Amazing what a little sugar will do for a 4 yr. old

This won't be one of those offer-a-poor-child-a-sweet-and-have-a friend-forever kind of story. It is amazing how ADHD crosses cultures. In the States we tend to give names to many behaviors so as better to validate the parents notion that their child has special needs. And many do. And many parents are complicit in this.

Today I was asked by a colleague in Lobatse to see a 4y/o boy who was apparently having "fits" in that he would sleep so soundly that he would urinate on himself. As we (med student, resident in FM, and medical colleague in the FM residency in Stellenbosch) walked into the room the child erupted and in no time had the place torn apart, had slapped us, bit one of us, and payed no attention to the entreaties of his mother to stop until he was given some sweetened juice. Then he spit through the straw and spilled the juice all over the room.

I did the usual history and PE. It turns out that he might have been slow to breathe after birth but that of course can't be quantified here. He appeared to have a touch of microcephaly and was truly off the wall hyperactive bonkers. I said "lets see if we can gain his attention", a true diagnostic branch in the differential. I held he head in my hands, raised my index finger in the sign of the alpha male and said with a loud and firm voice, "NO!" And he melted into my arms, whimpered, put his thumb in his mouth and wuzzed my arm, hair, ear hair (needs to be trimmed along with my nose hair), and head. Quiet...

And then after about a minute resumed the bonkers part. I mentioned the prognostic benefit of being able to gain his attention and congratulated the mother on her caring of what must be a difficult child. Turns out the only reason he sleeps so soundly is that he rarely sleeps! And when he does it is the sleep of a 4y/o that is dead to the world, enuresis and all.

As he ran around the room hitting us I emphasized the need and use of consequence behavior as it provides structure and a set of guide posts for a 4y/o boy. As he hit, I would restrain him between my legs. It he hit me, he lost the privilege of using that are for a moment simply to reinforce the notion that while consequences can suck they are never the less every where and we might as well start now. As I was discussing this he got so wound up in my arms and lap that he urinated in my lap. Good thing I have Walmart pants that are basically a suit of armor; hot as hell in the summer, but shed water for some odd and helpful reason.

His mother was aghast that I could "make him behave". I pointed out to her that she indeed had her hands full but with a little planning ahead at least the inmates wouldn't be running the asylum.

He obviously needs some medication help but it continues to amaze how the path of least resistance compounds this very vexing problem. And how it crosses cultures, ethnicities, and genders.

I excused him and his mom to write the note and discuss the case with my colleagues. After doing so we walked out into the hall and noted that his mother was again bribing him with some sugar cane! Sigh....and the cycle continues. Like putting a coin in his slot, the hallway and the patients there were not enjoying it.