Apr 11, 2013
Does Your Child Really Have ADD?

Psychiatrist Dr. Joel Fine writes that attention deficit disorder is grossly over-diagnosed and questions whether so many children these days really suffer from it.

By: Dr. Joel Fine - The Jewish Press

I recently read yet another article in a Jewish publication stressing the importance of having your child tested for attention deficit disorder if he is having trouble at school or finds paying attention difficult. I would have yawned if I hadn’t gotten so frustrated. The fact of the matter is that there is no scientific test for ADD. It’s a condition diagnosed by clinical evaluation – and grossly over-diagnosed at that.

There is no question in my mind that some kids have a bona fide psychiatric disorder. If an eight-year-old boy walks into my office and has his hands in the potting soil of my plants before he even sits down, medication is in order if I can rule out problems at home and some rare medical conditions. Usually, the improvement after medication is clear to all.

But non-hyperactive ADD is different. A seventeen year old came to see me last week and confided that he was sure he had this type of ADD because he was able to focus much better after taking some Adderall. He undoubtedly was telling the truth. But that doesn’t mean he had an illness that warranted treatment. I hardly think a baseball player who improved his home run production with steroids or a cyclist who peddled faster with EPO had an underlying disorder before his “treatment.” I am quite sure that if I gave my staff 5mg of Ritalin each day they would focus better and get more done. That doesn’t mean they have ADD.

The downside to giving medication to anyone who complains of not being able to focus – as many psychiatrists do – is that it absolves individuals of personal responsibility. If a child on Ritalin misbehaves at school, his teacher doesn’t blame him but rather the medication (“the meds aren’t working”). The child becomes a passive victim rather than a responsible agent.

Diagnosing children with ADD arguably helps parents much more than children. Parents no longer have to feel guilty or responsible for their child falling behind in school or not learning. By assigning a “condition” to the child, the psychiatrist essentially says, “It’s not your parenting, it’s the illness.”

It’s important to realize that we focus on something better if we are either good at it or interested. I’m sure that if I went with my wife to a quilting conference I would be easily distracted, wouldn’t retain information well, and might even be fidgeting away. But if the two of us went to hear the local college basketball coach talk about his new zone defense, I would be able to repeat, and probably expound on, his talk right afterward.

The same principle applies to schoolwork. I have found a high correlation between kids who come to me for an ADD evaluation and the difficulty they experience in reading at grade level. Reading is an integral part of schoolwork, but if a kid is not good at it, he is not likely to stay focused. That doesn’t mean he has ADD. He simply is uninterested.

We have to remember that some of us are better at certain things than others. I have seen a decrease in tolerance over the years from parents and teachers for the inevitable discrepancies in scholastic abilities between kids. Way too often the bottom half of a class gets referred to the local mental health practitioner for ADD testing for no reason other than they are in the bottom half.

I recall evaluating the junior-high son of a local professional who was quite flustered by his sons C’s in school. When asked, though, the father told me he had gotten C’s and D’s at the same age. My “treatment” was to help him and his wife redefine their expectations and present a more supportive, encouraging posture for their child.

The home environment has a great deal to do with how we perform in school. Strife or tension in the home can cause anxiety in a child that will certainly affect his ability to concentrate. But who needs to be treated here – the family or the child?

When kids are young, parents should focus on making learning enjoyable and the home as conducive to learning as possible. In grade school, catching up with basic skills by playing games that involve reading or math will tend to make the process more enjoyable. In early teenage years, tutorial help in weak subjects pays big dividends later. For older kids, providing structure and clear limits are in order since the responsibility for learning is more on their shoulders.

If a parent has problems instituting a plan along these lines, seeking professional consultation may be in order. The professional can be a schoolteacher or a clinician. However, if the former already has ten percent of his or her class being treated for ADD, or the latter “specializes” in prescribing medication for ADD, be wary. Hang on tight to the concept that the ability to learn and concentrate is a skill that comes naturally only to a minority of the population. For the rest of us, it needs to be developed and refined through years of hard work and perseverance.

About the Author: Dr. Joel Fine lives in Vacaville, California where he has been in private practice for 22 years. He has written and spoken extensively on healthcare-related topics and is the author of the recently-published “Arc of the Covenant: A Psychiatrist Tracks His Path Through Judaism.” He can be reached at jfinemd@yahoo.com.



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Opinions and Comments
1
!Thank you Lamplighters
For instituting this concept so very well for my son! Learning is fun!
(4/11/2013 6:12:39 PM)
2
Dr Joel Fine
Great Article. we miss you

Irvine CA
(4/11/2013 6:28:53 PM)
3
true
really enjoyed this article, hard to know who is and who isn't ADD
(4/11/2013 6:30:44 PM)
4
wow!!!
this article has so many amazing points i don't even know which one to focus on and compliment. seriously, so glad to have read this, thanks !
(4/11/2013 7:34:32 PM)
5
Very helpful
Thank you, I have to show this to some people who are thinking the worst for their kid who is actually really bright.
(4/11/2013 7:51:12 PM)
6
b'emet
this article is so true! any time a child does not listen or has, "too much energy" suddenly a dx is slapped and meds prescribed. kids are supposed to have energy! i've found quite often that the home environment plays more of a role in the childs behaviour and if more attention was focused on preventative and parenting services rather than reactive damage control, everyone may benefit. shko'ach.
(4/11/2013 7:56:04 PM)
7
Love it
Love the article.

One point that i disagree on though.
I have seen a decrease in tolerance over the years from parents and teachers for the inevitable discrepancies in scholastic abilities between kids.

i actually feel that in our schools, we have increased awareness and tolerance for different kinds of learners...
(4/11/2013 7:59:57 PM)
8
Well said
This article is a breath of fresh air!
(4/11/2013 8:52:54 PM)
9
As a teacher
loved reading this article, thanks!
(4/11/2013 8:59:28 PM)
10
Too true
My son was diagnosed with pretty 'severe' ADHD as a 6 year old. Special classroom for 3 years.... Gradually all the symptoms disappeared (I did NOT medicate him), and now he is a regular kid. I think he was just an immature learner (a very non-verbal and visual kid) who took longer than normal to reach a level of self-control, interest in learning, and ability to sit and concentrate. It came gradually over time. Why do we expect ALL kids to mature at the same age?
(4/11/2013 9:30:11 PM)
11
Abi Gezunt
Children are" taught" to not pay attention by video games, television and most recently, by texting, email, Face Book, Twitter and instant messaging. These activities (and the constant need to check to see if any new messages have come in) require constant stimulation and change, to reduce the anxiety generated by these media. When in the 1950's the Rebbe said that a TV.is a "Tumah She-ain Ko-mohu," he was not referring to the content. The Rebbe told us that the etsem experience of staring at constantly shifting, flickering polarized light for long periods of time puts a farshtel on the brain which then has to "cured" by medication. V'ha-mayven Yovin.
(4/11/2013 9:54:25 PM)
12
This is my point
I think my point is - anyway, what matters is, this article says that, oh well, I forget what I was saying, but I don't have ADHD, ADD, TNT, ABCD, EIEIO.
(4/12/2013 12:10:50 AM)
13
Wow!
I've always kind of thought this, but you've expressed it so well and put it into the exact right words! Thank you!
(4/12/2013 12:54:15 AM)
14
So true!
Havnt read truer words in quite some time! It's like someone took my jumbled thoughts and put it to paper in a way that makes sense! Beautiful article, and thank you for writing it!
(4/12/2013 4:50:11 AM)
15
Samech Vov
This idea is spoken about in The Re bbs Rashabs 'Samech Vov' and as well as many other places about people remembering things much better when it's "nogeya koi" when he relates to it as a person. Very nice and true article
(4/12/2013 4:55:14 AM)
16
Excellent article
Thank you for including specific way to deal with issue in more healthy manner
(4/12/2013 5:05:06 AM)
17
Great article
The schools have to read it, often they are the ones that recommend (otherwise expel) a child to be put on meds. When a cousin of mine told me the local school said ritalin (and the kid is always fine in my house) I told her to switch schools. Amazingly the kid is just super fine in the new school.
OT has too many OTs and they need jobs somewhere.....
(4/12/2013 7:56:04 AM)
18
I just want to say one thing:
My husband is one of five boys. Four of them (including him) have ADD/ADHD. The youngest has "learned" ADHD.

How do we know?
Stimulants are exactly what they sound like - stimulating. That means that they *should* make you more active. For some strange chemical reason, stimulants have the opposite effect on people with ADHD. It helps them calm down.

The youngest was put on medication - just as a test - and it made him wild. He was then taken to be tested - just to make sure that it wasn't ADHD - and it turned out that no, he wasn't ADHD, even though it looked like it.

So: If a kid works well with stimulants, and they don't cause him to become wild - maybe he does have ADHD. But if Ritalin causes behavior problems (and it often does but parents say it's not a high enough dose, it's the wrong medication, it's the teacher's fault, etc.) then the kid is NOT ADHD. There is no need to raise the dose. He's just NOT.

(4/12/2013 8:34:10 AM)
19
Thank you Dr Fine
Please continue to share your insights and practical advice with us.
(4/12/2013 10:01:13 AM)
20
Please give parents some credit
Raising a child with ADHD is a completely exhausting experience. Yes, it's rewarding and definitly leads to much personal growth in those of us who are intuitive. However, I have seen marriages break up when a child with ADHD is not properly treated. Parents are not typically quick to medicate their child. As a mother, it was very hard to put my son on ritalin at 6. He is 10 now and in a new yeshiva where no one believes me that he has ADHD. The medication has helped him slow down and absorb what is going on around him. He is well liked by teachers and peers and excels in his schoolwork. As parents, we attended parenting education seminars at our local LDA in order be sure we understood and managed his behaviours properly. As well, he is followed regularly by his physician. Instead of making fun of him and asking what's wrong with him the way they did in the past, my other kids now can see him for the cute lovable kid he is. They've also come to me secretly asking if they have some of his pills. It is we the parents who took the initiative to get our son tested, not the school. The school just said that he keeps getting up and walking around the class and yes, was slower to catch on reading( not because of a learning disability ....we know because we had him tested). We put together all the facts ( behavior at home as well, family history, sensory issues...)and after testing were able to rule out anything else.
(4/12/2013 10:28:59 AM)
21
Non-hyperactive add IS under diagnosed
I know because I have it. It's the child who is dreamy. Who wants to succeed, but can't get motivated. Often labeled 'lazy'. Suffers silently for years because he/ she is typically a good child who stays out of people's way. Is an underachiever. It hits this child when they discover their voice around grade 10 or 11. Please listen. If 5 mg of Ritalin can help then, why not?? By the time I was in university I had throbbing headaches from trying to concentrate. The workload was very dense. But no one believed me because I was always a 'good girl' and a good student. But no one knew how much effort I spent concentrating. It's very hard to reverse the damage once a student reaches 19 or 20. The labels stick like glue. One red flag is if a child is craving screen time and spends way too much time in front of a computer, iPod, ds...these devices act as stimulants because of the constant changing images. They actually relax the brain of the add child. If your child thinks they have add or difficulties paying attention, hear them out. If they interrupt a lot, have diffuculty falling asleep or crave highly stimulating entertainment look into things further.
(4/12/2013 6:59:24 PM)
22
Add vs anxiety
I have 2 children who many psychologist and o.ts wanted to put on Ritalin for add, which made not much of a difference. Recently I have taken them to a behavioral paediatrician who has looked at the child and all reports in depth and has found that they are both very anxious... So now we are seeing a neurological psychologist who is guiding then thru strategies and has tested then again for add just to make sure it's really not add. We finally feel like we have reached a solution without medication (which others drs etc were very quick to put them on!!!) keep searching until you find the right answer! It's not always the right answer to medicate!
(4/13/2013 5:44:29 AM)
23
dorm counsellor's mom
my son said it best - before you put a kid on Ritalin, put his parents on prozac! It's much easier to medicate your child than to be an effective parent. But that does not make it right. Find out why your child is having difficulties. Could be she is too advanced and needs to be given a more challenging education. Or maybe he is just not ready and should be held back a year. Oh but that will affect him socially? Not nearly as much as being thrown out of class constantly. You have to explore all avenues to find out what is causing your child to have problems. Fix the cause and your child will shine. So unless there really is a medical reason behind the difficulties, you have to put your child first. You brought them into this world. Now carry out your responsibilities instead of hiding behind a diagnosis and some pills.
(4/13/2013 11:25:37 PM)
24
ADHDers are able to focus! . Correct #21
One of my four children has real ADHD (the others have a touch but nothing that effects them terribly). He does NOT jump off walls. He is not constantly moving his body. It's his BRAIN that is hyper. It's not that he can't focus - it's that when he is HYPER-focused on something - he cannot re-focus other things - such as what the teacher is saying. Such kids often seem "in their own world" or spacey. They have a hard time transitioning. Adjusting to anything new whether it be meeting a new person or changing the subject. They tend to have a low self-confidence because they don't follow the herd and feel "different". They are very easily frustrated - the point that they have tantrums numerous times a day and are over-sensitive.

When his classmates are walking up one staircase- he, distracted is literally walking up the other. He needs to be re-directed constantly.

We spent thousands on testing and while, as suspected, all arrows point to ADHD B"H he is not medicated YET. He is 8 and doing much better because we found a "hobby" for him to focus on and to give him confidence in a field at which he excels. For some kids it can be sports, learning a musical instrument, dance...ideally it can also be a setting that forces these kids to socialize with others and feel a "part" of some group. For others - just excelling at something that they love is enough.

B"H our son is very bright - so despite being distracted - with frequent re-direction by his teachers and after two years with a full-time shadow in his class he is making progress. Socially, it's still a bit of a challenge.

I always tell my son "You don't need to be the most popular kid in the class. You just need one or two good friends". He resists even that but is gradually becoming more social with classmates that have similar interests. So I guess they can all "hyper-focus" on those areas together.

Commentator 21 is correct - this non-physical type of ADHD is often under-diagnosed and misunderstood. Just because my son does not have his "hands in the potting soil" - doesn't mean that he does not suffer from ADHD!
(4/14/2013 2:48:58 AM)
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