Exploding myths about ADHD

In her new book, mother and journalist Hanna Stern offers personal insight to families affected by one of the most common behavioral conditions diagnosed in young children.

By JUDY SIEGEL-ITZKOVICH
ADHD 311 (photo credit: illustration: Heather McKinnon, Seattle Times/MCT))
ADHD 311
(photo credit: illustration: Heather McKinnon, Seattle Times/MCT))
A hundred academic textbooks and a thousand medical journal articles on ADHD (attention deficit hyperactivity disorder) can provide the details on this children’s condition. But nothing is as useful for families as a personal account written by the parent of a child struggling with the condition, which affects one in 10. Hanna Stern, whose son Assaf, or Assi for short – who recently completed military service – was diagnosed with ADHD, tells their story and offers advice in a new Hebrewlanguage, soft-cover volume called Ulai Takshivu?! Mabat Ishi al ADHD (Will You Listen?! ADHD from a Personal Perspective).
The NIS 84, 254-page book, issued by Focus Publishing Company , was written by a mother who is also a journalist.
In addition to sharing the ordeal of her son and family, Stern also interviewed a wide variety of professionals in the field, as well as other parents. She puts the disorder in an Israeli perspective, describing where and how help is available from government ministries, health funds, voluntary organizations and private experts. The result is a compelling, optimistic and positive story about children who have many gifts despite their difficulties.
Assi was born following a long series of painful fertility treatments in November 1987 to Hanna and Itzik. The couple already had a daughter, Shirli. Assi was diagnosed with ADHD while his mother was under close supervision by obstetricians when she was pregnant with his brother Matan. Assi’s delivery was normal, but due to the persistent efforts by Assaf Harofeh Medical Center’s fertility specialists, he was named for the hospital. The pregnancy with Assi, writes Stern, was normal and nurtured great expectations, and the delivery was quick. He was a good baby, with a good appetite. He began to walk and speak at an early age and was all smiles.
But when he turned five, Assi turned into a problem child. His kindergarten teacher complained that he was “violent, does not participate and disturbs the other children.”
After his brother was born, things got worse. The parents learned that Assi spent most of his time in kindergarten “under punishment” and was regarded as different than the other youngsters. Feeling rejected, he bit his nails until his fingers bled and spent most of his time sitting on the steps near the entrance.
With a new baby, Stern felt helpless and unable to connect with the teacher, who preferred well-behaved kids.
But even though Assi was wild, no one suggested he remain in kindergarten for another year because he was unripe for school.
“I didn’t know where to turn. A friend suggested I go for a hospital consultation. The doctor looked at him for a few seconds and said: ‘He has ADHD. You have to give him Ritalin.’ I felt as if a 5-kg hammer had landed on my head. I felt weak and helpless.”
“How do you know?” I asked him. “You haven’t even examined him!” “I have experience and I’ve seen many children like this,” he said.
Stern recalls that she hadn’t a clue what ADHD was about or where it came from.
“I don’t recall even how I got to my car in the lot. I do remember feeling scared and uncertain about the new situation. We didn’t give him Ritalin because I didn’t believe the diagnosis. I wanted to hear a second opinion and more explanations.”
ADHD, diagnosed in boys much more frequently than girls, involves overactivity, lack of attention, impulsive behavior or a combination of these. It is one of the most common behavioral disorders of childhood and can continue through adolescence and adulthood. ADHD is categorized according to several subtypes. Most ADHD children suffer from hyperactivity, impulsivity and inattention.
It is incurable, but various treatments can relieve many of the symptoms and children with the condition can grow up to be successful in school and have productive lives.
Any child can be forgetful sometimes, or have difficulty focusing on one thing or listening to others, quickly becoming bored, daydreaming and refusing to follow instructions. But to be diagnosed with ADHD, the child must suffer from symptoms for at least six months and to a degree more significant than in other children of the same age.
AS THE condition appears to run in families, a number of genes are thought to be involved, although researchers have not yet pinpointed the exact cause. After diagnosis of a child, many parents recall behaviors of their own that suddenly seem to them to have been connected to ADHD. Chronic exposure to tobacco smoke and alcohol use during pregnancy is thought by some researchers to be involved, along with certain food additives. No single test can determine diagnosis, but TOVA (Test of Variables of Attention) can give an indication, and close observation by a specialist can confirm it.
The most common treatments for ADHD are stimulants such as amphetamines that, ironically, have a calming effect on such children. There are short-acting, long-acting and slow-release drugs in various forms and dosages that are prescribed by doctors and other qualified professionals, but one type does not fit all.
This was the case with Assi, who took Ritalin for a short period but had to give it up because of significant side effects including headaches, sleeplessness and nightmares when he did fall asleep. Other children have reacted to ADHD drugs with lack of appetite, anxiety, irritability and – less commonly – sudden, repetitive movements or sounds called tics. Dosage may be reduced to improve reactions, but some children may not be able to manage with the medications at all. Assi was prescribed another drug named Nitan, and with various dosage modifications and other therapies, his symptoms were significantly reduced.
There has been strong opposition among some parents to giving medications, for ideological reasons. The author, with help from the experts she consulted, explodes myths about ADHD, such as the belief that the disorder passes in adolescence, results from brain damage, does not have to be treated, or can be “borderline,” and that medication causes depression in children or turns them into “zombies.” All not true, says Stern after much investigation.
Stern praises a number of professionals she and Itzik encountered on the family journey through ADHD. One was Moshe Hamiel, an educational psychologist at the Ma’agalim Institute she describes as “our angel,” who taught them how to be nonjudgemental and not to conduct “investigations” when dealing with Assi.
“It was exhausting, and sometimes we felt like giving up because we didn’t see immediate results,” she said.
Eventually, however, the Sterns got to a point where they could “live together without going crazy, to see the good things while not ignoring the bad things. He brought us to love Assi without conditions such as being a good boy or not causing problems.”
Stern stresses that today, awareness and understanding of ADHD in the educational and medical systems are much better than when Assi was small. Kindergarten teachers working for municipalities are well trained to recognize problems. In her recent interviews with kindergarten teachers, she heard of numerous cases of ADHD that were much more difficult than Assi’s. Alon, a good-looking blond boy, used to bang other kids’ heads on the floor, touch electricity wires, climb fences and trees and refuse to observe the rules.
“I couldn’t cope with him,” the kindergarten teacher conceded. “We called in the parents and saw there was no father involved, only a mother who was in denial.
She said he was a wonderful boy and that it was the teacher who had the problem. But the man she was living with, who brought him to kindergarten, admitted that he was a difficult child who spent most weekends alone. Alon hit the kindergarten staff and other children and was suspended.”
Today’s teachers can turn to regional support centers staffed by professional ADHD advisers. There are computer programs today that help teachers diagnose ADHD. Children’s behavior and improvement with treatment are monitored using special forms. There are even integrated kindergartens that combine ADHD kids with “normal” ones whose parents are usually not reluctant to send them because they know the facilities are high-quality.
She gives many examples of ADHD children who “miraculously” changed thanks to medication. A charming, intelligent eight-year-old boy named Liel was very disruptive until he was given medication, after which he was able to read and write competently for the first time.
He lost his fear of crowds, and at a relative’s bat mitzva he congratulated her in public as a representative of the cousins. He was suddenly able to pay attention to the teacher; previously, he hadn’t been able even to copy anything from the board.
Stern cites Nitzan, the voluntary organization for ADHD families. Headed by Mali Danino, Nitzan has 36 branches around the country. Aside from helping with diagnosis, Nitzan offers support groups and workshops to help parents. A variety of complementary therapies proved to be very helpful to Assi. These include horseback- riding, psychodrama and martial arts.
The author notes that as Assi grew older, he found frameworks suited to his age, including Jerusalem’s Yeshivat Bnei Hayil, established many years ago by Dr.
Stuart Chesner, a clinical psychologist who has specialized in accommodating ADHD children. He was admitted from seventh grade and was bused to the capital even during the hair-raising years of intifada violence.
The institution uses special techniques to improve the boys’ self esteem and pride. Assi did well enough in his studies to be ready to complete his matriculation in the future with just a little more effort.
Although his parents thought he would never be able to cope with his assignment in the Israel Defense Forces – to be in charge of a medication storehouse – because of the difficulty ADHD youths have with organization, he proved to be responsible and capable and did well.
His military profile had been set at 64, Stern reveals, not because of his ADHD but due to an accidental eye injury he suffered as a boy. Although youths with ADHD are not exempt from military service, they are assessed and prepared by a special IDF center.
Although symptoms usually lessen in adulthood, they don’t disappear altogether. In numerous cases, the condition is diagnosed only when people are in their 20s or even older. Psychologist Orly Tzadok, whom Stern interviewed, was surprised to hear that she – who specializes in adult ADHD – had the disorder herself.
“I wouldn’t switch my ADHD for something else,” Tzadok enthused. “I have vivacity, creativity – although there is some lack of control – but I also have the ability to get many things done. You are alive! This characteristic of ADHD has benefits and shortcomings, but after school ended, I haven’t sat in one place for a moment.”
The psychologist’s schedule is thus packed, and to give counseling, she doesn’t hesitate to travel even to Eilat. Coaching programs for adults with ADHD have become quite common.
Stern concludes: “For us, this [book] is only an intermediate summary. Our story has not concluded; it continues within our family, with our children and with grandchildren to come. Coping is easier today, as we know the process, the problem and the obstacles we must overcome. But if we forget for a moment how to behave, it reappears. Our language with Assi is different, considerate, with low tones of voice.... This doesn’t happen with our other children, and maybe this is unfortunate. Maybe these rules should be adopted for all children and not only those with a problem. It would make child-raising easier.”
Now having completed his active IDF service, Assi faces the usual dilemmas of young adults.
“I am pleased with our child, his looks, behavior, the way he speaks and deals with people,” Stern writes. “I am happy for him ... he has succeeded in reaching his target, [and] volunteers with the Israel Police as he wanted.”
She concludes that he has talents that will ensure his successful integration into society. He can learn a profession using his abilities.
“I wonder if he will find a woman suited for him, have a family, what kind of father will he be, how will he take care of his children. I hope he will know how to do things in the proper order. What is certain that in any decision, we will be happy to be partners and give him backing, as we have not forgotten what we were told when he was born: ‘You are responsible for bringing him into this world.’”