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

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