Parents ask me all the time: "Do you think my child has an attention problem?" But when I ask them to explain what they mean, it becomes clear that most don't actually understand what "attention deficit" means.
The subject is vast, the research extensive, and the treatment options, especially medication, can be intimidating. That's why this series will unfold over four weeks, though even then we'll barely scratch the surface. Nothing here replaces a professional evaluation by a licensed specialist who knows your child.
This isn't personal opinion. It's a guide to clear away the fog around a term that's everywhere but rarely understood.
I've tried to simplify and illustrate the key points so that as many readers as possible come away with something concrete.
This week: What ADHD is, and why it matters.
Next week: Myths about the disorder, debunked.
Week three: How to recognize the signs in your own child.
Week four: How to help.
What is ADHD?
Attention Deficit Hyperactivity Disorder is a neurodevelopmental condition marked by difficulties with attention and concentration, and sometimes by hyperactivity and impulsivity that interfere with daily functioning.
What does that definition include?
ADHD has three components, which can appear separately or together:
Inattention — lack of focus, difficulty filtering information or ignoring it, and high distractibility from external stimuli.
Hyperactivity — excessive activity that doesn't match the situation and disrupts the child's functioning and those around him.
Impulsivity — difficulty controlling impulses, which disrupts the child's functioning and may also disrupt others.
Today, all forms are called ADHD (Attention Deficit Hyperactivity Disorder), with the specific subtype noted alongside.
In short? ADHD is functional instability.
Is there a definitive test for ADHD?
No. There is no objective test, no blood work, no brain scan that can determine whether a child has ADHD.
Just as depression or anxiety are diagnosed through patient and family reports rather than through blood tests or MRIs, ADHD diagnosis is based primarily on reports from parents and teachers about how the child behaves.
Why does ADHD need to be treated?
ADHD in children causes significant difficulties in learning, listening, social functioning, and emotional and behavioral regulation. Leaving it untreated can lead to serious functional impairment, which in turn can trigger developmental and emotional problems, and even psychiatric disorders like depression in adulthood, as well as medical conditions later in life. It also increases the risk of life-threatening situations like addiction and accidents of all kinds.
Adults with untreated ADHD often struggle to stay in one job for long and change positions frequently.
What causes ADHD?
ADHD is a disorder related to changes in nervous system activity.
The prevailing scientific theory points to frontal brain regions, responsible for behavioral inhibition and executive skills, functioning at lower intensity in people with the disorder. Research shows reduced activity of chemical messengers like dopamine and serotonin.
Stimulant medications like Ritalin cause these systems to become more active, and they are highly effective in treating attention and concentration problems. These drugs reduce restlessness and hyperactivity in those with ADHD, while in people without the disorder they actually cause arousal.
How do children with ADHD feel?
Children with the disorder describe a sense of injustice, both socially and academically. They experience difficulties that lead to frustration and problems integrating socially and advancing in school.
Socially: They often try harder than everyone else but can't "reach their potential," which causes great frustration. They try to be good friends but are told they don't respect personal space. They "react from the gut," impulsively, without thinking before they speak. Sometimes they misread social situations. They mean to play with a sibling or friend, but it comes out aggressive, impulsive, and they're labeled "bad kids" again.
Academically: They try to complete a task but describe feeling like they have "chaos in their head" and can't remember what the instructions were. They intend to do homework but get distracted and occupy themselves with other things.
These children struggle to concentrate on a worksheet, and despite being intelligent, their achievements are low.
At what age can ADHD be formally diagnosed?
In most cases, formal diagnosis of ADHD is made starting at age six, when the child enters a school framework that requires sustained cognitive effort.
Does ADHD go away with age?
ADHD is a neurological condition that follows the child into adulthood, though the nature of the symptoms may change and moderate over time.
Is it a physical or emotional condition?
It is a physical disorder, a biological deficit in the brain, and therefore a "neurobehavioral" disorder.
Next week: Part two, b'ezras Hashem
The writer, Rabbi Asher Grozman, is a rav and veteran mechanech at Talmud Torah Razi-Li in Bnei Brak.
