ADHD and Inconsistency

Rabbi Azriel Hauptman

Shimon was a 15-year-old whose behavior baffled his parents. Shimon enjoyed woodworking and when he would get into a groove he would be able to spend hours upon hours patiently carving out the most incredible creations. But when his parents would ask him to clean up his room, he would moan and groan, as if the five-minute task was cruel and unusual punishment. Even when it came to tasks that he enjoyed, his ability to perform them greatly depended on his mood. When he was excited about it, he would be able to really focus on the task, but when he was not in the mood he seemed to not be able to lift a finger. Shimon’s inconsistency was truly bewildering. What was going on?

Interestingly enough, Shimon might have ADHD – Attention Deficit Hyperactivity Disorder. ADHD is characterized by inattention, impulsivity, and sometimes hyperactivity, and is notorious for difficulty in focusing. This is perhaps the most common misconception about ADHD. Individuals with ADHD can focus quite well, and when they are interested they tend to hyperfocus. Rather, individuals with ADHD have their focus determined on their interest and not by the importance of the task at hand.

Life is divided into two different categories of tasks. One category contains tasks that do not really stimulate us, but we all understand that they need to be done. This includes washing the dishes, doing your taxes, paying your bills on time, etc. Then there are those tasks that give us enjoyment and pleasure. Most of us engage in both kinds of tasks, even if the first category does not especially stimulate us. 

If you are the kind of person who has no problem performing boring but important tasks, then you might look at someone who endlessly procrastinates as being lazy. That is not really the case at all. You just have a different kind of a brain. Let us try to explain.

Our brains are composed of many different parts that work together in order to help us execute a myriad number of tasks. There is one part of the brain that specializes in planning, monitoring, and executing specific goals, which is commonly known as executive functioning. This is the prefrontal cortex, and is located just behind the forehead.

As with many parts of the brain, the prefrontal cortex develops over time, and is relatively underdeveloped in children. This is partially why children have such a hard time in executing goals that are boring and very “grownup-ish”. Individuals with ADHD suffer from a lag in the development of their prefrontal cortex, and therefore they have a hard time carrying out “boring” tasks. In the absence of a fully functional prefrontal cortex, their focus turns to what is interesting and stimulating and not to what is important and necessary. 

This helps explain the paradoxical nature of ADHD medication. The two primary medications for ADHD are amphetamines (such as Adderall) and methylphenidate (such as Ritalin and Concerta). These are brain stimulants. How does this make any sense? Why would you give a brain stimulant to someone who suffers from hyperactivity? Wouldn’t it make them even more hyperactive? The answer is because the symptoms of ADHD can be traced to an underactive prefrontal cortex. Once you stimulate the brain and the prefrontal cortex is up and running, you can begin to focus and execute whatever tasks you need to accomplish.

Our sages tell us (Pirkei Avos 2:5) that you should not judge your friend until you have reached their place. This includes that you should not judge someone else who has a different kind of brain than you. You might have absolutely no problem with executive functioning, but your friend with the understimulated prefrontal cortex does have real and genuine obstacles to overcome.

Shimon, the hero of our story, might have ADHD, which would explain his so-called inconsistent behavior. Should Shimon take medication? Should he seek therapy? These are questions that depend on numerous factors and an experienced clinician would be able to guide Shimon through this process. Our main focus in this article is to help you understand that Shimon is not simply lazy and is not suffering from a moral deficiency. 

Individuals with ADHD are different than the rest of us, and need to be appreciated for their unique attributes and qualities. One thing we should never do to any child is expect him or her to be someone who they are not. As Dr. Seuss once said, “Why fit in when you were born to stand out?”

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