ADHD does not go away at age 18, is not caused by bad parenting and cannot be diagnosed by a computer test alone, according to Rabbi Asher Grozman, a veteran rabbi and educator at the Raz-Li Talmud Torah in Bnei Brak. He makes the case in the second installment of a series on attention disorders for the Kikar HaShabbat magazine.
A previous column in the series defined attention deficit disorder, explained how it is assessed, from what age it can be diagnosed, whether it passes and what it feels like to live with it. The new piece sets out to dismantle what Grozman calls the many myths surrounding the condition. For more background, see what every parent needs to know about ADHD.
The most common mistake in diagnosis, Grozman writes, is relying solely on a computerized test such as MOXO or TOVA. He explains that these tests were originally designed to measure the effect of medication. They are taken once without medication and once with it, to see whether attention functions improve. According to Grozman, the Ministry of Health has ruled, rightly in his view, that such a test should not be used to diagnose ADHD. The reason is simple: it lasts about 20 to 30 minutes in a separate room with no distractions, "and that is not life with ADHD." A diagnosis, he writes, should be based on a clinical interview of about 45 minutes with a qualified professional, along with comprehensive questionnaires.
He also rejects the belief that the disorder fades at 18. As far as is known today, he writes, ADHD never goes away. It changes form over the years as people develop mechanisms that help them mask it and function.
Grozman stresses that attention disorder does not always come with hyperactivity, and that hyperactive symptoms are not required for a diagnosis. Nor is it a learning disability. A learning disability affects a person's academic abilities, he explains, while ADHD can affect academic performance but reaches into every area of a person's life.
He calls the claim that ADHD is "just being spoiled," and that sufferers should simply try harder instead of being lazy, "an almost malicious statement." People with the disorder actually work very hard to concentrate but fail consistently, he writes, and live with a painful sense of frustration and self-disappointment. "Just as you would not call a child who needs glasses, or regular insulin treatment, 'spoiled,'" he writes, a child who needs regular treatment with Ritalin is not spoiled in any way.
The idea that ADHD results from bad parenting is a myth that needlessly burdens parents with guilt, according to Grozman. The only link to parents, he notes, is that the disorder is hereditary. It is therefore quite likely that at least one parent has ADHD and may have passed it on to the child.
He dismisses claims about intelligence in both directions. Children with ADHD were once said to be less intelligent than average, and today some say they are more intelligent than average. Neither is true, he writes. He also rejects the notion that the disorder stems from heavy internet use or from air and water pollution. In his account, ADHD is one of the most hereditary conditions in medicine, so heredity is probably the main cause, while environmental factors play a lesser or negligible role.
On the gender gap, Grozman says girls, teenage girls and women with ADHD are widely missed. Statistically, boys are diagnosed four times as often as girls, he writes. This is not because more boys have the disorder but because of low awareness of how symptoms appear in girls. Some argue that symptoms may be up to twice as common in boys, he adds, but certainly not four times. He also cites veteran teachers who told him, in a view he labels unscientific, that more boys than girls have ADHD, while more girls than boys have ADD.
Grozman warns against advice to put off an assessment, for example until a child reaches a higher grade. Because the disorder is lifelong, he writes, the difficulties will not disappear and will only get worse. In his view, diagnosis is not only about securing school accommodations or medication. Its first and main purpose is to give a name and an explanation to a person's behavior. Without one, he writes, many people explain their struggles to themselves with thoughts such as "I'm a failure," "I'm stupid" or "something is wrong with me."
He also cautions parents against thinking their job ends once the assessment is done. Receiving a diagnostic report without a guidance session amounts to "a diagnosis without a diagnosis" and misses the main point of the process, he writes, since the reports are often cumbersome and unclear about both the diagnosis and what to do next. He recommends a meeting of about an hour with the diagnostician to learn which treatments would be most effective.
Medication is not the only option, he notes, and it usually needs to be combined with behavioral therapy that teaches strategies for living with ADHD, such as time management, organizational skills and self-regulation.
