Because ADHD is a growing phenomenon, I have put together a panel of experts from multiple fields in order to give perspective and advice on the issue. ADHD is a disorder that can affect and therefore be affected by both the body and the mind. I see this all the time in my office, Strategies for Optimal Success (SOS), now more than ever. Therefore, I have asked people with differing expertise to weigh in. Sora F. Bulka is a consummate educator and the Dean of the New Seminary. Gary Abberbock, MD is a beloved and respected pediatrician. And, Eliezer Gruber, CN is a valued and knowledgeable nutritionist.
Many kids today are not as attentive and focused as they should be, especially in the classroom. What is considered a normal lack of focus and attention that many children have, and when is the lack of attention something that parents should be concerned with to consider seeking help?
Sora F. Bulka (SB): I must admit that I really don’t have expertise in the area of ADHD or other specific Special Ed situations. Nevertheless, here goes: in my early days of teaching, I remember having a student (junior high school) who really couldn’t sit still for very long… At that time, we would say about a student that couldn’t sit that the students didn’t have sitz fleish. Today, we have more formal names for this.
The advantage of identifying this behavior, and labeling it is that the child can now get help. The disadvantage is that the label can become an excuse, a crutch which will then continue to allow this behavior rather than devise means of dealing with the challenge.
Dr. Gary Abberbock (GA): Inability to remain focused at all times is a normal phenomenon for all children (and adults, too). Parents should become concerned when the child’s lack of focus seriously interferes with school performance – i.e. may result in the child being “left back” or creates significant problems in the classroom which interfere with the performance of classmates or creates problems at home with interfere with family functioning.
Rifka Schonfeld (RS): There are different levels of attention that are normal depending on the age of the child. Some people argue that children’s attention spans should be about 2-3 minutes per year of their age. Therefore, a two-year-old would you have a six-minute attention span and a kindergartener would have a fifteen-minute attention span. That said, different children respond better to different types of activities. Some enjoy visual stimulation, while others need to get up and move while they learn. And, studies show that girls generally have longer attention spans (sitting and staying power) than boys when they are younger.
There are ways to build short attention spans, but you should only be concerned if your child’s lack of attention gets in the way of social and academic gains.
Is there any specific age range in which intervention will be most effective for children with ADHD?
GA: Intervention is appropriate at any age when it becomes necessary at home or at school, but rarely should medication be needed before the age of six.
Eliezer Gruber (EG): This may come as a surprise, but the best time to start thinking about nutritional intervention is actually during pregnancy. A well-balanced prenatal diet with foods high in vitamins and minerals as well as Omega-3 is an important step to providing your child with a great head-start in a many including ADHD issues. Omega-3, found primarily in fish such as salmon as well as supplements, is especially beneficial (1,500 mg that are a combination of EPA and DHA components). This information can be easily found on most bottles of Omega-3 supplements. After a child is born, the earlier they are on a well-balanced diet with the inclusion of Omega-3, the better. Growing children who are in the critical stages of development are affected by exposure to harmful chemicals and dyes in foods far more than adults. The same is true with the healthy foods they eat.
RS: If you aren’t talking about medication, the younger the better with ADHD. The problem is that there is no definitive diagnostic test for ADHD and therefore children are not diagnosed with it as early as some other learning disorders. However, intervention that starts at age three is more effective that intervention at age five. The key is to catch it early and take steps in the home and in school to work with the ADHD symptoms.
In your experience, what is the best way for parents and teachers to help children who have ADHD while they are in the classroom?
SB: I think that parents who suspect that their child is challenged in this way should make sure to have their child evaluated, and they should bring the school into the process. A teacher who is unaware of a child’s ADHD might become frustrated with this ‘non-cooperative’ child and the teacher’s reaction can have serious academic and social consequences for the child.
EG: The general rule of thumb is that children should get an hour a day of vigorous exercise to help the child release energy and maintain optimal physical health. Additionally, children under 12 years of age should get at least 11 hours of sleep each night. This will amplify the effects of a healthy well-balanced diet that should include sufficient protein, vitamins and minerals, and the right carbohydrates (e.g. whole grain bread and crackers) and good fats (mono-unsaturated fats, polyunsaturated fats and Omega-3 fats). The above components play an important role in managing moods, fighting fatigue, and promoting focus.
RS: Educators can help in the following ways:
- Give shorter lessons and more of them, which makes it easier for children to stay focused.
- Acknowledge even partial success and extend approval generously.
- Compliment even in mid-assignment to encourage continued focused performance
- Smile and make eye contact with child.
- Use his name in the lesson or example that is being taught to the entire class.
- Tap on the desk (or use other code) to bring the child back into focus.
- Break down longer directions into simpler chunks.
- Allow physically hyperactive children out of their seats to hand out and pick up papers.
My child was recently diagnosed with ADHD. Does this mean he will be condemned to live a life in which he will not be able to succeed at a job or in learning Gemara?
SB: The answer is a resounding “No!” Don’t accept limited possibilities for your child. He may not have it as easy as other children in his class, but this in no way means that he is relegated to ‘sug bet’ (second rate). Don’t accept that prognosis for your child – be a ‘pushy’ Jewish mother – and encourage your child to push himself. Let him know that you believe in him. When you do, and when the school sees that you are not going to be satisfied with lower expectations, you may very well bring the rest of the team on board with you.
GA: Definitely not! Quite often, appropriate timely intervention will allow the child to thrive and even exceed the success of other children who have no focusing issues. The child hopefully will even outgrow the need for medication, if that is the treatment of choice.
RS: Of course not! There are thousands of extremely successful people who would argue that they were successful BECAUSE of their ADHD, not in spite of it.
I am a bit concerned about giving my child Ritalin to address his ADHD issues.
GA: Many parents are hesitant to begin medications as treatment for their child’s ADHD. Trials of dietary adjustments and “natural supplements” with proper supervision are certainly worth trying, but from experience, seem not to be as effective in children who truly have ADHD. Psychological counseling often can have a role in management of children with ADHD.
EG: Some important areas in the nutritional profile that may be overlooked – but which play a key role in addressing ADHD issues include:
- Sufficient protein (depending on child’s weight) which can come from eggs, fish, chicken, meat (or from whey powder as a supplement for sufficient protein).
- Good fats such as avocados, nuts, seeds, olive oil, and especially foods or supplements with high levels of Omega-3 oils.
- Carbohydrates from whole grain sources including whole wheat breads, crackers and pasta, as well as from quinoa, sweet potatoes and beans.
- Vitamins and minerals both of which can come from eating a diet rich in fruits, vegetables and certain nuts such as almonds. Specifically, minerals such as magnesium, calcium and zinc and vitamins such as vitamin D have been shown to have a positive impact of ADHD.
RS: I recently wrote a children’s book about this topic called My Friend the Troublemaker because I wanted to provide the top tips for helping children with ADHD. The list in the book is as follows:
- Use a daily planner
- Set a timer for small tasks
- Squeeze a stress ball to concentrate
- Set up a reward system
- Take short, fixed breaks to clear their minds
Medication can be paired with these behavioral modifications as well.
I want to thank all of the experts for sharing their expertise on these important questions dealing with ADHD!