Different Strokes

Posted on 1 October 2017

By Mark van Dijk

This is a story about Cameron van der Burgh, but it’s not a story about an Olympic champion. It’s about a parent whose child was diagnosed with ADHD, and about a little boy who just needed to play.

Cameron van der Burgh knew something was wrong when he came home to find his mother throwing his medication down the toilet. “She was crying,” he recalls. “I asked, ‘What are you doing?’ and she said, ‘We’re going to tackle this a different way.’”

Cameron had always been fidgety. “I was bouncing off the walls and it would drive my mom crazy,” he says. He was restless, constantly distracted, easily bored. And it was starting to show in his schoolwork. “I wasn’t getting great marks,” he says. “My teachers wanted to hold me back in Grade 1, because I was such a handful. By the time I was 10 it was easier to put me on medication and hold me back a year at school, than to work with me and try to find other solutions. My mom could see that whenever I did my schoolwork, I would get As and Bs at first, then lose concentration and end up failing the term.”

There were, inevitably, behavioural issues too. “I wasn’t crazy naughty and I wasn’t doing malicious things,” Cameron says. “But I was hyperactive. I couldn’t just pick something up, finish with it and move onto the next thing. I was doing five different things at once and the effort was half-hearted. That was the determining factor. My mom took me to a doctor, who diagnosed me with ADHD and put me on Ritalin.”

Typically for a child with Attention- Deficit Hyperactivity Disorder, Cameron found it difficult to start a job and see it through to the end. “ADHD is caused by a problem in two areas,” explains Dr Tertius Christie, a paediatrician at Mediclinic Durbanville. “One governs inhibition, where you’re hyperactive and impulsive; the other has to do with working memory, which is your ability to pay attention to a task.”

The medication methylphenidate, usually prescribed to young patients and often sold under the brand name Ritalin, works by increasing the concentrations of the chemicals dopamine and norepinephrine active in your brain. The result is an improvement in your brain’s reasoning, problem-solving and planning abilities, and in its ability to inhibit your behaviour. Unfortunately, Cameron suffered a not-uncommon side effect of the medication: “It killed my personality,” he says. “I was doing well at school, but I would come home and sit on the couch and just stare out the window for hours. The medication stole my personality. I was just a robot.”

Tumble turn

That’s when Bev van der Burgh threw the pills away.

Rather than medicating their child, Cameron’s parents tried a different approach, channelling his energies into extra-mural activities. “I did a different sport every day,” he says. “I was fortunate to have an array of options: rugby on Monday, cricket on Tuesday, swimming on Wednesday … it was great! I would go to sport after school, and when I’d come home I was relaxed and able to sit and do my homework. I wasn’t this crazy kid that my mom couldn’t control any more. When I was playing sport, I was spending my energy on something productive. And
I was still me.”

Swimming was the sport that came most naturally to Cameron. Something about the tactile sensation of the water appealed to his body’s craving for stimulation. And he took to it like the proverbial fish. “When I was in Grade 2 at Glenstantia Primary we had an inter-house competition and I beat all the other kids by far,” he laughs. “I’d had no training. This was just something I had inside of me. One of the teachers came to my mom and said, ‘Listen, I think this kid has a lot of talent. You should take him to a club.’ So I enrolled in a swimming club and went from strength to strength: from being best in the school to being worst in the club, from worst in the club to best in the club, and then on to winning medals. I was always trying to be better than I was before. And now I was able to pick something up and complete it, and put all my effort into it, without losing steam halfway through.”

As Cameron’s case indicates, exercise can help young patients who are struggling with ADHD. “To clean the mind, the blood must flow,” Dr Christie says. “You need to get a child outside, doing some exercise.” But Dr Christie also warns that exercise alone is not always an effective treatment. In many cases, exercise and medication should go hand-in-hand.

Dr Hannelie Potgieter, a paediatrician at Mediclinic Potchefstroom, agrees. “For a school-age child you would typically combine behavioural interventions with medication,” she says. The value of medication, she explains, is that it helps to organise the patient’s mind. “A child’s brain is like a computer desktop,” she says. “If you don’t organise that desktop screen, you’re left with a bunch of files lying around. If your ADHD child needs to focus on something they won’t be able to access the right file. Medications like Ritalin put those files into neat folders. This makes it [Continued on page 16] much easier for your child to access the specific file they need in that moment.”

In Cameron’s case, he found that swimming practice gave him a set of skills that helped him organise his brain’s cluttered desktop.

One lap at a time

Cameron’s strength is his ability – forced by his condition – to break a session up into manageable tasks. “Swimming training is interval work,” he says. “It’s start-stop-start-stop, and you’re swimming 100 or 200 metres at a time. You’ll maybe swim 5km in a session, but not continuously.

“So where other swimmers would look at 10 sets of 200m each, I would get in the pool and focus solely on the first 200m. When that was over I’d focus on the next 200. Then I’d go into the third set, then the fourth, and so on. I would have the big picture in the back of my mind, but it wasn’t always front of mind, where it scares a lot of people. I’ve learnt how to look at the big picture, and then micromanage the individual parts. When you put all the pieces together, it makes up a big puzzle.”

Again, where other swimmers would break a race down into laps, Cameron breaks it down into strokes. “That’s a trick of the trade, and it’s how we work out our pacing,” he says. “I know, for instance, that in a 100m breaststroke race, if I’m swimming at 18 strokes in a lap, I will turn after the first 50m at a time of 27.0 seconds. If I want to accelerate I’ll go 19 strokes, and if I want to go slower I’ll take it back to 18 strokes. That’s how I pace myself without using a wristwatch, and it’s also my way of dealing with things.”

Cameron is now a multiple medallist and an elite athlete, with an Olympic gold medal (100m breaststroke at the 2012 London Games), Olympic silver (the same event at the 2016 Rio de Janeiro Games), three Commonwealth Games gold medals (50m breaststroke in 2010 and 2014, and 100m breaststroke in 2010), plus multiple golds, silvers and bronzes at various long- and short-course World Championships. As strange as it sounds, he credits his ADHD as one of the factors that has helped him to achieve these successes.

Stay the course

“When you go into the Olympic Games or the World Championships, a lot of champions from previous events crack under the pressure. It’s a crazy thing to see,” he says. “I’ve learned how to deal with right now, rather than getting lost in the bigger picture. So I’ll go into the Olympic final, and in the back of my mind I’ll know it’s an Olympic final, but the pressure, the opportunity and the big stage are not clouding my mind. I’m not thinking, ‘It’s an Olympic final, it’s an Olympic final’ … That’s what breaks people. I’ll go out and live each moment – each lap, each stroke – one at a time.”

What worked for Bev van der Burgh and her son may not work for you and your child. But if your child does suffer from behavioural problems, and if a thorough examination does return an ADHD diagnosis, it may be worth speaking to your Mediclinic doctor about all your options – and about the benefits of physical activity.

Cameron still has ADHD – but over time, and by finding a positive outlet for his energies, he has learnt to manage it. “I still find that if I haven’t trained, I’ll wander off into a two-minute dreamland when I’m supposed to be working,” he says. “But I’ll snap back into it. I’m more mature now. I have a lot more self-control and I know how to manage my condition. I’m still very easily distracted. It’s in my nature. I don’t think I’ll ever change. But through sport I’ve learnt how to control it – and that’s something that will stay with me forever.”

Does your child have ADHD?

Probably not. “It’s definitely over-diagnosed,” says Dr Hannelie Potgieter of Mediclinic Potchefstroom. “Teachers will often say to parents, ‘Take your child to the doctor and put him on medication, because he’s hyperactive,’ without going through the proper process.

That process involves a full, accurate diagnosis, which should be done by a health professional – either a doctor (usually a paediatrician) or a therapist (often an occupational therapist). “They will look at the core symptoms,” says Dr Potgieter. “There should be attention deficit, hyperactivity and impulsivity, and those symptoms should present for a minimum of six months, and in at least two different environments – not just at school or just at home.”

Knowing the signs

The symptoms should also be abnormal for the child’s age. “We’re not going to say that a two-year-old child who’s hyperactive has ADHD, because it’s normal for a two-year-old to be hyperactive,” says Dr Potgieter. “I’ve seen children as young as four years old being labelled as having ADHD. Do you really want their growing brain to be exposed to medication – especially if the problem can be solved with non-pharmacological interventions like physical therapy, or play therapy, or occupational therapy?”

If the doctor suspects the diagnosis might be ADHD, they will first look at possible medical explanations for your child’s abnormal behaviour. “Children can’t always tell us where the pain or discomfort is, and sometimes they’ll become hyperactive because they’re not feeling well. You have to do a thorough examination, looking at things like elevated thyroid function, or other psychiatric disorders like anxiety. After that you’d look at other sensory organs, testing the ears and the eyes for example. They might not be listening because they can’t hear, and they might not be paying attention in class because they can’t see the board. Once you are sure it’s not a medical issue, you then move to the ADHD checklist.”

Only then – after the doctor has gone through the checklist with the parents and the teachers – should a final diagnosis be made. “As you can see,” says Dr Potgieter, “it’s quite a long diagnostic process!”

 

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