When Elizabeth Davis, mother of CESJDS senior Sammy Davis-Jacobs, was informed by her son’s second grade teacher that he was having difficulty focusing in class, she didn’t hesitate to take him to his pediatrician to get tested for Attention-Deficit/Hyperactivity Disorder (ADHD). As she had suspected, he was diagnosed with the developmental disorder and prescribed daily medication a week later.
The experience of being diagnosed and medicated from an early age has become increasingly common. According to a Center for Disease Control (CDC) national survey of parents, an estimated seven million (11.4% of) children aged 3–17 years in the U.S. were diagnosed with ADHD in 2022, which marked a 16.6% increase since 2016. Over 50% of these children were being treated through medication.
With such a large percentage of minors recently being diagnosed with ADHD, many questions arise. Should children be diagnosed so young? Is medication the right choice for every child? What should schools do to address this large issue?
Diagnostic process
According to the National Institute of Technology, ADHD presents differently in everyone. Thus, every diagnostic process is unique. Many professionals can diagnose ADHD in adolescents, including pediatricians, psychologists and psychiatrists.
Unlike other disabilities, ADHD cannot be read on a brain scan or blood test. Patients seeking a diagnosis must have their symptoms carefully observed.
“We assess, evaluate and diagnose based on self-reports, observations, other reports, clinical history and family history, all these things,” clinical psychologist and alumnus Dr. Michael Reiter (’99) said. “And then we use the official manuals as a guide to help us determine if what that person’s presenting with fits into one of these domains, which then allows us to prescribe what the treatment would be, whether it’s therapy and/or medication.”
The diagnostic test can be long and extensive. It includes many different sections such as reading comprehension tests, computer vision comprehension tests, a section organizing shapes, an Intelligence Quotient test and meetings with a psychiatrist or another licensed professional.
In fifth grade, after a JDS teacher suggested he get tested for ADHD, alumnus Eli Gordon (’22) sat in a room for multiple hours, clicking a button on a screen whenever he heard it beep, he was being tested for an ADHD diagnosis he knew very little about.
“At first I was really upset, because it felt like I was different than everyone else, and I was gonna stand out, and I just felt like I had a disability,” Gordon said. “And I really was against all medications, and just honestly, doing anything to fix it, because I was just so upset when I heard.”
Concerns with diagnosing
Testing for ADHD can be a controversial topic for families. Students like Gordon, who were diagnosed with ADHD at such a young age, often complain about the extensive length of the test. According to Gordon, the length of the test felt like it was designed to have him reach a spot where he simply could no longer focus on the task at hand, highlighting a symptom of ADHD.
“I obviously hated that it was so long because I don’t like sitting still and listening to a thing beep for hours and hours,” Gordon said. “But in order to really understand if somebody has ADHD or ADD (Attention Deficit Disorder), I think it is definitely necessary.”
According to Lenore Layman, the Lower School Director of Educational Support Services, another concern that many families share when considering testing or medication for ADHD or other learning differences is the high costs. The price of ADHD testing can range from a few hundred dollars to several thousand dollars, according to MedicalNews Today.
“Private psychologists, because they spend a lot of time not just giving the test but analyzing it and writing it up, cost a lot of money,” Director of Upper School Educational Support Services Sue Zuckerman said. “And so there are places one can go that might take medical insurance.”
Public school system tests are usually cheaper than private practices, but according to Layman, the price difference between the public and private testing has an impact on the quality of the accuracy itself.
“We do work with some families to guide them to have testing through the public school system here and there’s some psychologists and other clinical settings that take some insurance plans,” Layman said. “But testing from some of those places that aren’t private, there can be a much longer wait, and sometimes the testing may not be as comprehensive.”
The label of a diagnosis
Even without the concerns of the length or price of the test, there are still parents against diagnosis in the first place. They do not want their child to be treated differently due to their disability, according to Layman.
For Gordon, diagnosis at first felt like something that would hold him back. Because he was only ten years old when he was diagnosed, he did not fully understand ADHD, how to accommodate his needs or manage his self-confidence.
“Just knowing that I was gonna have to work harder than everyone else just to be in line with them, I felt like I was just put at a disadvantage academically and then also socially,” Gordon said. “It was something that I thought people would make fun of me for being, for example, like just being different.”
However, in hindsight, Gordon feels that getting this “label” early in life was helpful because he could learn how to deal with his ADHD well for the rest of his life.
“I was always a little bit behind, and it’s not a bad thing to have ADHD, but I think understanding how to learn with it when you’re young helps you when you’re older,” Gordon said. “I feel like I’m still at the point where I have to work harder than everyone else because it took me a while to understand how my brain really works.”
Despite the initial hesitancy that students like Gordon have, according to Zuckerman, confirmed diagnoses and labels are ultimately necessary for making sure students get the accommodations and the attention they need to succeed.
“I don’t like using labels, but if that’s the way you’re going to get the services that you need, whether it be in college or here or from the SAT, then you have to have a diagnosis,” Zuckerman said.
Medication and the potential concerns with medicating
Medications for ADHD fall under two main categories: stimulants and non-stimulants, according to Cleveland Clinic. Each type of medication has one shared purpose, which is to increase the number of neurotransmitters in the brain and minimize symptoms of ADHD.
According to the Cleveland Clinic, stimulants, like medications such as Ritalin and Adderall, increase the levels of dopamine and norepinephrine, playing key roles in stress and attention span. Non-stimulants do the same but are rarer. They take longer to work and are usually only prescribed if stimulants are not addressing a patient’s symptoms well or are causing adverse side effects.
Although medication can be extremely effective, an aspect of medication that can cause concern for families is the cost. 30 capsules of 50 milligram extended-release Adderall is $293, according to MedicalNewsToday.
“These medications are ridiculously expensive if you have to pay out of pocket or before you’ve met your deductible for the year,” Jacobs said. “I understand that we all have to meet our deductibles, but between the cost of the medication and the fact that so many of them are unavailable because of shortage issues since COVID, we’re constantly playing this game of ‘Can I get the meds, and at what price and how do I even access them?’”
Additionally, while Cleveland Clinic studies have shown that 80% of the time stimulants are effective in mitigating symptoms of ADHD, they come with side effects. These side effects, including loss of appetite, difficulty sleeping and increased levels of anxiety raise the question of whether ADHD medication is worth the risk.
Erin Gris, parent of senior Navah Gris, seventh grade student Avital Gris, and a child at a different school thinks these side effects should lead people to be more conscious of how young their child is when they begin taking medication.
“I think sometimes we need to give children time and space to just naturally go through their developmental stages, even if they are a little bit behind their classmates,” Gris said. “… Many little kids are [in] first grade, kindergarten and are medicated already. I just think, in my opinion, I think that’s just too young. We need to give the kids a little time to develop and grow into their abilities.”
Additionally, in some cases, the side effects of medication have a large impact on someone’s personality. Davis sees a contrast between Davis-Jacobs and his other family members with ADHD’s actions when they are taking and not taking their medication.
“When [they] are off their meds, they’re much more social, they’re much more creative and engaged, they eat normally,” Davis said. “It just tamps down the personality, the medications, for each of these family members. It makes them much more subdued, much more in control, which I guess is a good thing for impulse control and impulsivity and blurting. But it’s like somebody just kind of puts a scrim in front of the screen. It’s just looking through this haze.”
For Gordon, this change in personality leads to a concern of a reliance on a medication that drastically changes behavior.
“I’m personally against [ADHD medication] because I feel like now in my life, in order to really focus, I need to take my medication,” Gordon said. “I just don’t think it’s good for kids to rely on any kind of substance to get things done. It’s like an addiction. I feel like when you put kids on Adderall or ADHD medicine early in their lives, they don’t know how to overcome it without the medication.”
Despite his grievances with medication, Gordon, along with many other people diagnosed with ADHD, continues to use it. Andrea Lee-Zucker, mother of senior Stella Muzin, has been taking ADHD medication since she was diagnosed in her 30s.
Though Lee-Zucker experienced symptoms such as difficulty sleeping and increased levels of anxiety that led her to take medication, after figuring out the right medicine to address her symptoms, she felt very good about her decision to take medication.
“I started medication, and it really changed my life,” Lee-Zucker said. “It used to be that I didn’t know where to start with anything. And you know, either I can hyper-focus, or I would just be kind of scattered and all over the place … [The medication] really helped me to focus and suddenly I was able to feel like I could take all this energy that was inside me and put it out in the world before.”
JDS’ approach
In addition to medication, many students diagnosed with ADHD must also address the behavioral aspects of the disorder. Because of this, many schools are required to offer accommodations to address the learning gap that ADHD can cause for students.
At JDS, the specific accommodations offered for students with documented learning disabilities are extended time for tests, quizzes and in-class essays, preferential seating and extra white space or enlarged print for tests and worksheets. Any student who seeks these accommodations must qualify through documentation of their diagnosis.
Students with these accommodations must also take a Structured Study Hall (SSH) to address executive functioning skills, as executive dysfunction often goes hand in hand with ADHD, according to Zuckerman. Skills students work on in a SSH include practicing how to use a planner to spread out assignments, get assistance academically or learning test-taking and study strategies.
“Students have a tool belt and they have all the tools, but I get to teach them how to use some of the tools that they didn’t know how to use,” High School Learning Specialist and tenth grade Dean Brett Kugler said. “I really find a tremendous sense of personal value in knowing that the work I’m doing is allowing students to go into the world feeling more prepared, more independent, more able to also work with a team and to see the value in balancing those skills.”
One of the primary differences between a typical study hall and SSH at JDS is the supervision that is provided for students. In SSH, one of the things that the faculty member who runs the class does is “check-ins” with students to ensure that they are staying on-task, as opposed to a regular study hall, where students are not provided with specific guidance.
“Structured study hall, I think, is a pretty good system,” senior Sunny Coxe said. “While there’s a lot that could be improved there, the fact that there is a study hall specifically for people who struggle with this kind of thing is generally a good thing, because it means that there’s a system to address it, even if there are things that could be changed.”
In addition to these modifications, JDS gives teachers an ESS plan, a summary of each student’s unique needs to help ensure that they are aware of the fact that a student’s additional need in order to succeed in class.
“Teachers know that I have ADHD, which is almost on its own an accommodation because they know that I have to be understood in different ways,” Davis-Jacobs said. “[They know] that sometimes I might need to take a break or I might need to go on a walk or I might need to get a breather from the class when I’m off my meds or when I’m not able to focus.”
JDS’ assistance is helpful for many, as some students need some additional structure or time to complete tasks in an academic setting. For others, those accommodations do not feel appropriate.
One example of a student who sometimes finds the SSH “check-ins” tedious is Davis-Jacobs.
“There were times when I felt that the check-ins were important and I’m looking back and I know that they were important, but sometimes in the moment, it just felt like too much,” Davis-Jacobs said. “When I had to get something done, it was like, ‘let’s go through your planner and let’s check it and let’s make sure it’s up to date’ but sometimes I’m hyper-focused, and I really want to get this one piece of work done, and it’s like an interruption and in normal study hall, you really don’t have that interruption.”
An additional accommodation at JDS is extended time, which allows students who require more focus to complete tasks to get the additional time necessary for them to succeed. However, according to Reiter (‘99), it doesn’t always play that role.
“I think extended time can be very helpful,” Reiter said. “But also extended time can sometimes give people more time to struggle with something.”
Along with Reiter, several students, like junior Lilah Waldman, believe there is more that can be done to help students at JDS who require additional attention.
“Having extended time is nice and it’s beneficial, but that’s not the only aspect of ADHD,” Waldman said. “For me, I procrastinate so hard, I turn in all my homework late and then I get really behind and get really stressed. So, having extended time is helpful for [things] like tests, but there’s so much more to ADHD that those accommodations don’t fit and don’t help for.”
This issue has raised concerns for some prospective JDS parents. As Jewish families search for schools that provide accommodations that their child needs while getting a well-rounded Jewish education, some prosepective JDS families find themselves faced with the choice between having their children educated in a Jewish environment or educated in an environment where they will be best adapted to.
Gris is one parent who had to make this decision. When seeking out a school for her daughter, Gris struggled to find a Jewish school that could provide the accommodations she felt her child needed to succeed academically.
Ultimately, Gris decided to send her daughter to a secular private school that would be able to suit her daughter’s needs as a student. Regardless, her frustrations still lie in the fact that her daughter would not get the Jewish education due to the fact that she would not be in an environment where she felt she would be supported enough to be successful.
“I think what I would really like to see is a deeper understanding and a deeper training for all staff to understand and recognize ADHD behaviors and understand that they come from a learning disability, or they come from ADHD,” Gris said.
Jewish education is constantly evolving to help various groups in order to be as inclusive as possible. This includes adapting to learning disabilities like ADHD to provide a Jewish education that students can thrive in.
“I really firmly believe that Jewish educators can get there, and we are getting there very slowly,” Gris said. “But I do think there needs to be a lot more time, energy and money put towards how to keep children in a Jewish environment and teach them in a way that you know they can learn, [and that] would be my hope.”
Moving forward
Beyond symptomatic accommodations that schools and medications offer for ADHD, according to Lee-Zucker, there is more to be done in addressing the challenges people with ADHD face. Lee-Zucker believes that, while students like Gordon have fears of feeling different because they have ADHD, their learning disability shouldn’t make a student different from their peers.
“It’s sometimes challenging that the world seems to be built for a certain type of person,” Lee-Zucker said. “. .. People with ADHD are a gift to the world, and there are new things that we can learn from the way that people think. I hope for places to be able to make space for different ways of being, and not to try to force people into a certain box, because there’s so much that we can learn from having diverse perspectives and personalities and learning types.”
