JEWISH HOME LA

Dear Dr. T.,

My ten-year-old son has always been a real chevra-man. He is very impulsive and will do anything on a dare. He also has no sitz-fleish, so though he is very bright, he doesn’t do well in school. The worst part, though, is that he gets frustrated very easily and lashes out at his friends. Needless to say, he isn’t very popular.

I am writing to you now because this year’s rebbe is hocking us to put our Leizer on medication for ADHD. The rebbe says he is very experienced and knows ADHD when he sees it. As you can imagine, my husband and I are both very opposed to giving our child medication at age ten.

Don’t think that we have been neglectful parents. We have tried literally everything from when Leizer was three years old. We have consulted a nutritionist who took him off all red dyes and sugar. We went to a homeopathic doctor who gave us drops. We consulted with many different chosheve people to get their input and brochos. My wife even pays for a monthly phone conference with a rebbetzin/coach. Unfortunately, none of these strategies have worked; if anything, Leizer does worse every year.

We are at the end of our rope and could use some guidance. But, one thing I know for sure: no child of mine is going on meds at age ten.

Yehuda Aryeh

Dear Yehuda Aryeh,

How frustrating for you to have worked so hard with such poor results! But, here is something to think about: It’s not about working hard; it’s about working smart.

Let me explain. There are many, many children like Leizer who are impulsive, hyperactive, and easily frustrated. There is also a protocol for working with them. By following best practices, you can begin to get a handle on Leizer’s behavior.

When a child has trouble functioning in school for no known reason (i.e. no physical illness, death in family, or family dysfunction), he should be evaluated by a licensed mental health professional. Though Leizer’s symptoms are typical for a child with ADHD, he may have another issue entirely. He may have severe learning disabilities, anxiety, or even be the victim of bullying, neglect, and/or abuse. Only a trained professional is competent to determine the nature of Leizer’s difficulty.

The first step is to find the appropriate mental health professional and get a diagnosis. The course of treatment depends on the nature of the problem. The recommendations may include:

• Psychotherapy for you and/or your child
• Behavior management
• Social skills training

When warranted, medication (for anxiety, depression, and/or ADHD) is prescribed. However, only a licensed medical professional – such as your pediatrician, neurologist, or psychiatrist – can make that determination.

What I have described here is the gold standard in treatment. Some of the less orthodox methods you have employed – like diet, homeopathic remedies, and consultation with wise but untrained individuals – may be a fine addition to treatment, but do not replace conventional methods. It would have been so much more effective – and probably much less of a headache – to go for the basic evaluation first.

Though I am not a medical doctor and cannot say whether your child would benefit from medication, I do want to address both the rebbe’s suggestion and your hesitation.

It has become quite common for educators to insist that a child be medicated in order to come to school. However, as educators, psychologists, counselors, and social workers have no license to prescribe, the suggestion to medicate is inappropriate, to say the least. What is appropriate is a request to have the child evaluated by a qualified professional who has a medical license and can make that call. Because no amount of hands-on experience is equal to formal training and licensure, it is not for a rebbe or teacher to decide.

I would also like to speak to your reluctance to consider medicating your child if that is what is needed. Unfortunately, many a parent shares your view: Under no conditions will their child take psychotropic medication!

However, while it may seem that the parent is protecting his child from the potential negative side effects of medication, actually the parent may be denying his child the opportunity to function and succeed. Mental, emotional, and attentional issues are real – as real as physical ones – and the child may suffer needlessly from a parent’s refusal to follow the doctor’s advice. Conversely, many a parent has reported that their child benefits greatly from taking medication.

Having a child with school issues is never pleasant. But, dancing around the issue and distracting yourself from the issue at hand by searching out alternate methods of treatment solves nothing. Facing the challenge squarely and dealing with it by using the conventional wisdom of the day is the shortest route to success.

The Book Nook: Taking charge of ADHD by Russell A. Barkley is the go-to book on the subject. This treasured parent resource gives you the science-based information you need about attention-deficit/hyperactivity disorder (ADHD) and its treatment. It also presents a proven eight-step behavior management plan specifically designed for 6 to 18 year-olds with ADHD. Dr. Barkley offers encouragement, guidance, and loads of practical tips for parents struggling with their child’s ADHD.

Sara Teichman, Psy D. is a psychotherapist in private practice in Los Angeles and Clinical Director of ETTA, L.A.’s largest Jewish agency for adults with special needs. To submit a question or comment, email DrT@jewishhomela.com