or the
brainchild of an alliance between drug companies and doctors.
Just the fact that 18 times as many boys are treated for it in America as in
Britain, that Scotland has higher rates than England, and Alabama has twice
the rates of Colorado, creates scepticism about whether the disorder is
“real.”
But there’s a growing consensus among researchers that ADD exists everywhere
in the world and that regional variations reflect a society’s tolerance of
unfocused behaviour and its willingness to face up to mental health issues.
Once the profile is known it’s identified more frequently: 5% of schoolboys
in Britain have now been diagnosed with ADD.
Hundreds of research articles documenting its genetic origins and
pharmacological treatments have appeared in scientific journals since the
early 1970s – evidence that has been largely ignored by the British
psychiatric establishment until recently. As a result, there’s still tension
between parents and teachers about whether a child’s restlessness and
inattention are due to lax parenting, bad teaching, poor diet, underfunded
schools, or a bona fide brain disorder with biological roots.
Unfortunately for those who want concrete proof of the diagnosis, there is no
lab test. But there are diagnostic signs. Being accident-prone, dropping out
of school early, drifting from job to job, depending on other people to be
organised, being unable to complete projects, self-medicating with alcohol,
and a hair-trigger response to conflict – all are clues of a possible ADD.
These problems surface because people with ADD have brains with distinct
features, and these features emerge due to several genes that work together.
Environmental factors determine how severely someone will be affected but
the basic pattern is laid down before birth.
Most adults with ADD had chequered school histories but no idea what was wrong
until they brought their own children to a psychologist to investigate why
they weren’t learning. Only then did they see their experiences reflected in
their children’s.
That was Ron Wall’s story. When he brought his preschool-age son to a
neurologist he discovered why he found school unbearable as a child, and why
as an adult he always felt like a maverick. “I didn’t care for schoolwork. I
wasn’t captivated by it. I was more interested in looking out the window,”
he told me.
But as he listened to his son’s doctor, Wall recognised his own pattern – the
impulsivity, flighty attention, the attraction to risk. When he was a child,
this behaviour prompted his parents to take him to the Tavistock clinic in
London.
“That was when I learnt I was different. I was a naughty boy and couldn’t
concentrate on anything. I was six. The diagnosis was that my parents had an
unhappy marriage.”
His search for stimulation has driven him to climb Mount Kiliman-jaro, go dog
sledging in the Arctic, hike in Mongolia and take on ever riskier business
ventures.
“I’ve hired the right people. I’ve done all the hard work. But now the
question is, how do I keep myself amused?” he said.
© Susan Pinker 2008
Extracted from The Sexual Paradox by Susan Pinker, to be published by Atlantic
Books on March 1 at £12.99. Copies can be ordered for £11.69 including
postage from The Sunday Times Books-First on 0870 165 8585
