Marching to a Quicker Drummer
A brief report on ADHD in Jerusalem.
Since 1987 when ADHD made its first appearance in the Diagnostic and Statistical Manual (the most widely accepted index of psychological and psychiatric disorders), laypeople and professionals have increasingly viewed hyperactivity as a disability. While some hyperactive children and their caretakers appreciate this label -- partially because of the benefits granted to the officially "disabled" -- many are offended. "There's nothing wrong with me," one perceptive, unmedicated boy with ADHD told me with a smile, "I just march to a quicker drummer."
Those who don't like being labeled "disabled" -- or even "ADHD" -- often offer this eminently reasonable defense: ADHD diagnosis is somewhat arbitrary. There is no uniform standard for determining who is hyperactive and who isn't, and children who qualify as hyperactive according to one diagnostic index might not qualify according to any of the other half dozen competing indices. A recent study in Michigan found that disagreements over who is really ADHD produced a ten-fold difference in Ritalin prescription rates from county to county.
"These children are not hyperactive, they are more active. Hyperactive means too active. Who drew the line?"
Across the world, here in Jerusalem, where most of the research for my new book has been conducted, To Kindle a Soul] many of the most traditional parents and rabbis have trouble even comprehending the concept that high levels of activity constitute a disability. "These children are not hyperactive," a white-bearded Jerusalem sage gently rebuked me, "they are more active. Hyperactive means too active. Who drew the line?"
Not only have I found a less condemning attitude among some of the most traditional residents of Jerusalem, it has also become obvious that many artifacts of their culture heal this "disability."
For example, traditional academies of advanced Talmudic studies (yeshivas) generally don't have desks. Everyone has their own podium (called, in Yiddish, a "shtender"), and students stand while learning as often as they sit. One of my colleagues made headlines when he introduced this concept to special-ed teachers here in the West. "Within the classroom some simple, practical things work well. Let hyperactive kids move around," he told Time Magazine, "I've seen kids who from the chest up were very diligently working on a math problem, but from the chest down, they're dancing like Fred Astaire."
Another cultural factor that wipes out ADHD symptoms here in Jerusalem is the emphasis on imaginative play. Traditional Jewish sources stress the vital importance of imagination, and therefore many traditional homes shun television, videos, computer games and other imagination-killers. Not surprisingly children from these homes engage in far more creative games and fantasies than most North American kids. Reams of data tell us that besides enhancing sequencing skills, concentration, empathy, feelings of well-being, divergent thought, impulse control, expressiveness and a range of other cognitive and emotional strengths, imaginative play reduces hyperactivity.
The diet of some of my traditional, Jewish subjects here in Jerusalem might also be responsible for reduced incidence of hyperactivity. Partially because they have large families, and partially because Israel's economy has been depressed by years of terrorism, many of the parents I meet in Jerusalem have limited disposable income. Since homemade bread, fresh fish, and seasonal fruits and vegetable are cheaper than processed foods, children from these families often consume few preservatives, food colorings, and refined sugars.
By 1981, the data linking food additives and refined sugars to hyperactivity was already so overwhelming that the Los Angeles County Probation Department replaced all soft drinks and junk food snacks in the diet of juvenile prisoners with fruit juices and whole grain snacks. High sugar desserts and cereals were also banned. The massive change involved almost 2,000 juveniles detained in six California penal institutions. Confirming the wisdom of the move, after only three months on the new diet, antisocial behavior among all inmates fell 44% and remained low thereafter. Similar steps have been taken by correctional institutions and publicly subsidized schools across the U.S., consistently with the same result. In his well-known diet, the late Dr. Benjamin Feingold, Chief Emeritus of the Kaiser Permanente Medical Center Allergy Department in San Francisco, outlined a regimen -- very similar to traditional Jerusalem fare - that he claimed eliminated hyperactive behavior in at least 30% of ADHD subjects.
Other factors I see among some of my Jerusalem subjects -- like increased physical affection, increased daily exercise, reduced caffeine consumption, and a penchant for feeding kids breakfast and giving them enough sleep -- are similarly associated with decreased incidence of hyperactivity.
Reflecting on the natural experiment taking place here in Jerusalem, I appreciate the position of those North American parents and teachers who claim that their "more active" children are not disabled.
While a small percentage of hyperactive children might really need medication, the majority do not; and their parents make a persuasive argument that their kids are perfectly "able" but require more active environments, less TV, more fantasy play, better diets, more exercise, a firm bedtime, and an extra hug now and then.
And I pause to wonder how many other "disabilities" are really just perfectly normal differences that our culture fails to tolerate or exacerbates until they are indeed handicapping.
This article originally appeared in Olam magazine.