I am feeling very well today.  I have been able to focus well and concentrate for a little over four hours by now.  I never thought that I would be able to pass elementary school, or get a GED.  However, not only was I able to accomplish that, I am now working on my dissertation, in the final stage of earning a PhD. 

            Nobody in my family had gone to college before my older brother was accepted.  He was expected to do well.  He learned during the day, and went to college at night.  Both my younger sister and I were not "good" at school.  My youngest brother had difficulties also.  As a young child I could never focus on anything.  My family would get very angry when they had to repeat directions over and over for me.  I could never complete tasks, and would get distracted by the smallest noise, or movement, such as the tapping of a pencil.  I would always forget things, gloves, books, pencils, and once, I even forgot my shoe in school.  To this day, I have no idea where I could have lost my left shoe at age 11.  My bedroom was constantly in disarray.  This was very disturbing to my brothers who had to share a room with me.

             I usually started off with many friends when in a new school or camp, but would frequently lose them because they claimed I was "weird," and "said stupid things." I was always touching everything.  My brothers always said that they were embarrassed to take me anywhere because I could not keep my hands to myself.   Waiting on lines was very difficult for me.  I could not stay still.  After being yelled at several times, I was usually able to stand in one place, but my foot would be tapping, or my arms would be swinging.  My family was always asking me to "do better"...because they "know I could do better."  But they just did not appreciate how difficult it was for me. No matter how hard I tried, I could not succeed.

            Things got worse before they got better.  I was kicked out of two schools and had to repeat 7th grade.  The yeshiva asked my parents to help me by getting me medications to help me focus.  They said that they thought I had "ADD, or ADHD".  I later realized they were correct, although I resisted and resented all help at the time. 

            Attention Deficit Hyperactivity Disorder, better known as ADHD, comes in three types, the Inattentive type, the Hyperactive type, and the Combined type.   This can be diagnosed as early as 3 years old, or as late as adulthood.  According to the CDC (Center for Disease Control), 8.4% of children age 3-17 have been diagnosed with ADHD.  It is more common in boys, with 11.2% of boys age 3-17 diagnosed with ADHD, versus 5.5% of girls. 

            ADHD transcends all religious, cultural and ethnic backgrounds.   It generally is not diagnosed until a child starts school, because young children's attention span and ability to concentrate varies so widely.  Many children are active and energetic, and this is considered normal, not pathological.  However, once a child's academic and social achievement is affected, it becomes a cause for concern.

            Common signs and symptoms of ADHD fall into two categories.  Inattentive symptoms include: carelessness in schoolwork, not paying attention to detail, seeming inability to focus or ability only to maintain a short attention span, difficulties with organization or completing tasks, and forgetfulness, often evidenced by losing objects. 

            Hyperactive/Impulsive symptoms include:  Difficulty in sitting still, as evidenced by squirming, fidgeting, and leaving the seat in the classroom, blurting out answers in school, and appearing to be "driven by a motor," or "always on the go."  Children with ADHD may have difficulty waiting their turn, and blurt out answers unexpectedly.  They usually have poor physical boundaries in social situations.   For a true diagnosis, these symptoms must have been present before age 7, and are present in at least two environments or social situations, and cause functional impairment.

            Although hyperactive/impulsive ADHD is usually diagnosed early, a child who is very intelligent or who has an exceptional support system in place, as well as superior social skills, can often learn to compensate. In this case, ADHD is diagnosed later, usually when demands on the child are increased.

            When I was in danger of failing 8th grade, my parents took me to see a pediatrician, and explained the situation.  After hearing my difficulties, he said my symptoms sounded like ADHD, and I should try Ritalin, which is a stimulant that should help me focus.  For a short while it worked.  My rebbaim said that I was like a new person.  I sat quietly and earned A's effortlessly.   My English teachers told a different story.  They said I was like an animal, running around the classroom worse than before.  I began making strange movements at times, all through the day.  Sometime, I made sounds too, which I could not control.  I also began losing weight very quickly and could not sleep.   My pediatrician said it was time to see a specialist. 

            My parents took me to see a child and adolescent psychiatrist.  They explained that they were hesitant to do so before because my sister was about to start dating, and they did not want to jeopardize her shidduchim.  This doctor explained everything that had happened to me in the past. He said that the weight loss, insomnia, and noises (called tics) were likely side effects of the Ritalin.  He also explained that there were many medications for ADHD and they were not all good for all people.  Most importantly, he explained that I could do better, and my difficulties were not my fault. WHAT A RELEIF!

            ADHD appears to be the result of an immature frontal lobe, which is the "thinking and planning" part of the brain.  It usually fully matures in young adulthood, and is often the culprit in the adolescent’s inability to fully assess the consequences of their actions, which frequently leads to reckless decision-making.

            With DHD, the brain has difficulty breaking down tasks into their separate components. For example, getting to school involves accurately assessing the weather, putting on appropriate outdoor clothing, taking all needed paraphernalia to school, including schoolbooks and lunch, and remembering all of the above when exiting the bus. The walk through the schoolyard is fraught with distractions, all of which make it hard to make a timely entrance to one's seat. 

            Often, as the brain matures, a person with ADHD becomes less symptomatic.  Hyperactivity usually resolves as one enters adulthood, and concentration improves to a lesser extent.  This disorder continues into adulthood for approximately 60% of those diagnosed as children.  Of those adults with ADHD, there is a higher rate of car accidents, substance use and divorce.

            There are treatments for ADHD, most commonly involving medications to improve the symptoms and therapy to help the patient adjust to having these difficulties while maximizing their potential for success.  The stimulants most commonly used to treat ADHD are Ritalin, Focalin, Adderral, Vyvanse and Concerta.  Most come in short and long acting forms. The most common side effects are decreased appetite and insomnia, although tics and mood symptoms can occur.  For this reason, it is always important for the patient to be monitored by a psychiatrist. 

            Once I started on the right medication for me, my life changed tremendously.  My school gave me two sets of books, so that I would not lose them on the way home.  I learned to eat a full meal before I took my medications and before I went to bed. To this day, waiting on lines is hard; as is thinking before I speak. However, I have learned how to achieve academically (I am getting a PhD), and socially, as I am engaged to a wonderful kallah.  I have learned that I can succeed.

Pamela P. Siller, MD is a Board Certified Child, Adolescent and Adult Psychiatrist who provides medication management as well as individual and family therapy to children and adults.  She maintains a private practice is in Great Neck, New York.  Dr. Siller is also an Assistant Professor of Psychiatry at Westchester Medical Center, where she works in the adolescent inpatient unit, and is a staff psychiatrist at Interborough's mental health center in Brooklyn.