Small Victories

With his round wire-rimmed glasses, sneakers, yeshivish attire, and youthful ebullience, 34-year-old Rabbi Dr. Felt — known affectionately as Nachi — is eager to share the wisdom he’s gained from a lifetime struggling with ADHD and coming out ahead, and he approaches it with sharp intelligence, humor, and the earnestness of a proselytizer.

He greets us in the small office he maintains in Queens to see patients, a clientele he describes as “really motivated frum people who want to be the best they can be: families, yeshivah bochurim, and younger couples.” They comprise all points on the Orthodox spectrum, from modern Orthodox college students to yeshivah bochurim to chassidic businessmen to families of all stripes.

He puts in about 30 client hours a week, plus teaching and supervising other therapists. The only clients he won’t take are high-conflict couples and anyone who isn’t truly motivated to work on himself. “I focus on people I can be most helpful to,” he says.

In the frum community, Nachi has become a go-to guy for many families and adults struggling with ADHD, but he stresses that his job isn’t to be the fix-it man when kids or spouses get out of hand, and he won’t meet a child or spouse before meeting the parents or partner.  “I need to get to know the other players because it’s vital that we work together as a team,” he says.

For those who need to sharpen their parenting skills when raising a child with ADHD, he offers training in his office or via Zoom. He shows them how to help the children by setting boundaries and how to help them motivate themselves to succeed, working collaboratively to harness the incredible power of the ADHD child. Sometimes, even simple incentives can go a long way, like the Lego sets his own parents used to buy him as a child to keep him motivated to behave in class.

“The key is clarity and collaboration,” he says. “Clarity for the parents so that they can collaborate with their child to help the child create personal clarity.”

Nachi’s goal is to help kids develop their own solutions to the myriad challenges posed by their ADHD. He’s open with them about the various manifestations of their conditions, but instead of whitewashing those challenges, he helps them embrace them with honesty and hard work, teaching practical strategies for success. He also helps older bochurim who suffer from “failure to launch,” offering a large toolbox of skills, strategies, and workarounds to help them get through their day and develop effective executive functioning. Most importantly, he helps to rebuild their wounded self-esteem, as going through school unable to succeed leaves many children and young adults with a battered self-image and profound frustration, after being bombarded for years with constant negative messages.

Mr. and Mrs. G., for example, came to Dr. Felt because their teenage son, who suffered from ADHD and anxiety, refused to daven, do his homework, or maintain basic hygiene. “Each disorder complicated the other,” Nachi says. “He would neglect to write down his homework, but then he’d get anxious about it and avoid anything related to that class, leading to fights with his parents and the school.” Nachi coached the parents to develop a parenting style based on “empathy from a place of strength,” implementing boundaries in a non-conflictual way and praising small victories like remembering to write down the homework.

He avows that while some of his cases have been quite formidable, the rewards more than make up for the challenges. He mentions Hillel, a sweet bochur who wanted nothing more than to be a functional, successful eved Hashem who could have pleasant conversations with his family. But with ADHD, OCD, bipolar disorder, and autism, he was tremendously challenged.

“I joked with him that he has more letters after his name than I do,” Nachi says. “On top of all that, he had suffered early childhood traumas, and his single mom struggled to raise nine children on her own — three of them with special needs. Hillel, on the other hand, threw himself into my program to develop agency and self-efficacy. He took notes and would practice the tools until he got them right. He used them to finish a sefer he was writing and calm himself down before dating.”

The ability to master executive functioning skills (such as focus, planning and meeting goals, and emotional regulation) is so crucial for success in school and work that its absence can upend a person’s life path. Yet it’s also something that can be taught, especially with the adult cases Nachi takes on. One of Nachi’s clients, a chassidic yungerman named Yoely, was barely frum and on drugs when they met. Through their sessions, Yoely realized that what was holding him back was not any deep-seated resentment at his rebbeim or Hashem, but the lack of basic executive functioning skills that prevented him from succeeding at work and his religious life.

“Once we were able target areas of improvement, Yoely thrived,” Nachi says. “He outpaced his job and started his own company. Now he learns every day, and puts out messages on WhatsApp to inspire others to pick themselves up and give themselves another chance.”

Another client is a married father of four who went through a tragic childhood and struggles with OCD and ADHD. While medication proved to be a game changer, he still had a hard time getting his day started and accomplishing basic tasks. Dr. Felt worked with him to identify when he was becoming trapped in cycles of ambiguity and taught him how to master his use of time. The man went from unemployment to a nine-to-five job that he then used as a springboard for opening an independent consulting business.

ADHD can be difficult for the spouses, too, who often feel their other half isn’t capable, or isn’t pulling his weight, or doesn’t care.  Often a man with undetected ADHD can’t focus on what needs to be done or organize himself properly in order to make sure it happens, and his wife might respond by becoming either a nag, or distant, aloof and unengaged.

Been There

One of the reasons that Nachi is so effective with clients with ADHD is because he struggled with it himself for so many years, a struggle that was compounded by frequent moves and the pressures of being a rabbi’s son.

Nachi’s father, Rabbi Dovid Felt, himself struggled with ADHD as a young man growing up in England with a British father and Moroccan-born mother who had come to England with a group of girls brought by Rabbi Joseph Dunner and his wife. “ADHD definitely has a genetic component,” Nachi says. “My father would force himself to concentrate so hard in school and yeshivah that he would have massive headaches. As a teenager, he lived on huge doses of aspirin just to handle them.”

The senior Rabbi Felt started out his married life in Jerusalem with his American wife, living in Har Nof and attending the Mirrer Yeshivah in Jerusalem. Little Nachi was always overactive, and when he was three years old and his mother was on bed rest, he entertained himself by throwing all the clothing in the house out onto the neighbor’s porch. “I even ran away from home, and neighbors found me and brought me back,” Nachi relates.

The combination of challenging pregnancies and even more challenging kids led the Felts to decide to put their dreams for long-term life in Eretz Yisrael on hold, and the young family reluctantly returned to the US.

Rabbi Felt’s father-in-law, Rabbi Yaakov Deitsch, was close to Rav Henoch Leibowitz of Yeshivas Chofetz Chaim in Queens and that’s where they landed. At the time, Chofetz Chaim allowed an option for its avreichim to earn advanced degrees in education, so that they could go out into the wider world to teach with credentials. Given Rabbi Dovid Felt’s own history and his son’s struggles, it’s not surprising that he opted to write his master’s thesis on the pros and cons of medicating for ADHD.

“Childhood, especially my school years, was a very confusing time for me,” Nachi remembers. “One of the schools I was in considered me a danger to myself and others. I would imitate the teachers, I would steal snacks and supplies, once I even kicked the principal. I would randomly slam a kid’s head into the water fountain when he’d bend down to drink, just for kicks. Once, when I was about eight or nine, I brought a pack of matches to school and showed the kids the cool things you could do with them. But I was by the storage for cardboard boxes and everything went up in flames. I almost burned down the building.”

How does a seemingly incorrigible child feel about himself when he’s acting out? Is there anything left of his self-esteem?

“I think in the moment, I didn’t feel anything,” Nachi relates. “Many of us, especially people with ADHD, get caught in what I call a ‘stream of stimulation,’ going from one stimulus to the next without ever pausing to stop. Always finding another way to act out without stopping to think. And the reason we don’t stop is because we’re afraid of what would happen if we stopped. What would we have to face? There’s something I call a Delayed Sensory Affect, meaning that we don’t feel our sensory cues until after the fact. While we’re in the stream of stimulation, going from stimulus to stimulus, the internal cues get washed over by the flood of stimulation in the moment.

“So as a kid, I think I was too caught up in the sensory stimulation to even feel anything in the moment. I do remember feeling lots of rage as a child, but I didn’t have the ability to articulate any of that, even as I was dragged from one therapist to another. I don’t think I ever really thought too much about what I was feeling.”

With all that wildness, was he at least having fun? “I would say, I wasn’t necessarily looking for fun as much as I was seeking stimulation,” he relates, explaining that most neurotypical people are motivated if something is either important or beneficial. “But for us neurodiverse folks, even if we see the importance of something, it doesn’t mean anything in the tachlis stage. So things that seem beneficial, like charts and points, are not always going to work.”

After seeking professional advice, Nachi’s parents put him on stimulants, but it took some time and fiddling with the dosage until the doctors found the right meds. “Until they got it right, I felt broken,” he recalls. “I would think, ‘Even the meds can’t fix me.’ But once they worked, they were lifesaving.”

Eventually, Rabbi Felt took a position running a high school in San Diego, and enrolled his own children in the community school. For a challenged kid like Nachi, all of this was not easy. He’d been moved around from Jerusalem to Queens to California, and from one school to the other. It was so hard for him to behave, yet as the son of the menahel, he was expected to be a model of good conduct.

“I was the oldest child, so I got double portions of attention and double portions of punishment,” he recalls. The social situation was also tough, especially as his coed grade began making bas and bar mitzvah parties, typically fancy, mixed events with nonkosher catering.

“My social life was basically limited to the chess club,” he says. But there was a silver lining. “There was more acceptance there, and I remember that even though I was still getting all these pink slips, the principal invited me to her house to hang out with her husband, and we watched a football game together. She really invested in me as a person and not just as a troublemaker. She saw ‘the person behind the pathology.’ To quote my mentor, Rabbi Dr. Chaim Feuerman, it’s not enough to ‘love the child.’ You also have to like him, and like his lizard collection, too.

“I was on every program, every kind of med, and eventually I felt like I was just a total disappointment to the adults around me,” Nachi continues. “Kids pick up what the adults really feel about them. So I was lucky to have people in my life that really cared about me and saw beyond that troublemaker status. I think the transition — how I got from little Nachi the arsonist, an unsalvageable terror, to becoming a successful professor and ben Torah was because of the special people who not only believed in me but conveyed that respect.”

He can count the educators who he felt were able to see past the misbehavior. “There was my third-grade rebbi, Rabbi Schwartz: I once got an alef-plus and my parents thought it was a typo. He really liked me, and he really liked my airplane collection. I had a whole fleet of fighter planes under my desk. I also really appreciated my rebbi in San Diego, Rabbi Hollander, who would chuckle at my misbehavior.

“And years later, when I’d finally buckled down and was learning in Chofetz Chaim, I bumped into my first-grade rebbe. I recognized him and introduced myself. I didn’t remember any details of those crazy years, but somehow I knew that I was okay in his eyes back then, and I felt safe with him. I said, ‘Hi, I’m Nachi Felt, I don’t know if you remember me, I now have semichah and am a professor at Columbia University, I’m even writing a sefer on Ohr Yisrael, and I just want to say thanks.’  He took my hand and said, ‘You should know, I always liked you. And the reason I became a rebbi was because I myself was dyslexic, and none of my rebbeim believed in me when I was a kid. I was looked upon as a loser, and I didn’t want any other kid to go through that.’ ”

Your Best Shot

The Felts saw that their children needed an upgrade socially and academically. Rabbi Felt took a position as the principal of Valley Torah High School in Los Angeles. Nachi was placed in the more religious track, with the kids of the rebbeim, where he found himself woefully unprepared.

“In San Diego we had an ‘honors Talmud class’ in which we learned how to break apart a mishnah,” he says. “But I had never learned Gemara. So in high school, when the rebbi used to give tests on three levels: gold, silver, and bronze, my test was the wood one.”

He was fortunate that his father stepped in. Every Shabbos, Rabbi Felt would sit him down and offer, “Tell me about the Gemara you’re learning.” He taught Nachi to analyze each piece by breaking it into statement, proof, question, answer, and rejection. “We started from scratch,” Nachi says, “and I learned to tread water. He never fed me the Gemara, I always had to tell it to him, and that taught me how to work hard and create my own clarity.”

When he was 16, he graduated high school and went to the Yeshivah Gedolah of Milwaukee, popularly known as WITS (Wisconsin Institute for Torah Study), but the Gemara learning was just too foreign, and so difficult.

“I hated Gemara, and eventually I was starting to hate Yiddishkeit, and I especially hated the well-meaning rebbeim’s lines about how Torah learning is the besteh sechoirah. Because I could never relate to that, it only widened the gap between us. But I think the transformative conversation was a conversation I had with my father, who struggled like me and basically told me, ‘You think Torah is easy? I had to break my teeth when I was in Gateshead. I also had trouble reading…. You gotta break yourself, you gotta give it your best shot, and if not, you’re not being fair to yourself.’ So I asked him, ‘Okay, what’s my best shot, to the end of the zeman?’ And he answered, ‘Five years.’ ”

Nachi took on the challenge, one year at a time, slowly absorbing his father’s love of Torah and making it his own. He dreamed of becoming a talmid chacham and an educator like his father, until at some point it actually became within his grasp. Perhaps it was this that gave him the fortitude to push himself through where others would have long given up.

The techniques Nachi found to help him succeed in learning are techniques he now shares with his clients. Because he’d mostly worked from memory for so many years in yeshivah, he realized that he hadn’t really mastered Aramaic. But determined as he was, he began writing translations in the corner of his Gemara and forced himself to progress. He wouldn’t nap on Shabbos until he finished reviewing what he learned that week, consecrated time to learning the Aramaic translations, and by the fourth year was able to read a piece of Gemara on his own.

In order to keep up with his shiurim, he would review the material every night, sometimes till after midnight, and then write it over until he had clarity. He would do his best to organize the material in his head before every shiur so that he could follow clearly, which helped him find the shiur much more interesting.

He also continued his meds, whose side effects include increased heart rate and reduced appetite, and less sleep. “Having a reduced need for sleep was actually convenient for a bochur. I never needed coffee,” he says. Nachi admits that the side effects weren’t always so pleasant, and he didn’t particularly enjoy the nausea, headaches, and discomfort that came with his increased concentration. “But I was honest with myself, that whatever the side effects were, they were better than living without the medication and failing at life. I needed the meds for so much more than just concentration. As a teen, I was probably at least five years behind my peers in terms of executive function and emotional regulation.”

When he moved on to Chofetz Chaim after WITS, he developed a close relationship with Rabbi Dr. Chaim Feuerman, a distinguished educator he characterizes as an “educational guru.” Dr. Feuerman lived in Queens, and Nachi found himself as a frequent guest in his home, becoming Dr. Feuerman’s regular Shabbos chavrusa.

“He really believed in me,” Nachi says. “I even brought my wife to him when we were dating. He was the one who pushed me to get a PhD, to go beyond my semichah, and become ‘Rabbi Dr.’ like himself. His belief in me was very empowering.”

After Nachi married, his wife — known as Morah Necham in their neighborhood in Flushing — was another ace in the deck, supporting his long hours and drive to achieve.

“Her father, Rabbi Hillel Waxman, has a yeshivah in Ramat Beit Shemesh, and she grew up with that kollel lifestyle,” Nachi says. “But between yeshivah and college, she basically didn’t see me for eight years.” He recalls that he used to come home from kollel so wiped out by the effort that he’d need to change his clothes and take some space for himself before eating and going back out.

“She is the biggest resource I have, and its only because of her that I am able to invest so much into myself,” he says, noting that it was her help that enabled him to get through the day and was able to throw himself into the rigors of Torah learning.

Accomplish Your Dreams

Like many kids who had a checkered history in school, with some teachers who “got it” and others who failed miserably, Nachi always cherished a dream to become a rebbi. Following in his father’s footsteps, he thought about earning a degree in education.

“Dr. Feuerman advised me not to go that route,” he says. “He said it would mean I’d become a principal, and that is rarely a long-term job. He thought I would be more valuable and have more influence as a psychologist.”

Nachi Felt chose a hybrid program through Walden University, the only one that both accommodated his learning schedule and allowed him to get licensed. He spent several years working extremely hard on very little sleep, but the fruits of his labor were sweet: In 2021, he finished both his semichah and his PhD.

Perhaps in the merit of his constant Torah learning, he says, he has since enjoyed tremendous siyata d’Shmaya. His current teaching position at Columbia, for example, came about in a Providential way.

Nachi’s PhD thesis focused on trauma and caring for caregivers, that is, how to provide the right support so that professionals like therapists, doctors, and nurses don’t burn out. It was published in the middle of the Covid pandemic, when everyone was in trauma and caregiver support was an issue on everyone’s minds. “My thesis was the Flavor of the Month,” Nachi jokes. But the upshot was that he received an invitation to speak about it at Yale University Medical School.

On the heels of that success, he applied to speak at NYU as well, and on the strength of his speech they offered him a lecturer position. Then Columbia University, always in competition with NYU, decided to step in and grab him. “They were looking for someone young who was willing to come in and teach without a mask,” he says. “They heard I was fun and charismatic. The whole thing was a neis. I was able to begin studying attention and cognition in their labs and gain access to this incredible brain trust, people like Dr. George Bonanno, the father of resilience, and Dr. Ari Tuckman, who’s a world expert on ADHD.”

Teaching was always a dream for him, and now he greatly enjoys the opportunity. “This job found me — it sharpens me, makes me smarter.” He teaches psychopathology to graduate students and specializes in complex diagnoses. So far, he says, the anti-Semitic turmoil at Columbia hasn’t affected him, even though he proudly wears his yarmulke to campus. “Well, I’m not an idiot, I also carry pepper spray in my bag,” he says.

At the beginning of his career, Nachi didn’t discuss his ADHD publicly or seek out those clients.

“For me, my ADHD was my shame and my weakness,” he says. “My worst-kept secret.” But one day, while attending a class on ADHD by Dr. Norman Blumenthal, Nachi joked aloud, “I have that! Look, here’s my pill!” Dr. Blumenthal told him, “See me after the lecture.” Nachi admits that “I was terrified, I felt like I was back in 2nd grade, getting in trouble with my teacher again.”

But it turned out that Dr. Blumenthal was actually interested in having Nachi come speak about his ADHD at a seminar for OHEL.

“He was very supportive. When I protested that I wasn’t officially trained in ADHD, he said, ‘Look at where you got yourself with your ADHD, you have a lifetime of experience — Ein chacham k’baal hanisayon.’ It felt good, but I was still very nervous,” Nachi says. “I had always kept my ADHD in the closet. Dr. Blumenthal was the one who pushed me into this field. On my own, I would have been too ashamed. But once I took that step, I went for specialized training at NYU’s ADHD Center, and started attracting clients who needed help from someone who really understood them.”

He now spends two days a week teaching and researching at Columbia, two and a half days seeing clients, and a full day dedicated to professional development, with a group of outstanding professionals including Dr. Benzion Sorotzkin, Dr. Victor Yalom, Dr. Ari Tuckman, Dr. George Bonanno, and Dr. David Pelcovitz. He still spends morning seder learning iyun, and at night, he is finishing his peirush and English translation of the sefer Ohr Yisrael, and schedules one-on-one time every night of the week with each family member (his wife and four children).

“ADHD people need practical, attainable rewards that are aligned with their goals and values,” he comments. “For myself, the reward for writing the sefer was a brand-new Tesla. I ordered it to get my juices flowing, but made it very clear that if I don’t finish the first draft by the time it gets delivered, my wife gets to exchange it for a new Honda Odyssey.”

Nachi’s status as a role model, a person with ADHD who achieved great things, is surely the secret ingredient to his success. “Because he has a history of ADHD and today is very accomplished,” says his longtime friend Rabbi Rafael Adler, “he can truly tell other people with ADHD that the sky’s the limit. ADHD, rather than hindering one’s growth, can give you the ability to accomplish your dreams. And he truly wants the best for his patients and strives to keep improving his methods to best serve them.”

“He is great at communicating with clients in an effective way, and understands the cost of ADHD to the client,” says Dr. Tuckman. “He knows that people’s very lives are at stake.”

ONE BRAIN

There is actually a physiological difference between an ADHD brain and a neurotypical brain, according to Dr. Nachi Felt. The brain of a person with ADHD has lower levels of dopamine, the neurotransmitter that contributes to our sense of pleasure, our attention levels, and executive functions. That means he needs higher levels of stimulation to compensate for the deficit.

“The ADHD brain doesn’t use dopamine as effectively in some parts of the brain. That means it’s harder for the brain to put on the brakes for itself — to hold back from distractions or impulses,” says Dr. Ari Tuckman, who specializes in diagnosing and treating people with ADHD and author of More Attention, Less Deficit: Success Strategies for Adults with ADHD. “The ADHD student can’t tune out as well when the kid behind him in class is tapping a pencil, and maybe he’ll miss the teacher saying that there’s a test tomorrow. Or he’ll call out inappropriately. These are universal problems, but ADHD exacerbates them.”

“A neurotypical brain will be motivated if confronted with stimuli it believes to be important or beneficial,” Nachi says. “A neurodivergent, ADHD brain is only motivated by what it finds interesting. Its executive functions only kick in if the person finds something compelling. The ADHD brain is a slave to stimulation.”

This craving for stimulation means that ADHD kids are more likely to seek the rush of daring, high-risk behaviors: the roller coaster, the crazy skateboard move, scaling a wall. As a consequence, they’re more frequently seen in emergency rooms.

Our sedentary lifestyle likewise exacerbates the struggles of people with ADHD, as we expect both children and adults to be able to sit and concentrate for long hours, which is not always realistic. In the same way that Type 2 diabetes didn’t manifest so widely in an era before massive sugar consumption and minimal physical exercise, ADHD was less obvious and challenging in an era in which people did more physical labor and their brains didn’t have to keep track of constant, unremitting input.  In fact, physical exercise is an excellent remedy that might work as well as ADHD meds, although yeshivah bochurim generally don’t invest the amount of time needed to obviate the need for meds. Nachi himself devotes short slots during the day to jogging, pushups, or pullups.

“Sometimes a rebbi will punish an ADHD kid by taking away his recess,” he says. “That’s the worst thing he could do. Those kids desperately need to run around.”

Ritalin is typically prescribed as a treatment because it is a stimulant that increases dopamine flow, making it easier for people with ADHD to focus. But too much, Dr. Felt says, can make you like a zombie, locking your attention into anything that comes into your view. He collaborates with prescribers such as pediatricians and psychiatrists to confirm ADHD diagnoses and find the dosage that is the most effective with the least side effects. He adds that ADHD symptoms often decrease with maturity; he himself takes half the dose he did as a child.

In some cases, emotional issues may masquerade as ADHD. Sleep disorders, PTSD, depression, and anxiety are among the conditions that can lead to a loss of focus and inability to stay on track at home or work. A good diagnostician needs to be aware of this so that he doesn’t prescribe Ritalin when an anti-depressant or sleeping pill would be called for.

While Ritalin and other stimulants can give dopamine production a boost, Nachi warns that meds won’t “cure” a person who’s unmotivated to grow. “It won’t solve all your problems,” he says. “If you’re spending your time watching dumb video clips, you won’t do better on your bechinah just because you took a pill.”

Clear the Confusion

Dr. Felt’s approach to managing ADHD and executive functioning deficits is manifested in what he calls his Cycle of Clarity model, a way to alleviate the ambiguity and confusion that leaves anxiety and an overwhelming feeling of “stuck-ness” in its wake.

The opposite of this “Cycle of Clarity” is the “Cycle of Ambiguity,” which starts when we are confused by something and feel unsure of how to respond. This can instantly generate a feeling of nervousness and anxiety, which almost always drives us to avoidance of those feelings of discomfort, which means avoidance of taking action in the situation. So we wind up in this cycle that goes from ambiguity to anxiety to avoidance, which leaves us with more ambiguity and confusion as the cycle starts again and traps us.

How to get out of this trap, to gain clarity and move forward?

“It starts with creating calm — either by working on our mindfulness and cognition, or by physical techniques such as deep breathing or even listening to music — which allows our brain to relax and get back in line,” Nachi explains. “This critical intervention enables us to reduce the confusion and create clarity about the situation. And that clarity empowers us with the confidence to take action and move forward, and to enter into a new cycle. This is a reinforcing cycle that helps us harness the entirety of ourselves, not just what we think and feel at the moment, but even what we hold to be our deepest values and dreams, in order to align all of ourselves with how we most deeply want to live. The more we can create clarity in ourselves and our situation, then the more control we can exert over our thoughts, our feelings, our behavior, and the trajectory of our lives, helping us create the changes to be who we really want to be.”

(Originally featured in Mishpacha, Issue 1035)