"Does your 15 years with Eliyahu automatically get erased after 15 minutes with a neurologist?"

My French was as bad as the next guy’s, but Rabbi Dadon had spent several years in Gateshead and worked hard to teach his children English.

Even so, aliyah had certainly been tough for Rabbi Dadon’s oldest son Eliyahu, who had been struggling mightily in yeshivah ketanah since the family moved from Paris to Netanya.

“He’s a fine, responsible bochur, Dr. Freedman,” Rabbi Dadon explained. “He loves tefillah and is an absolute tzaddik helping out at our beit knesset. At home he always looks out for his younger siblings.”

I looked out into the waiting room to see a pleasant-looking adolescent boy just over bar mitzvah age. He was sitting engrossed in his Gemara, reading line after line and translating them into his native French.

Rabbi Dadon continued, “But in yeshivah it’s been a disaster. The fights, the lack of respect for his rebbeim, getting kicked out of class time and again with onesh after onesh. It was like a dybbuk got into him.”

Rabbi Dadon proceeded to tell me how Eliyahu had been diagnosed with ADHD shortly after their arrival in Elul and had already been taking medications for a number of months.

“At first, we were surprised, as we never noticed that he had behavioral or attention issues back in Paris. But after several class disruptions and a few fights with his fellow talmidim, the menahel suspected unaddressed ADHD and was insistent that we take Eliyahu for a neurological evaluation. I argued with him for a few weeks, but eventually I relented and took him to Dr. Diamond, who was accessible and had available appointments. Dr. Diamond agreed with the menahel’s assessment and practically before I could blink, Eliyahu was started on Concerta.”

I wasn’t sure that this was the most professional assessment — there are some very gifted pediatric neurologists out there who have extensive training in attention-deficit issues and do thorough, hours-long evaluations, but this sounded like an average kupah doctor where a brief evaluation is done in the 15-minute slot.

Still, I wanted to let Rabbi Dadon paint a complete picture.

“Well, the medication certainly glues him to his seat, which makes his rebbeim happy, but it also makes him anxious every afternoon and he has a bit of a crash around 5 p.m. when he gets tired, frustrated, and ravenous, as he has no appetite from the morning until the pill wears off. When the menahel recommended we talk with the neurologist again, who suggested we add another afternoon medication, I figured it was time to get a second opinion.”

I took a full history from Rabbi Dadon, and it was clear that Eliyahu had been without any signs or symptoms of ADHD up until the family moved to Israel and he started at a new yeshivah. Here was a kid who was clearly experiencing behavioral problems — but it was entirely possible that it was due to something else.

Once Eliyahu came into the room and began to talk, it became evident — to me, at least — that the “something else” was bullying at his new yeshivah.

“I guess yeshivah is okay, I’m starting to make friends — but I just had to fight my way through the first month.” Eliyahu smiled sheepishly as he described his aliyah experience. “There may have been other French bochurim in my class, which we thought would be a good fit, but they didn’t really stand up for me at first, and because I didn’t speak Ivrit, I couldn’t really defend myself.”

“Is it better now?” I asked Eliyahu. “I mean, is everything good at yeshivah?”

“Yeah, it’s fine baruch Hashem,” he answered, looking at his father. “I finally learned the language, and now they let me play soccer bein hasedorim which is great because I’m a very good goalie and that makes them want me on their team. I think my Abba knows that I’m doing much better now too.”

Rabbi Dadon smiled encouragingly back at his son who continued. “It’s just I have this terrible crash from my medicine every afternoon and feel really tired and depressed. I hate it. I guess I need it, though, so maybe there’s something you can do for my medications or whatever?”

“Eliyahu,” I asked, “do you think you really need the Concerta? Do you feel like it really helps you?”

“Well, the other doctor prescribed it to me and my menahel thinks so.”

“Eliyahu, I’m asking you honestly what you think. Do you feel that you need this medication?”

Eliyahu looked like he was about to cry. “I don’t take it on Shabbat and I can focus fine — I’m great at beit knesset. I just had a really tough time with aliyah. But now I have some friends and I am doing better, so maybe I can start doing okay even if I don’t take it?”

Rabbi Dadon was silent and asked Eliyahu if he could speak to me alone. Eliyahu good-naturedly stood up, wished me a good day, and went back to the waiting room and his Gemara.

“What, so we just stop this medicine like that and call it a day?” asked Rabbi Dadon. “I mean, he’s right that it’s much better, but who’s to say it’s not thanks to the medication that he’s doing better?”

“Look, it’s not clear to me that there was any ADHD to begin with, and he is having difficulty with the medication’s side effects, correct?”

“Dr. Freedman, not to argue, but why, then, did both the menahel and the neurologist think otherwise and make such a clear diagnosis of ADHD?”

This was a question I’d confronted may times. Was the menahel a responsible fellow? I had certainly hoped so. Was Dr. Diamond a reasonable fellow? I wanted to think so. But this wasn’t the first case that had come across my desk of a struggling young kid whose family had come on aliyah — and who was misdiagnosed with behavioral and attention issues.

“Rabbi Dadon, im kol hakavod to the menahel, who is an experienced mechanech and runs a fine institution, is he really the best person to make a psychiatric diagnosis on a bochur when his own parents had never seen symptoms of extreme inattentive or hyperactive behavior? And even the best neurologist, even if he’s an expert in epilepsy, multiple sclerosis, and strokes, isn’t necessarily an expert in pediatric psychiatric psychopathology unless he’s studied that extensively. I would venture to say that Dr. Diamond went on the assumption that your son’s menahel had hit a proper diagnosis instead of doing his own comprehensive evaluation. Does your 15 years with Eliyahu automatically get erased after 15 minutes with a neurologist?

“I agree with you, Dr. Freedman, but you have to understand — my wife and I felt railroaded by the two of them, and truth is that Eliyahu was struggling mightily in yeshivah…” Rabbi Dadon trailed off in an almost apologetic tone.

“Rabbi Dadon,” I said, “I’m not a navi, but speaking with your son, I believe he’ll be fine. Let’s see how it goes without the meds of a while. Let’s not take a normal, yet often-frustrating aliyah experience and pathologize it. Since when is adjusting to a different system a psychiatric illness? Eliyahu is going to keep on getting better — it’s a natural process that doesn’t have to include the side effects of stimulant medications.”

“You know, I already feel better and I’m sure Eliyahu feels the same,” Rabbi Dadon said optimistically.

“Yep,” I said, returning his smile with my own, “it’s not every day we get to make medical conditions disappear just like that.”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills around Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com

(Originally featured in Mishpacha, Issue 847)