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In fifth grade, Timothy Denevi got on authority’s bad side. During the first week of class, he challenged a teacher’s assertion that jazz was America’s sole homegrown music: “What about rap?” he asked. “I would suspect that rap music originated somewhere in the tribal regions of Africa,” the teacher replied. Denevi laughed at the indisputably idiotic reply. Who wouldn’t?

That’s a small, relatively nonconfrontational moment in Hyper, Denevi’s half-memoir, half-history of ADHD. Growing up in the Bay Area, he had plenty of moments that were more alarming—tantrums and fistfights and spasms of self-harm that sent him on and off medications since he was 5. But the real trouble with the condition, Denevi suggests, lay in more modest conflicts, ones where people can alienate those who are best positioned to help them. And kids with ADHD need all the help they can get.

Help how, though? There are and have been drugs—Adderall, Ritalin, Thorazine—but none that work consistently in all cases. Worse, as Denevi details, psychological theorists’ notions about childhood hyperactivity have often been all but snatched out of thin air. British scholar George Frederic Still called it a “defect of moral consciousness.” A German doctor suggested a “schizophrenogenic mother” may be to blame. (“Shitty parenting,” Denevi helpfully translates.) There have been forced-sterilization schemes, dietary schemes, psychiatric schemes—countered, since the ’60s, by antipsychiatric schemes claiming that ADHD is just an invention of Big Shrink and Big Pharma to keep brilliant iconoclastic types down. (Denevi argues that a Scientology anti-Ritalin campaign along such lines prompted a 39 percent drop in prescriptions between 1988 and 1990.)

That Denevi, a D.C.-area resident and visiting nonfiction writer at George Mason University, can articulate this clinical confusion without blowing a gasket himself is a credit to his poise as a writer—and the intense support he received from teachers, therapists, and family. (Denevi’s mother supervised her son’s teachers almost as much as they supervised Denevi.) He is frustrated at “misdiagnosis and overdiagnosis, and a reliance on drug therapy as the primary line of defense against disorders that, because of their nature, demand a multifaceted approach.”

It’s unfortunate, then, that Denevi writes little on how many of those children who suffer from ADHD get such demands met, and what that approach should look like. Two thirds of the 6.4 million American children with an ADHD diagnosis are taking pills, but how many get years and years of training to acquire mental skills to stay focused during the SATs? Denevi did, and he botched the test the first time around anyway.

For his own part, Denevi considers himself lucky. After falling into boozy trouble with a couple of classmates in high school, he had enough presence of mind to be compliant at his expulsion hearing. “If ADHD doesn’t determine you, it does tend to limit your second chances,” Denevi writes, “a reality that, at the very least, places a premium on the moments in which you’re conscious of deciding what happens next.” Hyper’s conclusion suggests he got through OK, but that optimism is based on a sample size of one. As drug companies push a single-pill solution on one side and critics decry overmedication on the other, the tools to help kids develop that necessary consciousness can seem as far away as it did a century ago.

Denevi will appear at the F. Scott Fitzgerald Literary Festival in Rockville on Oct. 18.