Prevalence and Diagnosis
Despite the fact that ADHD is a disorder that afflicts between 5% and 10% of children and adults worldwide and appears to occur with equal frequency in males and females, it is not well understood by the lay public. In simple language, the average yeshivah classroom contains at least one, and probably two, children with ADHD. You probably know an adult or two or three with the diagnosis, as well.
ADHD is perhaps the most exhaustively studied disorder in the history of child psychiatry. Though there are occasional cynics and doubting Thomases in the media, who question the validity of this diagnosis, ADHD is a diagnosis recognized by the major medical, psychological, and educational organizations, including the National Institutes of Health and the US Department of Education.
It does not result from bad parenting. ADHD symptoms, such as impulsive and immature behavior and distractibility are not just a childs bad attitude. There is likely no one to blame. ADHD is not a mind problem; it is a brain problem. This disorder is physiologically based, and genetics do play an important role.
It is important to note that there are three sub-types of ADHD:
1) Predominantly inattentive;
2) Predominantly hyperactive-impulsive;
3) Inattentive/hyperactive-impulsive combined.
Thus, a person may have ADHD without being hyperactive or impulsive, because he primarily has serious attention deficits. On the other hand, an individual may be hyperactive or excessively impulsive but not inattentive. Most affected patients however, have problems in both spheres.
Typical ADHD symptoms include: difficulty focusing or maintaining attention, failure to finish tasks, disorganization, distractibility, fidgeting and inability to remain seated, excessive talking, intrusive behavior, impulsive verbal or physical activity, and excessive impatience.
Until the age of five to seven years, the presence of such symptoms may be the result of maturational delay. It should also be noted that inattention can be caused by depression, anxiety, auditory processing problems, or other issues. However, when a cluster of the above listed symptoms appears, ADHD is to be suspected. The best course of action is to consult with a mental health professional experienced in this area. Further, since the co-occurrence of ADHD and other neuro-psychiatric disorders is so high, other conditions have to be ruled out as well.
The ADHD Experience
ADHD affects social and academic performance. It impedes the simple yet vital ability to be at ease in life, so that the mind and body can relax mentally and physically. A person with ADHD can be loud, frenetic, extremely messy, moody, or fall asleep at the drop of a hat. Living with a child or adult with ADHD can be a supreme test. Among the ADHD population, divorce and delinquency rates are high. Sometimes, people suffer from ADHD in silence, either out of shame or ignorance.
Often, ADHD children are so overwhelmed by the internal pressure to touch things and move, that they cannot keep their hands to themselves, and they are constantly seeking involvement for their bodies. Sometimes, they become classroom clowns. Others may be oblivious to social conventions and details in general; they may seem insensitive or self-centered. ADHD children are not necessarily oppositionalthey simply have a running inner motor which drives them to move. For this reason, being required to sit for hours in a classroom can be indescribable misery for an ADHD child or adult.
Causes and Development
ADHD is a physiologically based disorder, with a strong genetic component. Aside from a genetic tendency, pregnancy complications and exposure to environmental toxins (lead, smoking or alcohol) in utero, may predispose a child to ADHD.
For some children, symptoms abate at the onset of puberty. For others, they fade during adolescence. For perhaps a third to a half of all ADHD-affected individuals, some symptoms will persist into adulthood. These symptoms often take the form of difficulty in focusing and maintaining attention, incessant fidgeting, impulsive behavior or inappropriate mood fluctuations or intensity. These adults, if untreated, face major obstacles in finding and keeping a job, sitting and learning for any amount of time without someone to refocus them, maintaining intimate relationships, being patient with others, as well as many other difficulties.
Treatment
ADHD can be very well managed with the right combination of parental behavior management; behavior modification therapy for the patient; and medication. While behavior management and behaviorally oriented therapy can be very helpful, they are rarely successful without the use of medication. Medications used for ADHD are among the safest in pharmacology and often turn life around for a suffering child. Unfortunately, many uninformed parents fear that their child will be drugged. In reality, the purpose and main effect of ADHD medications is precisely the oppositeto help the patient become more attentive to life.
Consultation for ADHD should begin with an experienced psychologist, who can evaluate the symptoms and behavior and recommend a course of treatment. Often, this is the beginning of a new life.
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Dr. Nathan Solomon is a clinical psychologist in independent practice in Brooklyn. He is a past president of NEFESH International, the international network of Orthodox mental health professionals.
