Is ADHD Really a Disorder? // Two mental health practitioners express very different views on the condition and its treatment

I understand that you’ve ruffled a lot of feathers with your theories about ADHD and its treatment. I’m curious about how you got interested in the topic.
There’s an expression from the Torah, “Et chata’ai ani mazkir hayom.” It means that I must begin by admitting and reminding myself and others of my own sins.
I’m a clinical psychologist, and in the course of my training I learned about ADHD. I accepted the ruling narrative of what we call the “scientific consensus.” During my internship, I found myself telling parents that they should listen to their doctors and use stimulants, such as Ritalin, to help their child perform better and improve his self-esteem and all that. I didn’t see any problem with using Ritalin and the like as the treatment of choice for ADHD.
Then my oldest son, Maayan, was born. He was energetic from the moment he entered the world. When he was four years old, he was diagnosed with ADHD by the developmental pediatrician we consulted on the recommendation of his kindergarten teacher. He told us that we had to start treating him with stimulant medication.

What were his symptoms?
He was making a balagan. He wasn’t behaving nicely.

In what way? Was he destructive?
He’s a good kid. He didn’t have behavioral problems. But when the teacher asked everyone to sit quietly in a circle and listen to her, he got distracted very quickly and started doing other things he wasn’t supposed to be doing. The teacher would then put him in the corner, which is a very harsh punishment for a child who is already having difficulties. I don’t like to call them difficulties, but we will use this term for the sake of this conversation.
When you put a child like this in the corner and tell him that he can’t talk or move around, you are forcing him to search for other stimuli. The child will now make even more problems, as he needs to find creative ways to attract attention. Things escalate very quickly, and the teacher gets even more upset. From there, the road to treating him is short. But it’s not really treating him; it’s suppressing his energy with powerful drugs.
My son’s diagnosis forced me to start delving more deeply into this condition that is considered a mental disorder. ADHD is listed in the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM. ADHD is introduced in the cluster devoted to neurodevelopmental disorders, near autism spectrum disorder and intellectual disabilities. These are all considered life-long conditions you are born with, meaning that they are not caused by environmental conditions. But these disorders, as well as others that can have environmental causes, such as depression or anxiety, aren’t objective physiological conditions. In other words, there is no hard evidence to prove them.

Are you saying that there is no blood test or brain scan that can detect anything physical indicating that someone has ADHD?
Right. And that isn’t just for ADHD, it’s for all the conditions listed there in the DSM. There are no biomarkers. Human beings decided which behaviors we want to define as pathologies.
There are four “D”s used as criteria. The first one is deviance, meaning that the behavior you want to define as a pathology must deviate from the norm. This is actually a precondition; without this criterion, you cannot move on. Otherwise, you can’t say that a person has an abnormal condition because it might be perfectly normal due to the fact that we are human and may have some weaknesses.
The second criterion is dysfunction. The person must experience significant impairment in his daily functioning. Then you have the third and more subjective criterion, which is distress; the person is suffering. The fourth criterion is that the person is a danger to himself or to others, which isn’t always the case.
After looking into the literature, I discovered that ADHD doesn’t meet these criteria at all. Just think about the criterion of deviation from the norm. The first DSM to mention ADHD around 40 years ago said it was a very common disorder whose rate in the population approached 3 percent. That’s a lot of people who were allegedly born with a neuro-developmental deficit. As scientists, we usually consider something deviant only if it’s under 2.5 percent.
That was back in the 1980s. As time went on, the incidence of the disorder surged. Today, the DSM states that the rate is around 7.5 percent in children and 2.5 percent in adults. And 7.5 percent is a very conservative number. In 2016, a national survey taken by the CDC suggested that 9.6% of all children and 13.6% of all adolescents received a diagnosis of ADHD, and for boys who were aged 12 that number was higher than 20%!

Let’s go back to your personal experience. After your son’s school told you that they thought he had ADHD, what happened next?
We were sent for a thorough evaluation, after which it was recommended that we start him on pharmacological treatment. I told them, “I don’t think we’re going to drug our perfectly healthy child.” Then I became very involved in my son’s education, making sure that his teachers loved him and cared for him and weren’t getting angry at him all the time. I found many solutions to help him navigate the traditional educational system. We live in a small village outside of Jerusalem, so we don’t have many alternatives. We send our child to a regular school. It’s not a fancy school or a private school or a special education school.
My wife and I joke that Maayan is a medical miracle, considering that we were told that he was born with ADHD, which they claim is a life-long brain disorder. It took a lot of effort, as well as understanding, compassion and lots of rigid boundaries, but he made it. You don’t need to be a licensed psychologist to know how to treat children. You can make miracles by sticking to common-sense principles.

How were you able to manage your son without medication?
We were fortunate to be able to stay on top of things. Sadly, it’s much harder for a single mom who works two jobs. For the first few years, up until he was in the second grade or so, I visited the school quite often and spoke to the teachers, recruiting them as allies. I promised them that my wife and I were really doing our best to clarify to our son what the expectations were. But it was hard work. I am not naïve. Energetic or distracted children are not easy to raise.

How old is Maayan now?
He’s 12 and a half.

Have his ADHD symptoms lessened over time, or is he learning to navigate life with it?
In order to answer this question, I must preface it by saying that “symptoms” is a tricky word because it implies sickness. I am pointing this out because it’s an important component of the conceptual change I am trying to promote—what we call symptoms are simply natural traits or behaviors that are part of who the child is. This key understanding solves half of the problem, because then you aren’t placing the issue in the child’s brain; you’re placing it between the child and the family, or between the child and the educational system.
By the way, the DSM itself articulates a very important reservation. There’s a section that defines the concept of a mental disorder, and it says that an acceptable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder.
ADHD is a conflict between the child and his surroundings. Nothing is wrong with the brain in the vast majority of cases. At the very most, fewer than 1 percent of children have something wrong in their brain.

Can the diagnosis be traced back to the time we started confining children to a seat in a classroom for many hours at a time?
I’m not sure I know the answer to your question because I approach the subject as a scientist rather than as a historian. I am less interested in the reasons that led to the emergence of this made-up disorder. But I can speculate that after the Industrial Revolution, the schools created a situation where children were expected to sit for long hours and concentrate. Because parents wanted their children to succeed and go on to higher education, the pressure on them increased.
What I am doing is calling for a major change in the way we perceive childhood and the education of children. I think that we as a society have made mistakes in how we treat children and what we expect from them. Yes, we do need to set boundaries, and sometimes we need to be tough. But this toughness should be manifested when they are behaving in a way that hurts others. We need society to change, but not by telling our children, “Oh, you poor kid! There’s something wrong with your brain.” We need to do the opposite, telling them that they have wonderful qualities that perhaps make things more difficult for them in school.

You’re telling parents that their children shouldn’t be put on medication, but you don’t argue about the problematic behavior being there. How, then, should they manage their children?
I’m not telling parents whether they should or shouldn’t medicate; that’s not part of my mandate. I simply deliver information about the medications, and I strongly believe in informed consent.
I am not a parenting guru. I’m not going to give a series of recommendations. I want to talk about the principle, which is that once you start taking a powerful stimulant, it gives you “superpowers.” But after it wears off, not only do these superpowers disappear, but the brain now has to compensate for the artificial inflation caused by the neurochemicals. This creates a backlash, and the so-called symptoms become much stronger. I discuss this in my book, citing all the literature to support this very simple argument.
I would also tell parents that there are many non-pharmacological interventions that work. You can do behavioral therapy. You can do martial arts, yoga or meditation. I also recommend that parents read a book by Dr. Thomas Armstrong called The Myth of the ADHD Child. In the new edition, he discusses 101 strategies to help children without drugs while giving them support.
The good news is that the “symptoms,” as we call them, lessen as the child grows up. This is not my personal view; this is common knowledge. More than two decades ago, researchers at the National Institute of Mental Health who are world-renowned experts on ADHD conducted a famous longitudinal study that compared various treatments groups. Based on the study and a three-year follow-up, they concluded that regardless of which treatment or lack of treatment the children received, they all exhibited the same degree of improvement.
In fact, when you go back to the DSM to check the numbers, you can see that there is a sudden and significant drop in ADHD rates in adulthood, which doesn’t make sense if you have a congenital, life-long illness. How did all those children suddenly disappear?

Let’s talk about action. What did you find was helpful with your son? I know I’m going a little off track, but you are wearing two hats, one as a psychologist and the other as a parent.
Whether or not a child has ADHD personality traits, he needs to know that he has responsibilities in the home. That would be one tip. The other would be to talk to your child and reflect on his struggles and challenges. For example, you can tell him that he’s going to have to work hard to compensate for the things he is naturally not good at. Perhaps you can say, “Yes, I know it’s hard for you to sit still in class for such a long time. I understand that. Maybe this is one of your weaker qualities, but you have many other strong ones.” You can give positive feedback and encouragement without labeling weaknesses as mental disorders.

Do you think it’s fair to expect such a child to sit through eight hours of school every day?
No, I don’t. To me, it’s like taking a child who is sensitive to gluten and throwing freshly baked rolls at him.

So you’re saying that we need to understand that this child is wired a little differently and that the school should accommodate him or her.
Yes. As long as we keep sending our wonderful children to regular schools, we need to find ways to accommodate them. But I’m hoping that there will be a big revolution in everyone’s thinking.

Your dream is that the label itself will be eliminated, right?
Yes. I want it to be removed from the DSM because ADHD is not a deficit.

Do you believe that ADHD doesn’t exist at all, or would you concede that there might be a small percentage of children who meet criteria for a mental disorder?
There are two options here. You can change the criteria for ADHD and make it much more serious so that it fits perhaps 1 percent of children. Or you can toss the label into the dustbin of history and focus on children who have pervasive difficulties. There are hundreds of other labels in the DSM, and if you don’t like any of them, you can invent a new one.

Is the diagnosis of ADHD more prevalent in Western countries?
Yes. In fact, secular cultures in general have more diagnoses of ADHD than traditional ones. I actually did a very interesting study here in Israel that found that the more religious you are, the less prevalent ADHD is.

I don’t have any numbers, but anecdotally it would seem to be a subjective diagnosis because of the disparate rates that are cited.
Yes. When the rates vary so much among places and cultures, it challenges the reliability of the diagnosis.

Your whole premise goes against the establishment and what we consider accepted wisdom. What happened when you first came out with this idea?
I started out by writing in Hebrew in Ha’aretz. The first paper I published on this topic was one of the most read in the country that year (2019), and I wasn’t ready for what happened next. I was blasted and attacked relentlessly. Then the foremost Israeli expert in ADHD filed the complaint against me with the Ministry of Health, which is responsible for issuing licenses. I was terrified in the beginning.

I’m sure you were afraid that you would lose your license. What happened next? Were you called down for a review?
It’s an interesting story, because once I received the complaint, I had to reply. So I sat down and drafted what turned out to be a ten-page fully referenced article that I submitted to the Ministry of Health. The complaint totally disappeared after they saw it, and no one came after my license. That semi-academic article became the foundation of my scientific book. I’m actually about to publish a book in Hebrew for laymen that contains practical tools for parents. But in a certain sense I’m even prouder of my scientific book, because that’s my real calling. I am currently a formal faculty member at the Ariel University of Samaria.

What’s your title?
I’m a senior lecturer in the Education Department. My main field of research is media psychology. I’m interested in the psychology of children and adolescents as it is affected by the digital age. I’m also interested in how we can utilize social media and artificial intelligence to identify suicide risk and depression. In fact, due to my unique expertise in the application of AI in mental health, I became a research associate at the Centre for Human-Inspired Artificial Intelligence (CHIA) at the University of Cambridge.

You aren’t a practicing psychologist?
I am. I have a private clinic, but most of my time is dedicated to research and teaching.

Are you still involved in ADHD research, or are you done with that?
It’s very hard to publish non-mainstream ideas in mainstream journals, even if they’re backed by research. So I publish these rebellious ideas in places that some of my colleagues consider to be less prestigious. But many of my studies in my primary field of research are published in the top psychology and medical journals.

Have you converted any big names?
I’m not sure.

How long ago did you go public with your theory?
I started writing and talking about it in 2019.

And you haven’t been able to persuade anyone in the establishment?
Not that I know of.

I understand you were flagged as being a danger to society.
Yes. I was even accused of being a Scientologist. I didn’t even know what that was. I’ve been called all kinds of names.

Have you gotten feedback from parents who implemented your ideas and saw an improvement?
Yes, definitely. But most of my impact is the result of my public lectures on this topic. A lot of parents are initially shocked. They don’t believe that all the information I present is being concealed. The concept of informed consent seems to be ignored in psychiatry in general, and particularly when it comes to ADHD. It’s unbelievable that parents aren’t educated about basic, mainstream psychiatric concepts. They also don’t know how dangerous many medications can be, the way they can possibly put a burden on the cardiovascular system or the fact that the FDA has determined that the use of these drugs may lead to misuse and abuse even when they are prescribed for the treatment of ADHD. The problematic uses of the drugs may cause overdose and death! Due to the serious risk, the FDA recently issued an update requiring that this information be highlighted in a “box warning,” which is the FDA’s most prominent warning. This is in complete contradiction to the reassuring messages parents receive from their doctors.
Are you putting Ritalin in that category?
I’m not the one who put it in this category—the Drug Enforcement Administration (DEA) did that. The medications that are considered treatments of choice for ADHD are methylphenidate (e.g., Ritalin and Concerta), amphetamines (e.g., Adderall) and methamphetamines (e.g., Desoxyn). They are all stimulant drugs—similar to cocaine.

Why do you think you haven’t had an impact on the establishment?
I don’t want to sound like a conspiracy theorist, but I think that there are powerful interests involved. All of these stimulant medications are best sellers.

What are the risks if one chooses not to medicate a child who has ADHD?
The ADHD experts say that if you don’t take this stimulant, you will put yourself at great risk. Some experts even connect it with contracting severe illnesses. Of course, most of them are careful with their words, but they’ll strongly imply that lack of treatment increases your risk for all kinds of things like car accidents and suicide. I talk about these unfounded intimidations in my book. The doctor will tell a parent, “If you don’t give your child this drug, he will grow up to be a criminal. If he doesn’t listen to his teachers and gets bad grades, he’ll feel frustrated and end up in prison.” This is scary stuff. But these doctors aren’t directly to blame; they’re merely parroting what they were taught in school.

Thank you so much for your time. This has been very interesting.
You’re very welcome.

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