ADD and ADHD - Questions and Answers  

What is ADHD and who diagnoses it?

Experts in the field, i.e., neurologists and child psychiatrists, diagnose ADHD.

I'm the mother of a 12-year-old boy who's been diagnosed with ADHD. I would like to ask if there is some sort of alternate treatment, instead of medication, that's already been proven statistically?

My son is seven-years-old. The teacher suggested that he might have ADHD. The neurologist suggested giving the TOVA test. What is the TOVA test?

The main measures this test checks are:

1.       Attention/Lack of Attention - correct responses and incorrect responses to the intended stimulus

2.       Impulsivity - incorrect responses to unintended stimuli

3.       Response time - the amount of time need for the brain to react to the stimulus. The speed is very important since children who suffer from ADHD are much slower. Similarly, the speed responds well to medication.

4.       Change in response time - does the brain react consistently or inconsistently to stimuli. This is the most sensitive measure since children suffering from ADHD show before anything else a lack of consistency in responses to stimuli.

The second part of the TOVA is evaluating the effectiveness of drug treatment. The most accepted drug treatment is with Ritalin, both because of its effectiveness and also because of its short response time. Performance of the test without treatment, then afterwards under the influence of Ritalin, allows receiving an objective estimation of the effectiveness of drug treatment.

My son is 13 years old. He was diagnosed as having a learning disability already at five years of age and since then has been treated continually. He has a problem that every noise in class bothers him (whether it's a pencil that falls, a child walking past in the hallway, etc.). Despite my requests of professionals (Attention Deficit in Schneider and also TOVA test) they disregarded the topic of Ritalin. I wanted to know if there's another way to help him. I understand that there's a special computer program for children with attention and concentration problems. I'd like to hear more about this topic.

Biofeedback is a treatment method, which can decrease different bodily reactions. The method works by means of guided imagination and different relaxation techniques.

My 17-year-olds room is always a mess, which causes serious conflicts between us. According to you opinion, is this connected to the ADHD he was diagnosed with? And if so, do I imply need to give in? By the way, he's not  being treated with medication.

ADHD can be diagnosed at different ages, and without a doubt if you desire to learn, then it's possible to help you. At Nitzan, there is a multidisciplinary center that offers assistance to people with ADHD of all ages. We work with a child specialist and with an adult specialist.

Does the lack of appetite, which is caused as a result of taking Concerta, remain always? My daughter is 17 years old; she doesn't eat almost anything during the day. What should we do besides giving her vitamins?

Indeed, the different types of Ritalin, including Concerta, cause a decrease in appetite. Occasionally, it's possible to overcome this side effect by means of eating before taking the pill and after its effect has worn off. If there is a problem, then your daughter should return to the doctor who is treating her and consider taking Ritalin, which is active for shorter periods of time.

My daughter is 10 years old. At school, there are a lot of complaints about her not "paying attention". The counselor even recommended going for an evaluation for ADHD. The teachers complain that she disturbs, chats, and is busy with her matters. In contrast to this, my daughter can sink into reading a book for a long time in her room, play games with her dolls, or sit fascinated by the television. Does she have ADHD perhaps, and if so, how is it that at home she is so different from at school?

According to the international evaluation code, in order to diagnose ADHD, it must be present in two different places, but not necessarily at home. How does your daughter behave in after-school activities, in youth groups and the like?

In any case, it's a good idea to take your daughter for an evaluation in order to understand the behaviors at school and to help her improve her functioning.

My son learns in 4th grade. His teacher claims that lately attention problems have begun in class and she recommends taking him for an evaluation. However, he has high grades on exams; his conduct at home is wonderful. As far as I know, when there are attention problems, there are also behavioral problems. It's difficult for me to understand why an evaluation for ADHD would be necessary. I'd be happy to hear your opinion.

Even though behavioral disorders accompany ADHD in many cases, they are not the same thing. Considerable amounts of children with ADHD do not have behavioral disorders.

It's not clear to us which problems the teacher is referring to, but grades are not always the measuring scale. It would be worthwhile to speak with your son and to clarify with him if he feels any difficulty, and if there is a difficulty, then to go to conduct an evaluation.

I am 27 years old and learn computers. I have ADHD and the truth is that it's really hard for me. It's hard for me to concentrate. I don't know what to do in order to get through the studies and if it was even a good idea that I went to study. What's the best way to get through my studies? Maybe I should dropout, because in class I'm not successful.

We don't have a doubt that there are many ways to help you, and certainly the way isn't to dropout. The first stage is an evaluation, both in the areas of attention difficulties and learning difficulties. Afterwards, it will be possible to construct for you a treatment program.

I wondered how that in recent years the phenomenon of ADHD has become more and more prevalent and the age is also getting younger.

Could it be that there's something cultural here? Maybe the clip culture where everything happens fast from moment to moment, the internet culture where we're always overloaded with information and with different links, all of the advertisements that shorten our consciousness and many other factors like these have made our attention span shorter and shorter with time?

I predict that the phenomenon will become worse with time. Do you think there's something in this claim and is the cure to give medication to everyone or maybe we should demand a deeper cultural change?

ADHD is not a cultural disorder but rather a disorder in brain functioning. The many cases that have been diagnosed recently are on the one hand a result of better testing, and on the other hand there are more prematurely born children with low birth weights and additional biological factors that are living.

The proof for such is that the prevalence of the disorder in different countries and different cultures is very similar. The treatment of ADHD is a combined treatment using medication and treatment of environmental influences.

In most cases, ADHD is a genetic disorder that the person is born with, which is revealed in childhood. According to the International Diagnostic Book, the disorder must appear before seven years of age.

With the accumulation of knowledge of the disorder in adults, it seems that this clause should be changed, and perhaps the disorder can begin later. There is no need for tens of medications. In general, one medicine helps.

If it's true that there are cases where the disorder begins at a later age, what causes this to happen?

As with other genetic illnesses, diabetes for example, the age in which is begins varies. Perhaps, another gene or genes are influencing this disorder. Research on this topic is accelerating and we should hope that in the near future the cure will be found.

What are the most common and effective treatments for learning disabilities and ADHD, besides Ritalin, for adults?

I'm a 27 year old woman, as long as I remember myself, it was hard for me to learn. Just recently I did the TOVA test and I was found to be borderline ADHD. I tried taking Ritalin at times when I needed to learn for a long time, but Ritalin didn't help me. I even felt more energetic, and still, I have trouble concentrating when learning for more than a couple of minutes. I usually do a lot of other activities at the same time. What should I do?

The TOVA test doesn't diagnose ADHD but rather is a tool for the doctor who is conducting the evaluation. We recommend going to a neurologist or psychiatrist who specializes in this field in order to be evaluated and plan treatment.

I heard that there's a test called the TOVA test that is used to diagnose ADHD. What is this test exactly, whom is it intended for, and how effective is it in diagnosing?

How can I know if I have ADHD? Are there home test methods I can use to know if I'm in need of additional evaluation?

The TOVA test is a computerized exam that checks for a disorder in continuous attention. This test is a tool used by the examiner and sometimes contributes to prescribing the appropriate dosage of medicine.

Today, there are computerized tests that check different types of attention and also management ability, in other words, the ability for learning regulation. These tests give a more comprehensive picture that the TOVA test and their reliability is greater as well. There are not at home tests, the diagnosis in any case is a clinical diagnosis made by a specialist doctor.

My son is 30 years old. He has always had ADHD and he's been diagnosed with tens of tests about this issue. My main question is what do we do when he loses his keys, visa, ID card, and more all of the time? Also, his sleep schedule isn't organized. Currently, he works as a computer programmer, with all the problems. How can we help to solve, at least partially, the problem of losing items? Could coaching help at this age, or something else?

Coaching is certainly an intervention that could be appropriate and could help also in cases like yours. The Nitzan Association trains coaches who specialize in the areas of learning disabilities and ADHD. It's recommended to look for a personal coach who specializes in these fields close to your area of residence.

As far as I understand, there are cases of problems with vision and focusing that are incorrectly diagnosed as ADHD. Is this routinely checked in evaluations for ADHD?

When checking a suspicion of the presence of ADHD in the visual field, it's most important to conduct a professional differential diagnosis and to verify that it's not a problem with visual focus or vision. Sometimes there is a combination. In order not to err in the diagnosis, the sections that are connected to attention, it's best if a psychiatrist specializing in the area of learning disabilities checks them. An optometrist should check the areas connected to visual focus. Even if some of the symptoms are similar, there are clear differences.

I have ADHD. One of my biggest problems is impulsivity and a short memory span. I would like to know how I could help myself without medication (Ritalin depresses). I would like to learn techniques for self help in order to control my life. This harms all of my connections in life, if this is with a boyfriend or with my parents and friends.

One of the approaches that are appropriate for dealing with the questions you raise is coaching. You are invited to be in touch with the Nitzan Association, who trains coaches who specialize in the areas of learning disabilities and ADHD.

Even though I'm not an expert, but according to what I see, my wife (23 years old) has severe ADHD in her daily life (with a significant negative influence on her academic studies). Among her problems are: difficulty maintaining a fluent conversation and difficulty concentrating on specific tasks. Where can we turn for professional help at this age? A child-psychologist can't help already.

It's recommended to turn to a specialist in ADHD in adults. At the Nitzan Association, you can make an appointment with a psychiatrist who specializes in ADHD among adults and sleep disorders.

I heard that there are alternatives to Ritalin. I'd like to know what they are.

In order to order to properly prescribe medication, a psychiatrist or neurologist who specializes in treatment of ADHD and in treatment of children or adults according to the situation must evaluate you.

For advice on the topic you can call the Attention and Concentration Clinic at Nitzan. In any case, the recommendations given are likely to include therapy in addition to medication, for example, emotional treatment, parent training, and more.

I am 43 years old. I discovered two years ago as a result of reading a book on the topic that I suffer from ADHD, and understandably, from learning difficulties. Is there something that can be done at my advanced age? My life isn't simple, and I'm still considered like someone who doesn't take advantage of her "potential". I very much want to behave differently. I want things to fit together, to flow in doing and creating in all of the aspects. It's difficult for me not being able to concentrate for an extended amount of time. What can be done? 

In recent years there are lots of referrals of "adults", both because of the public consciousness to the issue and the many advertisements, and also because of parents who come to evaluations as a result of their children.

We strongly recommend for you to be evaluated, if only to receive some answers regarding your functioning currently and in the past. As part of the proper evaluation process, you can also receive advice and guidance regarding your daily life and treatment and support options.

Does ADHD cause outbursts and anger?

ADHD, mainly in younger ages, can appear as a combination of impulsivity and difficulty in regulating responses and these may cause outbursts and anger. However, each case must be evaluated separately by means of a comprehensive assessment. Combined evaluations, which include attention and concentration assessment, can be conducted at The Nitzan Association National Center.

I want to ask about disorders that appear like ADHD but are not congenital. They appear as a result of brain damage and they affect memory, and cause distractibility, a lack of concentration, and lack of organization skills. If they are neglected many years because of inappropriate treatment, what can be done? And what can be done with the emotional problems and low self-image that come with this?

This issue can also be treated and it's never to late. At the Nitzan Association, we offer treatment through coaching for adults with learning disabilities and/or ADHD and help them cope with their difficulties and challenges in their lives. We recommend that you make an appointment for consultation at the Nitzan Association.

Not too long ago, I was in touch with you with a claim that my daughter is very smart and has already been sent twice for exams at enrichment centers (for gifted children). Nevertheless, I am suspicious that she has a slight attention disorder. You referred me to an evaluation by a psychiatrist, but I'm not interested in this, for many reasons. Is there another way to evaluate the attention disorder?

Attention disorders are a physiological phenomenon. The experts in defining it are professionals from the medical field such as neurologists and psychiatrists. Evidence and signs of this disorder can also be found in didactic and psychological assessments, but only a specialist doctor is qualified to diagnose if ADHD is present. For further details we'd be glad to meet with you and to discuss your daughter's specific case.

Can ADHD be diagnosed in a 23-year-old woman? What are the symptoms? Can this be checked at Nitzan?

ADHD can be diagnosed in different stages during life and can be treated.  A psychiatrist or neurologist who specializes in ADHD among adults should be consulted. Dr. Mical Lustig is a psychiatrist specializing in ADHD at Nitzan. You are invited to schedule an appointment.

I am 16 years old and suffer from ADHD. I was found to have the problem a year ago. I was treated in the past with Concerta. The medicine didn't help me, so I began a different treatment with Ritalin, which also didn't help and even made the problem worse. The problem just gets worse with time. And since I don't take medicines that can help, I wanted to know what you recommend for me to do in order to improve my ability to concentrate, or how is it possible to work on learning disabilities and to improve them?

We understand your concerns about determining the dosage and type of medication. We recommend that you return again to your doctor. We would like to inform you that at the Nitzan Association National Center there is a multi-disciplinary center for diagnosis and treatment of learning disabilities and ADHD. We can assist you within the framework of the center and to refer you to Dr. Tami Moses, a child psychiatrist who can advise you about this problem.

In addition, we recommend that you visit the Nitzan branch closet to your place of residence in order to check the possibility of receiving assistance in the learning area. 

My 10.5-year-old younger sister has been taking a full dosage of Ritalin for one month already. Previously, she took a partial dosage of Ritalin for 11 months. She's known as a "dreamer" and the findings of the evaluation that was conducted suggested that Ritalin is what will bring the solutions to the problem.

From this a new problem was created, it's know that Ritalin can cause problems in mood swings, and since she's been taking it, she's very quick tempered and with very bad moods. She has outbursts, screams, cries, in a way that's not characteristic of a girl her age, and the issue has already began to be bothersome. Is there away to prevent situations like these? Or maybe this is something that goes away?

We are glad that you're concerned about your younger sister; certainly it's not easy for you either. We recommend returning to the doctor. There are a number of different medicines used to treat ADHD. Occasionally, it's necessary to try a number of medicines until finding the appropriate one. And as for you, it's a good idea to talk about the situation with your parents and think together how to cope. It's important to note that experts recommend seeking emotional assistance together with taking Ritalin. From our experience, Ritalin without psychological intervention or counseling is less effective.

I have a nephew who suffers from ADHD and behavioral disorder. It's very difficult for him with his studies and also for his parents to deal with his learning difficulties. He tends to have mood swings and when he's angry he slams doors at home and yells. I wanted to ask if there's here someone that can advise me how I can deal with the child and which methods can help him and his parents?

The situation you describe is a known situation for us from parents of children who are suffering from learning disabilities or ADHD. These parents need to learn about the nature of the disability in order to help their children cope with the difficulties. The Nitzan Association runs support groups for parents. In these groups, the parents learn effective coping methods with their children at home and at school. We recommend that you refer the parents to The Nitzan Association in order to check the programs offered for parents.

It's impossible not to react to people with ADHD who wear "fashion" from previous years. Has this disorder turned into an easy explanation for children who are a bit strange?

In recent years we have witnessed a significant rise in the number of children diagnosed as suffering from ADHD. This can be attributed both to consciousness and development in the field of testing and treatment.

How is it possible to treat ADHD in a 6 year old besides Ritalin and Omega 3?

At the Nitzan Association, even in cases where medication is given, we recommend learning assistance according to the need and also leveraging the strengths and talents of the child in order to strengthen his self-image. Similarly, paying attention to the social aspects is no less important than the learning aspects and allows a broader frame of reference.

The Nitzan Association has intervention programs for parents of children with ADHD whose goal is to assist the parents in the daily coping with their children.

If a child has been diagnosed with ADHD, is an alternative educational framework offered? Or maybe the child stays in a regular class? If it's recommended for him to take Ritalin, but the child's parents strongly oppose this treatment, does the teacher have the right to take the child out of class? Are there other/additional treatments for ADHD? From which age is ADHD diagnosed? When is it possible to begin treatment?

The trend today is to integrate children with special needs in regular education and within this setting to try to provide for their special needs. In general, the fact that there is a diagnosis of ADHD or learning disabilities doesn't necessarily warrant placement in special education. It's important to create a cooperative relationship with the school and to try to find the way in which the child can fit in the school and fulfill the school's expectations, and on the other hand to receive maximum assistance and understanding of his difficulties. We recommend for you to join one of the Nitzan Association's parent's groups, in which you can learn a lot about the school system and to learn how to create cooperation with the school and to influence the teacher for the child's good.

ADHD can be diagnosed from a very young age. There are a variety of treatment methods. Sometimes, there is in fact a need for medication, but it's always recommended to combine medication with additional intervention methods to help the child. It's recommended to seek professional counseling for this issue by a psychiatrist or neurologist who specializes in ADHD. You are invited to come to the Multi-disciplinary Evaluation Center at Nitzan.

Are the teacher and principal allowed to force a mother to give her son Ritalin even if she isn't interested, when the neurologist recommended giving the medicine? Are there schools for ADHD and learning disabilities without giving Ritalin, because the mother is absolutely not willing to give the medicine?

In principle, the school cannot force parents to give their children medication; however, it's important to stress that the most effective treatment for ADHD is medication, accompanied by parent training and in coordination with the school. Therefore, it's very important to consult with a professional (child psychiatrist who specializes in ADHD), and similarly to consult with a professional about effective dialogue with the school, for the child's good. From past experience at the Nitzan Association, children who suffer from ADHD have improved as a result of training and support that their parents received through our parent's groups.

My son is 7 years old and learns is in 2nd grade in a public, religious school in a small class. He took the TOVA test but it came out borderline and there was no clear answer since there weren't improvements in the results, even though he was diagnosed as suffering from concentration problems. He's like they say, "Doesn't fulfill his potential". His grades fluctuate between very high and average, and the teacher also says that he has "ants in his pants". Despite everything, he doesn't receive any sort of assistance. Is there another evaluation that can be done in order to receive a clear answer? I'd appreciate a response.

It would be worthwhile to seek advice with the school psychologist or counselor and to check what the possibilities for help are at the school. According to the report of the school staff, you can in cooperation with the school build an intervention program in order to help him. It's a good idea to clarify what are the reasons for difficulties in concentration and focusing and according to such to determine the type of intervention. Since you note that the results of the TOVA test were not absolutely clear, it's recommended to seek a neurologist or child psychiatrist who specializes in the field of learning disabilities for further consultation and clarification. You can also refer to the Multi-disciplinary Evaluation Center at Nitzan.

What can be done so that a child won't feel different or strange? How should we behave with this ADHD when he doesn't want to take his medication but can't concentrate for more than 15 minutes while reading study material? When it's an interesting movie or a computer game, it's seems like there never was ADHD; maybe it's just the studies bother/bore him?

The ability to concentrate during an interesting movie or computer game doesn't negate the possibility of the presence of ADHD. The functioning required in these situations is different than those required in learning tasks. From our experience, in many cases, children with ADHD feel different than other children, especially in light of your description that the boy cannot concentrate for more than 15 minutes while reading learning material.

First of all, it's very important to assess the causes of his difficulties in reading if they are only a result of a difficulty concentrating. Problems reading are caused frequently as a result of a learning disability in this area. Similarly, perhaps there is a combination of ADHD and learning disabilities. It's very important to help the child cope with his different feelings that are caused by his difficulties. This can be done through different interventions, for example: psychological treatment, art therapy, therapy with animals, etc. according to the child's preferences.

It's recommended that the parents seek advice and receive training how to create dialogue with the child and to encourage him to receive help. For parent training, you can be in touch with Nitzan and join one of the parent's support groups or individual parent coaching.

My 11th son was diagnosed with ADHD and it was decided to treat him with Ritalin. For medical reasons we were forced to stop the Ritalin. The child is aware of his situation and also that because of his health situation he cannot take Ritalin. It should be noted that he tries very hard and makes noticeable efforts. As far as grades, you could say that he's o'kay, but he disturbs in certain classes with certain teachers with whom he doesn't get along. The homeroom teacher lets him go out of the class for 10 minutes when he feels that he needs a break so that he doesn't disturb the class, but there are certain teachers that he simply can't deal with. These are teachers who yell, don't pay attention to him and he has a lot of trouble getting along with them and he simply disrupts the class.

You didn't specify the medical reasons for which your son was forced to stop taking Ritalin. There are many different medications that can be used for treating ADHD besides Ritalin. If until now you haven't consulted with a child psychiatrist who specializes in ADHD and learning disabilities, then it would be advisable to do so.

It's very important to find alternative methods to help your child cope with his difficulties and to function his best in the school setting. An intervention program should be built for your child in order to help him. It's important to do this in cooperation with the school staff and with the relevant treatment providers. The school counselor and psychologist can help you with this and in giving emotional assistance for the child himself. We recommend seeking parent training in order to help you help your child. Parent training is given in different places, among them, at The Nitzan Association where there are support groups for parents and also individual parent coaching.

Mother's Response to the Above Answer:

Thank you very much for your answer. The medical reasons why the Ritalin was stopped are a weak immune system and frequent pneumonia. After consultation with the family doctor it was decided to stop giving Ritalin and other medicines cannot be given.

As far as the school, the teacher is involved, school psychologist, and even the principal. The greatest difficulty for the child is with teachers yelling. He can't deal with this. It's enough that he says something inappropriate and he's thrown out of the class...or if the teacher answers him by yelling, then he loses his bearings and starts disturbing in class.

I'd appreciate it if you could do something and help, in addition to your recommendation to consult with a child psychiatrist.

Continuation of the Response:

It would be worthwhile to involve the relevant figures at the school in collaborating with the teachers who have the most problems with your child. It's advisable to request the intervention of the principal to give assistance to teachers in order to teach them alternative coping methods and in order to explain your child's crisis and difficulties. You can think of creative ideas, such as a lecture at the school about difficulties like that of your child, a meeting with a professional who treats your son, etc... From our experience, creating the personal connection by means of directly approaching the teachers with whom he has trouble can help to recruit them to help him and to build the beginning of a different connection with him. The power of the parents to influence by means of dialogue with the school is immense. A change in the relationship between the child and the teacher can begin with the small step of a conversation, a gesture, etc... and lead to significant change in the relationship with that teacher and with other teachers as well.

My son is 8.5 years old, is in 3rd grade, and is diagnosed with ADHD. Already in preschool there were problems of "annoys others, hits, doesn't pay attention, does things intentionally..." And it's the same thing today at school; therefore, after endless assessments, consultations, occupational therapy, group and individual therapy, and neurological monitoring, we're giving him Ritalin. With Ritalin and without Ritalin there are ups and downs. In other words, there can be a situation where I forgot to give him Ritalin and they'll tell me that today he behaved wonderfully... and there are day that I give him Ritalin and I receive just negative criticism... Maybe his problem isn't ADHD at all and the Ritalin doesn't even help him???

After consulting with our psychiatrist at Nitzan, we recommend that you seek a new diagnosis by a psychiatrist who specializes in ADHD in order to examine if in fact the problem is ADHD.

This service is given through health clinics and also at the Nitzan National Center in Tel-Aviv.

My oldest child is 6 years old and was diagnosed with ADHD half a year ago. I give him Ritalin every morning and when he comes home from preschool and its effect has passed, he simply drives me crazy, jumps all over the house, hits, and bothers everyone. My middle child imitates him. I don't know what to do already. Sometimes I feel hopeless against my 6-year-old boy. In general, I try to let go, but there are situations that I lose my patience, and I simply speak with him inappropriately, for example: I'm fed up with you, and afterwards I'm just angry at myself and sit down and cry. I am pleading with you if, is there someone who can help me? Thank you.

Indeed, it seems like your dealing with situations that aren't simple. As far as the medication, our opinion is that you should return to the child's doctor (we recommend a child psychiatrist) in order to change and adjust the dosage.

In addition, we'd like to recommend for you to join a parent's group. The Nitzan Association operates parent's groups intended for parents of children with learning disabilities or ADHD.