By Ronen Hizami, MD

As Printed in the Jewish Press Health Supplement of December 29, 2010

The phone call every parent dreads . "Mr. and Mrs. Cohen, we need you to come in to the school for a meeting about your Yanky." With trepidation, the parents arrive at the school. They are aware that Yanky has always been a happy and bouncy boy, but he never caused too much trouble at home or in the neighborhood. What could be happening with a second grader to warrant a meeting at the school? At the meeting, both the rebbe and English teacher report that Yanky is disruptive to the class. He is always moving, talks in the middle of class and makes the other boys laugh. His learning isn't as good as it should be. Somehow he manages to get B's on his exams, but he doesn't seem to be applying himself. He just spaces out in class, when he isn't causing trouble. When the menahel (supervisor) tried speaking with him, he replied in an inappropriate tone, and he told the principal to mind his own business. The school recommended that the Cohens have Yanky evaluated by a qualified mental health professional

Mr. and Mrs. Cohen are very upset. They don't understand why the school is making such a big deal about these problems. He is just a kid. Aren't kids still allowed to be kids? The school is just too strict. If they would just be more flexible, everything would be fine.

The Cohens have been given an opportunity to potentially save themselves and their child a lot of trouble in the future. They leave the school with a dilemma. Should they take their child for an evaluation? But their child isn't crazy! If word gets out, what will it do for prospects for a good shidduch, not just for Yanky, but for his siblings as well?

Choice A:

The Cohens decide to speak with their pediatrician, who refers them to a local child psychiatrist for evaluation. The psychiatrist meets with the parents and thoroughly reviews Yanky's developmental, medical, academic and behavioral histories. The parents and teachers fill out standardized rating scales, and after receiving permission from the parents, the psychiatrist speaks with the school faculty and administration about their concerns. The rating scales are indicators for symptoms of inattention, hyperactivity and impulsivity. The ratings are consistent between teachers and parents. The child is then brought in for the evaluation. In the evaluation session with the psychiatrist, Yanky presents as a cheerful boy who is unable to stay seated. He can not keep from exploring the room and touching everything, even when asked to stop. Yanky is careless in his reading and other tasks he is given within the session.

After carefully reviewing the data, the psychiatrist informs the parents that their child is suffering from Attention-Deficit/Hyperactivity Disorder (ADHD). He educates the parents about the research findings regarding the natural course of the condition and the various treatments available. After considering their treatment choices, the parents agree to follow the recommendations and Yanky is started on the medication Concerta. They see the psychiatrist again after two weeks and the dosage is adjusted. The school and parents agree that Yanky is doing much better. Yanky is then referred to a time-limited social skills group. After three months, Yanky is functioning at a level consistent with the rest of his class, both academically and socially.

Over the next several years, Yanky continues to develop typically. In eleventh grade the psychiatrist, school and parents agree that he no longer needs the medication and it is discontinued. Yanky goes on to have a successful life and lives up to his full potential.

Choice B:

The Cohens decide to ignore the school recommendations and Yanky is never evaluated. He is not accepted back to the school for third grade. His elementary school career is marked by three school changes, and by the time he enters seventh grade, Yanky is convinced that he is a bad kid. He is always getting in trouble, both in and out of school. He is suspended repeatedly for being disruptive in class. Numerous well-meaning individuals have tried to help him, but he defies everyone and refuses to follow anyone's rules. He is not interested in learning and doesn't want to keep Shabbos anymore.

In eighth grade he starts hanging out with kids who abuse drugs, and he starts drinking alcohol and experimenting with marijuana. He drops out of school completely at 14 and continues to abuse substances. He spends the next two years in and out of drug rehabilitation programs. Finally, at 16 years of age he is diagnosed as having ADHD and is treated with Concerta. At this point he starts to improve, but requires long-term therapy to deal with his substance addictions, low self-esteem and ADHD. He eventually becomes a productive member of society.

While Attention-Deficit/Hyperactivity Disorder afflicts 10% of school-aged children, it affects 100% of their parents and siblings. Children with ADHD are not bad kids. The coordination center of the brain is not working fast enough. Imagine a symphony orchestra with maestros at every instrument, but the conductor has taken cold medicine and just can't keep up. The music would sound horrible. This is analogous to the physiological abnormality in the brains of individuals with ADHD. This results in problems maintaining attention and/or hyperactivity/impulsivity.

Most of these children have other problems as well. They tend to suffer from anxiety disorders, mood disorders, disruptive disorders and learning disabilities. These problems, left untreated, generally lead to greater difficulties over time. Children who do not receive treatment are more likely to become "at-risk" teens, develop addiction problems and become demoralized. Adults with untreated ADHD have higher rates of substance abuse, car accidents, relationship difficulties and financial problems.

Yes, parents, the most effective single intervention for ADHD is medication! Certain psychotherapy modalities, classroom strategies and parenting interventions are also used. The treatments available tend to be well-tolerated and effective, but they require the expertise of a medical professional specifically trained in the diagnosis and management of ADHD. Rejecting the advice to have a child showing symptoms of ADHD professionally evaluated often results in years of lost opportunities and unnecessary pain.

Admittedly, the two choices listed above are at opposite extremes. Most cases fall somewhere in the middle. Not every untreated case will end in addiction. Not every treated case ends up improving as quickly. Nonetheless, which parent wouldn't choose to provide evidence-based treatment for their child's condition? Which parent wouldn't choose to help prevent immense suffering to the entire family.

Dr. Ronen Hizami is a child, adolescent and adult psychiatrist practicing in Brooklyn and New City, NY and can be reached at 718-645-5138.