Eps 14. Let's Talk Medicating Kids (Feat. Dr Mayer Grunfeld)

How do I know that's actually real? You can't measure it. You have no physical evidence to support your theory. >> I would rather do everything I can in the intervention world, whether it's getting him a tutor, right, and getting him, you know, maybe a basketball coach and working on his diet. All of that are interventions, of course, to avoid the not good choice of medication. >> Every parent can try whatever they want. [music] If you see your kid's confidence starting to flag, you must intervene. Welcome to the Learning Curve podcast brought to you by Mishbaka Magazine. [music] We're raising children in a changing and challenging world. >> So, let's tackle the important issues [music] facing families today. I'm Rabbi Rhiel Garfield Manal of Yeshiva Terosis in Houston and I love talking about >> I'm Rabbi Ari Shfeld Manal of Yeshiva Katana Manhattan Meister of Bypra Manhattan director of camp. I also love talking and of course a little bit of fishing. >> Join us as we answer your questions [music] and discuss the topics that matter to parents the most. This season of the learning curve is sponsored by Israel Bookshop Publications. You know that moment when a child gets their very first humish? That's not just a milestone. That's a memory that shapes a lifetime. And right now heading into Kumish party season, we're heading that way in Shiva Katana Manhattan. Moishi gets a book from Israel Bookshop Publications is the gift. Oversized, fully laminated, stunning. But more than that, it's a collection of powerful, beautifully written stories, some from Khazal, some contemporary, all capturing the excitement of those first precious steps in Torah. And there's nothing else like it. Pair it with its companion, Once Upon a Sitter, and you've got a complete meaningful gift set that kids and parents will actually remember. 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And welcome back to episode 14 of season 3, the second to last. >> I was going to say, how many do we have? 15. >> I think 15. The next one is the big the live event. >> Yeah. Tell us more about that so our listeners could participate >> on May 17th. I'm assuring our listeners have seen it in Mishbah magazine so they don't really need us. But in case you're one of the four people that don't get a subscription to Mishbah magazine. So I think May 17th is our live event at 8:00 at night. It's a Zoom link and it will be all around Jewish social media which means WhatsApp statuses. You did this once before, right? What's the format? Remind me. >> The format is that we have parents who join us on a live Zoom. Some people send in questions beforehand. We talk live. We can't even like, >> you know, scheme and conspire beforehand >> and then we obviously post that as a podcast. But >> so some people are like watching the Zoom live and other people have present things. >> Correct. And people live who are embarrassed to speak, >> right? They write it to us >> voice or their face. So they write in questions. It gets very exciting. >> But >> okay, >> this is this is just a boring this podcast, >> right? This is our So this is our last regular podcast. >> Yes. Season three and what a season it's been. We're not going to do all emotion. I won't cry till the fifth till till the next one. So we're going to say that for now. our last episode I got a little bit of I don't want to say negative push back because no one's ever negative about the learning curve and about my ideas but a little bit of felt that I was like trying to push an agenda >> really >> uh yeah about middle school behavior and maybe yes versus non yes again I don't know >> well you did put that you kept saying Baltimore is like hairy or something I don't know I don't know if you said those words [laughter] >> I never said I live in Payic the joke they always say is that Payic is the bus that broke down on the way to Baltimore, right? We're Baltimore. Go Baltimore. But no, so that there was like this claim against me that I have this agenda about I don't know yivish. Now again, who decides what is yeshivish or not is really depending on that raam. The ram says you're supposed to take the middle lane. So I guess wherever you think is the extreme. I I want to just crystallize I think the challenge that many people in the world have and it's a challenge and I'm not is that for good reason and well actually we'll discuss that maybe in the first question the perfect segue for good reason there is a need to be and to nullify and to ridicule and put down you know a large components of secular society because of the fear of it creeping into our society and our culture and it having very negative impacts on us and the larger we get as a society as a from orthodox society, the more freedom we have to almost be our own inner culture like the have done to a large extent. The challenge becomes how do you and I you know on the one hand not put down but like separate ourselves for good reason from some of the ills of society and on the other hand still take part in society and namely secular education your example the last podcast of you know the magician right so magician is not secular education it's the magician that does a magic show and it's a little corny and you're like the yeshiva kids eat them up right part of that is there is a certain tendency to not accept what is like the standard things and and and and you know and is and that's a real struggle for us today whether >> you say the nuances of this message and I don't mean that to be cute although you know it is something we've talked about but you're saying that how do you say but not the stuff that's not stay away from right >> right and I know we're not discussing this Now but it's this is like a trick like science for example you know evolution big issue whatever if you try to you know develop evolution within certain Dr. shoulder forget that evolution big isophically. Age of the universe big isoprophically. So it's easy just to say science is horrible and then they're like really so then how come I go to the doctor when I have strep? that I believe right that is I think one of the fundamental challenges and it's a challenge a struggle it's a struggle I would say and that seeps into whether it's behavior whether it's approach or mindset of some of our boys and girls is to have on the one hand and on the one hand to really appreciate and to really want to learn secular studies and to at least have a baseline on the other hand what do you mean but they're horrible and they're kyim that is some of the struggles. >> You know, it's interesting you say that because when I was preparing for the Torah Masur Manal conference that as you know I'm very involved in and excited for, I asked for different topics. So, someone sent me the following topic. It's like one of these things like spark a conversation. General studies doesn't work because we don't care enough about it. >> Statement, right? >> And it's like, of course, we care, but there's always a but. Or do we? Right. Yeah. Fine. That was >> I thought that was a very, you know, insightful line to debate and discuss, you know. >> So, that was episode 13, but now we're episode 14 >> and now we're on the next one and two small questions and then um we're going to go above the board to Toronto to bring in a professional to discuss an interesting topic. So, here we go. >> Okay. You said it's a small question, but it's actually a long small question. So, I'll do my best to read it in a way that is helpful. Dear TLC, I am a regular listener of the podcast here in Town New York. I know the show is heard all over the world, but I wanted to reach out with a concern regarding the sports culture I am seeing in camps and various sport programs year round. While sports are an amazing outlet, I am deeply troubled by a trend towards pro-style ego on the court. I have noticed significant increase in kids taunting and mimicking the flashy aggressive celebrations you may see from professional athletes. To me, this is straight up hookas. Instead of using sports as a training ground for midos, it feels like we are allowing our kids to act foolish. What is the best way to redirect that energy towards menite? Additionally, how do we push back against a culture where kids feel they need to imitate secular athletes to be cool rather than valuing the refinement of a bentyra? I'd love to hear you discuss this on the podcast. Thank you for all the incredible work you do for the claw. So as someone who enjoys sports, I have a little bit of an unfair advantage in this question and that is that I had one of the great role models in in the last 50 years in cloud in America and that is a region Kramer maybe one who came on this podcast. So bearers Kramer was my head counselor. He's the eighth grade rebby in in Halb in the five towns and you know it's like the legend has it you know the best Jewish basketball player ever right definitely an unbelievable basketball player I get everyone has stories you know it's like with your guttle right so I have stories of Kramer with me about basketball how many shots hit in a row but I think that Kramer who's my rebby in camping in how to deal with a child really one of the people that for better or for worse made me who I am today in the world of so I want to share two stories about literally on this topic. One was that the big game of the year was always Heler Manov. We had Spiro on who discussed that and before game um the gym is wild and going crazy at pack and before the game one of the players in our team one of the star players on our team Ka took baby powder gave out little like packets of baby powder to the crowd and said one two three right before tip off like LeBron James does before his games. He still does it. Probably does. Poured it and clapped his hands together and threw it up into the crowd. Kramer was the head counselor who takes basketball very ser loves the game of basketball. I was standing right there. I was on the team T4 and he almost threw this counselor who was a star player on the team. He knows who he is. I won't say who it is. Out of camp and he turned to the team and he said, "Isaim." He kept screaming it. And his point was, we love basketball. We played basketball. We took it very seriously. We were competitive. If we beat Manavu was the it was the highlight of the summer. But to mimic the silly little isms of LeBron James, of NBA players, and to just want to be like Mike, right, and just to want to be like them is hazard. And again to hear it from a rebby who doesn't appreciate sports, who doesn't enjoy sports, who doesn't care about sports, it's much it's, you know, yeah, what do you know, right? But Gersh Kramer who was the coach of the basketball team, who was always the best player in the basketball team, it this happened 20 years ago. It was such a moment. Wow. of delineating and separating enjoying athletics and enjoying the outlet of athletics and competition and self-esteem and camaraderie and not letting it overstep the line of >> do you see this trend that the writer is talking about like in camp or whatever. Yeah, it's a real it's a real challenge in camp because I'm Mama Ver Kramer. I am I get very frustrated, upset when they will mimic, you know, the NBA players, they have this thing when they hit a three-pointer, I don't know, they go like this with their hand, whatever they do, right? And I will whenever a kid does it fifth grader, >> go. >> No, [laughter] I don't. No, no, this was remember this was Dumb Robin from a staff. I'll call them over and this is my line. That line generally is when you hit a three-pointer, that's enough. When you try to be cool and mimic LeBron James, let's say, and mimic the player, you're just showing how uncool you are. There's nothing less cool than trying to copy the NBA player, the football player. it. No, part of the answer is that with the advent of the internet and you know and social media even though our kids bashm don't have it but they have their parents' phone and they're watching highlights and the highlights are just celebrations. This is a real challenge. >> I know they're into sneakers. I want to get to your thing but like they're into every player has like their sneakers. I don't know what they are today. >> Yeah. Right. >> But do you think that's a problem like that your kid want? I want whatever Michael Jordan sneakers >> for some reason sneakers bother me less. It bothers me. The midas bother me. I don't mind so much buying a pair of sneakers because everyone had you know basically every sneaker is someone but the midas on the court though when you hit a shot and you like what whatever the the mimicking and the copying the midas on the court really bothered me. I have an unfair advantage because of a Gresian Kramer who was the best basketball player I ever saw in my life. Listen to the story and it will end and this is my end of the story this at his son Kramer who's an Alan Cherry Hill a very dear friend of mine at his Chevraus Rabbi Jacob Benenfeld who was another head one of the head staff members in camp a rub in Harrison New York he said over the following story he said I was speaking I think it was like in Colombia and some college like to the Jewish corporation you know the hill of that college I was describing what it means to be a Jew on the basketball court and I was describing desing he said this rabbi of mine this friend of mine Gishian Kramer stories a legendary stories of his midos on the court and a Jew is a Jew wherever he goes he said I finished my speech a guy comes over to me I never met before and he says rabbi that Rabbi Kramer that you discussed does he have a son that lives in Miami Florida and he says whoa yes why he says because I play I live in Florida I'm from Florida he said and I play basketball in the local you know down whatever they play and there was Jew on that court who was an amazing basketball player who plays with the same level of character that you just described. It was Kramer's son Kanani Kramer. >> That's amazing. >> Um so you know it's not the Kramer Chevra but too bad these are my >> That's an amazing story. Wow. >> But it's an amazing story. But to me what we have to do and yes this person is right that there is a challenge. We have to stop blaming the kids. And if we're going to put kids in scenarios in which we treat them like the NBA, you know, when we celebrate in camp, I'm very I get very upset in camp and I talk to the kids about this about these celebration when you win a game that's wonderful. I have a muscle in camp when these kids have these crazy celebrations and I tell them there's a NFL player Barry Sanders and Barry Sanders is a great running back and whenever he would score a touchdown, he would just turn and hand the football to the ref. And they asked him, "Why don't you celebrate?" And he said, "Because I've been there before and I'll be there again. It's not a big deal." And I said, "The whole idea of celebrating is just it's egotistical. It's goish. It's a lack of sportsmanship. And there's a way to win. There's a way to lose. And it's something that we as yeshiva work on and definitely have to impart to our children." >> I did notice in the last like two years there have been a few players that have become like well-known players that are like news like I don't know >> Sebie Sam. Sebie Sammit and there's a guy named Galbett I think Galbat >> I'm laughing because we played against him this summer Galbat we almost beat him and now he's now he's joining a division one school like >> so maybe another one I'm not I don't want to disrespect >> Tamar Goodman is the legend from >> yeah no but in between so anyway the point is that like this has become much more like a conversation amongst you know >> right and if you follow Zevy Samut's story I know Zeb's family a little bit he uses basketball and his as a platform form. That's not I'm not going there. You know, that's a separate that's a unique >> story. >> All right. Question number two is for me to you, Rabbi. Here we go. Dear TLC, we're moving to a new neighborhood next year, and I'm concerned about my nine-year-old's transition. She tends to be a warrior as it is, and it's going to be a lot of life changes for her at once. She is a sweet kid with a couple of good friends, but she's never been effortlessly charismatic. How can we set her up for success? She doesn't know that we're moving yet. We didn't want to tell our kids too early, but we're getting close to our moving date. >> Wow, that's a really good question. I remember seeing statistics about moving being one of the top most stressful things that a person could go through. And I know as an adult, I moved 15 years ago and it was remarkable. It's just remarkable. You know, first I would just say to the parent, it's going to be hard, but it will be over. You know, it takes time. There's no there's no easy way. I mean it's not it is a very hard thing but you know you have to give your child the confidence to know that and you also need to know that that difficulty is a and it will be avar that said um depending on where you're moving it might be good to identify some kids who could be friends and help your son help your son or daughter your daughter in this case connect with them by making playdates with them specifically and facilitating that because it might be hard for them to real to make meaningful connections. So maybe there's a neighbor or someone you know in advance and like you know sort of fixate on that relationship a little bit in the beginning so that your child has like a safe friend or a safe small group of friends that you facilitated that move. But um no question that it's going to be you know a really hard challenge and she needs support and and space and concern and validation all those things that we all need when we go through very difficult transitions. >> So I'll just share two things. Number one is I moved at the age of nine. Hello. >> So uh maybe I was 10. I was in fifth grade. I moved from Staten Island to Queens in middle of the year. >> You switched schools also or did you stay? >> I went from RJJ which is like a you know you know >> community school let's say >> community school to run me um in middle of fifth grade. It was and >> again maybe I'm different than my siblings. I don't my personality. I wasn't it didn't bo it didn't affect me. It didn't bother I moved from one day to the next and in I went. Some of my siblings struggled. But so I I personally maybe just my personality like kind of like things, you know, I let things go. So I had that. That being said, I will share without giving it too many details. It's not a secret. There's a family moving from my yeshiva out now and it's they have a nine-year-old boy and and a boy in pre1A and it's a hush of a family with superstar kids, regular well adjusted kids. And we have been helping them throughout this process as everyone helped. You know, my kids moving and setting them up and talking to the new yeshivas and getting them ready and talking to the boy. And I I think that when you you know, I'm not so sure this parent is doing the right thing not telling the kid until June, July or I don't know, not you know, let the kid grieve a little bit that she's losing friends, >> you know. Um it it's it's it's a move as exactly what you said. It's a um it's something that it's part of life. if sometimes you move for for the for for a million reasons. I do think though that when you allow the kid in the process, I don't mean in in contract signing of the houses and picking houses. But at certain point, and now we're that time of year, talk to your daughter, talk to your son who's 9 years old, is 10 years old, validate that it's going to be hard of all all the basic parenting tricks, nothing fancy. You know, when when you choose a new school, make sure the school's ready for a kid. It's going to be hard in September. But as you said, um, plenty of people have moved and then he'll make new friends and and she'll make, you know, and and our family that's leaving from from Yeshiva selfishly, we're devastated because they're an awesome family with an awesome kid. And I told him, listen, I moved. Um, you know, you're going to be great and and they'll they'll they'll be just fine. Just just be just be there for them. >> Wonderful. Okay, now we're going to go to our spotlight question. >> It's now our pleasure to welcome to the learning curve, Dr. Mayor Grunfeld from Toronto, Canada from above the border and Dr. Grunfeld who went through the Regal Shiva system and then went to medical school and became a doctor and runs a clinic in Toronto, a few clinics actually in a few different very important parts that help the from community. But for us for the learning curve as a clinic that cogent healthc care that deals with ped pediatric behavior which is what we do in we deal with p pediatric behavior. >> Well said. >> So Dr. Grunfeld a very wellrespected doctor clinician in the Toronto area. His father is a very wellrespected mechanic Rabbi Grunfeld in town. So he comes from a family that really cares about Klisro and I know the fact that he's a doctor in Toronto it really means he's in right because it's basically the pay is the same if you're in medicine in Canada Dr. Grimfield, thank you for joining. >> Thank you. My mother is the only Jewish mother in the world who when I told her I'm going to med school, she was disappointed. She's like, "Do that mean you're not going to be a Rebby?" They got over it and here we are today. >> So, we're going to ask you a question as a springboard. But before we do that, I just had one question about like what you do in your bio, which is you mentioned you went through family pra you have a family like a medical degree in in family medicine, but you have a behavioral clinic where for children behavioral health. I wonder like wouldn't that be something a psychiatrist would normally do or how does that where's the line between when one would go to a child psychiatrist versus when one would go to someone like yourself? >> It's a fair question for most family doctors. You're going to find there's a couple areas of expertise. The they're interested and therefore they're very knowledgeable in those areas. There's going to be a couple areas where they don't know much. So as soon as the guy walks in and says blank, they just refer off. and then a whole bunch of areas of middle of the road almost like they're going to have the areas of that they're highly knowledgeable in and maybe it's going to be shabas and because those two most common things and at what point do you go to what point do you go to I'm not sure I'll exactly answer that question but I originally went into medicine I thought I was going to do developmental and behavioral pediatrics and then I got bored of the paperwork may or may not have a titch of the ADHD and I ended up in family medicine where you could do whatever you want and here I am today. So why would someone go to you versus a child psychiatrist? >> Because I have an area of expertise and a reputation regarding behavior. >> But you're really doing the same. Are you doing the same kind of work? >> Yes. But more specifically in our world, especially when it comes to anything in behavioral health, you need a lot of cultural understanding about what's going on. When someone's going to talk about if you're going to get the snap forms for ADD from the English teacher at your local school, everyone has ADD, right? Because I understand the difference between the rebby and the teacher and what happens in the afternoon, what happens in the morning. But when we sit and talk about, you know, he does pretty good in but not so good in Gomorrah, I'll be able to understand the concept of maybe he's not so good at more abstract thinking but pretty good at understanding and memory. There's a lot of cultural understanding that >> he's like an insider. You're an insider and therefore that gives you a unique ability. >> What I'm getting at and I think you're answering it Dr. Runfeld is I know as a principal like if I have a student who has a complex behavioral challenge, I don't want them going to the pediatrician because the pediatrician knows how to medicate very basic and you know they have one or two things they'll do. Oh, I'll just get a prescription from my pediatrician. Like I want them to go to a child psychiatrist and get the proper medication that's properly managed. So it sounds like what you're saying is even though your training was more similar to a typical pediatrician, you've put a lot of focus, energy, effort, you know, and developed yourself to the point that you have that expertise. Is that right? >> Yes. And also I ended up doing a lot of training in developmental and behavioral pediatric. I thought I was going to do that before I decided to stick with family. >> Wonderful. >> I just want to speak that out for other people listening that you're a bit of a unique general practitioner. Most general practitioners might be general practitioners. You're a specialist, you know, in a way. So >> yeah and yes Canada is also a little bit unique in this way that I'm essentially >> given the freedom over here to do whatever I want. I can write prescriptions for chemotherapy and no one will say boop. It's probably not a good idea to write chemotherapy but >> is that a Toronto thing you mean? >> Canadian. Yeah. Yeah. Canadian. >> All right. So here's the question to start us off. Dear TLC, our seven-year-old son is bright and curious, but he struggles to stay focused and manage frustrations both at home and in school. His rev suggested we quote unquote look into ADHD. While we're wary of quickly labeling or medicating him, how could we support him in a way that's healthy for his growth without rushing into any decisions we might regret? I think before we get into this specific hit, I wonder if it may be worth I was just discussing what is ADHD. Once we understand what ADHD is, I think we can get a little bit more into details of uh the labeling, the medicating and all of that. Fair enough. >> Yes. >> Okay. So, what is ADHD? Let's try to understand it a little bit, right? ADHD is a problem of impulsivity. What does problem impulsivity mean? My mind is always racing, running, moving, doing, thinking. The mind is always running. Right? Now the mind is everything. So everything is moving, coming, going, doing. This is going to affect three primary buckets. Right? It's going to affect my attention, my mood, and my body. So let's go through that a little bit, right? If my mind is always racing, so that's going to affect my attention for this reason. So you know, let's say something is I'm sitting in the classroom. The Revy talking is an audio impulse that's coming my way. My brain is always on thinking and accepting everything in, right? I cannot regulate or temper any impulse that's coming my way. Rebby is talking. I hear the Rebi talking. That's an audio impulse and I'm listening to Reb. Very interesting. But then out of the corner of my eye, there's this audiovisisual impulse maybe coming because the principal is walking by the door. Or so that's where you Jack was my attention. And then I have this sensory input from my stomach where I feel, oh, I'm a little hungry because I forgot to eat breakfast cuz I was in the middle getting dressed and my mommy was yelling at me. So then I'm like, oh, I really want to eat a bigger breakfast. And then I hear behind me this, you know, visual, this audio impulse. Maybe someone's passing a note and I turn around and that's grabbing my attention and then oh wait, Rebby is still talking and I'm back to Rebi. Right? So it's almost a problem of it's not so much a problem of too little attention to some degree. It's a problem of too much attention. I'm paying attention to everything because everything is always going right now. I do want to make an interesting point when we talk about this attention problem of whenever we think about a rebby talking or information there's always going to be three levels of classes. Right? means you know because everyone always asks what do you mean my kid could have could focus on a movie everyone could focus on a movie so how in the world you think he can't pay attention you know how does that work and the answer is there are three areas of interest you know everyone could pay attention to a movie now if let's say you have some guy who's droning on and on in French about Egyptian hieroglyphics no one could pay attention it doesn't mean he's add it just mean that the guy is boring right so whenever we're thinking about >> Dr. Phil just to pause. We're 3 minutes into this conversation. You are not boring. So continue. >> Not boring. Okay. Got it. >> So you know, so now we have whenever you want to assess ADHD, it's always a question of the middle level. So a regular pedal look. I'm sitting in the class. I'm here anyway. Do I want to be out in the field playing baseball? Of course I want to be. But I'm here and the rep is kind of interesting. So I pay attention. So with ADD, the mind is always raging. I'm just so easily distracted that I don't end up keeping my attention. That make sense? >> Yes. >> Yes. Okay. So, now there is also another point to be made. There's also an impulsivity of attention is that they can hyperfocus on things. So, they're always going to come and say, "But my kid at home could really focus on a book, could really focus on his Lego, can really focus on this and this." And the answer to that is it's the exact same problem of I cannot regulate or temper any impulse that comes into me. So, I'll explain this. So, you know, when you go to sleep at night, even if it's going to sleep, and there's a little baby down the hall who's sleeping now, in middle of the night, the baby starts fetching, right? So, Tati sleeps right through it, and mommy wakes up, right? >> Yes. >> How in the world did mommy wake up? I mean, she was so tired when she went to bed. The answer is, cuz when mommy went to sleep, she realized there's a baby down the hall. So even though her impulse, her desire is I want to go to sleep fully, she stays up a little bit because I know I have a baby down the hall, right? So her impulse is to go in all the way to sleep and yet she tempers and regulates the impulse and stays a little bit up. Her ear is a little bit open. On the other hand, someone who is impulsive, every impulse comes in and I take it all the way in. I give every impulse all the attention it does not deserve. So then I want to be involved in reading. I'm really into this. You leave nothing left out here. I'm calling your name. You hear nothing. You're in. You're all the way in. The impulse took you all the way in. And the ears you're hyperinterested in because again, you cannot regulate your temper any impulses coming in. So the same problem on the middle level of interest makes you hyper distractable. I can anything can grab my attention. But the areas that I'm really interested in, I hyperfocus on. cuz summarize in like in maybe like for people like me that first of all have no idea what you're talking about in ADHD but is it that basically there's a lack of ability to regulate your impulse and therefore sometimes you'll focus on nothing >> and other times you'll focus hyper on one thing >> because you don't have the ability to be like just balanced in picking and choosing what is appropriate almost >> exactly correct >> is there any um measurement in for this. Like, could they see this on a cat sc brain scan or something where you see >> No, >> maybe you're just making this up. Like, you just made this up. How do I know that's actually real? You can't measure it. You have no physical evidence to support your theory. >> Physical evidence? No. But sit in a classroom watch a kid with ADD and tell me you have no evidence. >> Yeah. You know, everyone's I don't know. I'm poo pooing it a little. like you know you're would think that there would be some brain evidence but okay >> one one of the biggest challenges that we hear from parents and teachers oh is the mislabeling and the similarities between anxiety and ADHD >> fair enough let's do this I think it may be worth let's go through our buckets of ADD >> and then we'll differentiate a little bit between ADD and maybe some other diagnet number one how an impulsivity can affect my attention because I could hyperfocus or as you ra just said I won't be able to pay attention to anything right I can't focus on anything that would be the problem with the attention and the hyperfocus problem number two is going to be it's going to affect my mood and my mind right so what that means is you know I'm driving down the street and someone cuts me off okay I get irritated for a second I get angry at him okay but then you have a life so you move on right okay so but someone who is impulsive Any impulse that comes my way remember I give it all the attention it does not deserve goes all the way I get really irritated and really angry right so every mood I have an impulsive mood I get irritated I get really irritated I get angry I get really irritated I get really angry I get happy I'm disregulated in happiness it comes perm they're running in circles right all the moods become disregulated in the extent and height of the mood right so that's going to be the impulsivity of mood and again I'm generalizing to some degree and then we have the impulsivity ity of body and let's explain this again. You know the brain is really you know what are your senses is just they all end in the brain they're all just nerves right if everything is on all the time that means my ears are always on and my smell is always on and my taste is always my feel is always on so these are the kids who are very sensory my you know there's a label in the back I'm so itchy from it I hate it and and they can't wear anything wool because it's scratchy on my skin if someone's chewing at the table they're freaking out because I chewing right in my ear and I want to twist his head off and you know it's every single little smells bad. I can't. I'm biting it and it's mushy in my mouth. You hear these funny things from these kids, right? So, you have the impulsivity of attention, you have the impulsivity of mood, and you have the impulsivity of body. And when you get all those snapshets that you get, and then you have to fill out or are filling out, you'll find that there are really 27 questions in there. Nine questions are going to be about attention, nine questions are going to be about hyperactivity or movement, and nine questions are going to be about mood. Right? Do typical ADHD kids have all three? >> So, let's break that down a little bit. So, nowadays they change the terms every couple of weeks just to confuse us. Officially, it's ADHD. And then we have our inattentive subtype and we have our mixed subtype. So, on a very technical level, you're going to say the nine questions about attention are going to be inattentive ADHD. The nine questions about hyperactivity are going to be hyperactive ADHD. And the nine questions about mood officially equals oppositional defiance disorder. But that's kind of garbage and really it just boils down. >> Sorry for clapping but I like what you just didn't. >> Yes. >> For the people who are very familiar the only question dear that matter the last one of when they say that a kid looking to spite you is a child spiteful or vindictive. A child who's spiteful or vindictive truly so not because he's in a fight with the rebies who wants to spite the rebi but a child who's truly spiteful or vindictive that's when you get very nervous for other real problems. But other than that, the mood liability is really just going to be that other effect of an ADHD. So an inattentive ADHD will have the attention and the mood. Hyperactive ADHD will have all three typically >> is conduct disorder. Not to get too technical, but you touched upon oppositional defiant disorder and it's a questionable diagnosis. Would you say the same about conduct disorder? >> Oppositional defer and conduct disorder is just different ages. >> So but you said opposition define disorder is somewhat not legitimate. And I'm wondering if you feel that way about conduct disorder, too. >> I think the word was garbage. >> Right. I'm asking, do you believe conduct disorder also is not legit? >> You think I got myself a little in trouble. Now you want to get me in more trouble. >> Exactly. >> Got it. Conduct disorder is what it is. >> Let's move on. For the record, I would like to publicly state that I do believe in conduct disorder and I do believe in oppositional divine disorder. Although you have to know the whole context and there's a lot to unpack, but I don't like the dismissal of it. But I am not a doctor of medicine. So therefore, I am not here to argue with you per se. I just feel the need to say that. We can move on now. >> Yeah. No, I will say and by the way, you know, I'm being maybe a little too facitious with it. At the end of the day, medically, you are correct. By the way, I would just say that it's, you know, the fact that someone went through three foster homes and then, you know, maybe went through three sets of addiction before he turned 18, you know, had a disorder or just he had a really bad life and is angry at the world, so we just give it a name. >> At the same time, a 10-year-old who had a great parent and and is defiant to everything anyone tells him to do, he does the opposite in great haste, may be a reason to say there's something going on here. I would push back and say if the kid is vindictive, if the kid is trying to hurt you, so then he was probably hurt in some way. There's going to be if I see a child with who's vindictive across the spectrum, he's victim many people in all likelihood you will find trauma or abuse. >> Okay, so you could say the oppositional defiant behavior was brought upon as a result of abuse. Fine. >> Correct. Fair enough. >> But it is what it is. Well, let's move on. >> All right. >> Yeah. >> Sorry, it's a pet peeve. >> Okay. So, now to your question about like anxiety, depression, anything like that. Let's say when someone comes in to let me even give a bit of an intro to this idea. One of the I had a family recently. One child ended up with brain cancer. Another child ended up with a behavioral health disorder. So, it was very interesting to ask them which one did you find harder? >> What would you think? >> Cancer. I would obviously say cancer but you're asking the question so I obviously know that the answer >> a lot of parents interestingly will find the behavioral health a lot harder okay very it's very set okay you go to the doctor he did it like Rabbi Garfield said before I did a cat scan and here it is and now the treatment is very well defined right there's a rubric which we follow so we're going to go for surgery and then we're going to get some chemo and radiation and then you're going to be on this and this med for the next two years everything is very set and clear right when it comes to behavioral health there's so fluiness that it's hard to even know in what direction to go. Right? So, one of my goals with a lot of behavior and in partly in creating this kind of creating a lot of our processes, it's create some clarity that parents can come in and say, "Okay, these are the steps. This is what we're looking for. This is what we need to do." Okay. So, when someone comes in with behavioral health, any type of behavioral health concern, we're looking at four buckets we're thinking about, right? We're thinking about the bio, psychos, social, academic. We look at biological or physical causes that could be affecting behavior. This is anything from vitamin deficiencies to celiacs if that exists, right? You're going to ask. Yeah. From any of the physical things. So you have your vitamin deficiencies to all the way up to brain tumors. You can imagine all those will affect behavior, mood, attention, whatever you want. Bucket number two, psychological diagnosis, right? This is going to be the anxiety, depression, ADHD, autism, all of those things. Bucket number three, social. If there's a lot of instability in the kids's life, trauma or abuse, right? Any of those. Bucket number four, academic. That would be IQ, learning ability, disabilities, maybe language ability, disabilities, >> right? So, there's four buckets we're going through, and that's going to be the rubric we use to try to figure out what in the world's going on with this. >> Can I pause just for a second? This is fascinating. I just want to share an anecdote. We had a a child two years ago who was in third or fourth grade. Third grade. And we thought he was being manipulative, and we really didn't deal with him. He was like lying. He was consistently lying to us and called in his parents and it turns out he had a language processing disorder. And what we thought was him being manipulative was him not processing properly the information that it was coming and he would therefore answer a question and then once he got stuck he would lie. Right. Literally one of the but we misbucketed him you know and to this which is so terrifying as an educator. >> Yeah. Continue. >> Yeah. So I I could be I still I think hold the claim of the only person who ever has someone come into the office complaining about the anxiety and I diagnose Crohn's you know these types of things. So we have our four buckets and the way to assess all them become somewhat interesting. So the physical the bio that's the easiest one right we have our blood tests and we have our scopes and you have your imaging and all of that. Okay, bucket number four, the academic is also some this is where we have the psyched assessment and this is where there's some confusion when it comes to psychoeducational assessment. They think that it assesses for the autism and ADD. That's not what the psycho educational assessments are for. Psycho educational assessment a full psych it has three parts. There's going to be IQ testing. There's going to be ability testing. That's the learning ability disability. And there going to be language testing, right? Language processing, you know, expressive language, all those things. That's what a full cycle is essentially meant for to rule out the academic bucket. But let's go back to the psychological, let's say, right? The psychological bucket where we're looking at our ADHDs and autism, anxiety, depression, and here's a problem that comes up in all mental health that well, it's a problem. There are many people who have anxious personalities. Correct? You ever met someone like that? >> Yes. One or two. >> And maybe some people who have a little bit more active personalities and but they're just personalities. So here's the problem. All mental health is on a spectrum, right? So we all have our midas, we all have our characteristic, we all have our character traits. So you know when we think about ADHD or attention, no, there's those kids who can just sit for three hours listening to whatever. It's not a Jewish kid. Don't worry, you don't have any of these kids in your school. The point is everything is hurry. So you can have the kids with attention. You know, I could just sit and listen to some guy droning on and on for an hour and a half. And then you're going to have the kids who, you know, you got to keep me entertained or in two minutes I'm out, right? Where do we go from, you know, in anxiety, same thing, by the way. So, some people are just very relaxed and chill. Some people are more anxious personality. Some people get really anxious. Where do you go from anxious personality to anxiety disorder? Where's the line? >> Amazing question by the way. And I think that is the question that every parent who's listening to this is wondering because you know labels or just medication, no medication. I know all of thing no one wants to medicate unless they are supposed to. Like if your son has strep, you got to give him strep. But you're not going to give your son a maxicillin because he has a virus or because he has a sore throat. So this question of personality, you know, character, midos verse disorder, verse condition is like it's why you're here. [laughter] >> Okay. So here's the problem. I'm going to disappoint you. There's no great answer to that question, right? Okay. So let's say mathematically, you know, you look open your textbook. was going to say if you're two standard deviations from the normal, right? Top and bottom 2%. Okay, but here's no here's here's an interesting problem. You know, a lot of people I've heard this concept a lot that people say like, "No, the non-Jewish schools are really academic. Our schools aren't so academic. Nothing could be further from the truth. Nothing." Right? Think about your classic 9th grade yeshiva kid. No, your public school kid is up for what time schools start? 9:30. They're done by what? 3:30 p.m. >> Right. >> Okay. Our kids are up by 7:30 a.m. for shakas. They're coming back after their 945 MARV and they have to learn all this in at least two languages. Right? Our schools are one full standard deviation of public public school. It means someone who's getting a 50 in our schools would be getting a 70 in public school. Right? So we have very high academic standards in all our schools. More than that by the way again this is very you know the lot the average Jewish IQ is around 115. The average American IQ is around 100. Means our schools run at very high levels. So let's say you take the top 2% we just said top 2% of not being able to pay attention equals ADHD. Let's say what about the guy in the 97th percentile? How is he doing? You think he's being successful? Is he learning? Is he getting the information? Is he feeling good about himself? Is he feeling I'm able to do this and I'm going to thrive in the yeshiva? >> Right? >> Well, not great. So it's a bit of a random cut off to say okay the top 2%. So okay. So let's ignore that one for a minute. So there's another answer. So what do we do? >> Why don't you use a functional diagnosis? >> There's another approach that says, okay, is it affecting function? So you'll see every diagnosis of every behavioral health is always going to be it has to be an affecting function. No, but affecting function is also subjective matter, right? You go to let's say a much more modern orthodox school. My kid got a 98 today means it's affecting function. You should have gotten 100. You go to NC school, he got a 52. He's doing great. It's two points more than necessary, [laughter] right? So it's a bit subjective. What does it mean affecting function? Some people say affecting function means he can't do the things he needs to do. What are the things he needs to do in our world? He needs to go to chakras. He needs to know how to read Gumarra. He needs to. So that becomes a little bit problematic. So I'm going to go out on a limb here and I'll give you the answer that I use in my clinic. Right? At what point do we need to consider medication? It boils down to one thing and one thing only. Confidence of the kid. Right. Explain. >> Is he maintaining confidence that he can do well? >> Self-esteem. Confidence is another word for self-esteem. >> Yes. So, this is the one. Let's talk about your classic ADHD kid. Just because we're focusing on ADHD, but you can say the same thing about anxiety or anything else. Your classic ADHD kid, right? He wakes up in the morning and his mother woke him three times already. I know he gets up and he gets distracted. So, he's running around trying to get his clothes while his mother yelling at him downstairs, right? He runs downstairs with his shirt untucked and one shoe on and he missed breakfast. He has to run out to carpool. It's a very toplant. He gets into school and now the Rebi keeps telling him, "Sit down, buddy. Sit down. Sit down." And he also doesn't know what in the world is flying. He goes out by recess and now he's getting into fights with all the other kids because he lost the game and wanted to try to ruin the whole game because he got all riled up over there. >> Do you work? Are you a Rebisha? [laughter] How do you >> Okay. Then he goes to English and obviously got expelled, right? Or kicked out already halfway through and he's sitting in one of your offices. And then he comes home in the evening. He's fighting with his siblings. Tati is yelling at him. Mommy is spending way too much time with him. And now it's the end of a random Tuesday, right? Tomorrow, rinse and repeat and rinse and repeat. So here's the beautiful thing. Every 5-year-old, you know, when you go to 5-year-old, who loves you? Mommy loves you and Taty loves you and Bobby loves you and everyone loves you, right? They're so full of confident. They believe in so much. Why wouldn't someone love me? Around the age of seven, they're going to start realizing something isn't going over here. I can't maintain my friendships. I'm fighting with everyone. I don't seem to know what's going on. Reb, they start losing self-confidence, right? And then what happens is I lose my self-confidence. Around the age of 9, 10, they start developing anxiety. Why? I'm coming to school every day. I'm not doing well. Of course, I start hating to go to school. I need to like it. I need to thrive. I need to be able to I need to at least be able to do well in order to want to go to school. So, I get anxious about going to school because everyone's yelling at me. And if I have no self-confidence and now I'm also anxious around the age of 12, they develop depression and now I don't know anyone who gained confidence in high school. Right? So it's the end. >> They're doomed. [clears throat] >> To me, it's one thing and one thing only. Every parent can try whatever they want. If you see your kids confidence starting to flag, you must intervene. >> Absolutely. >> You said the word intervene, not must medicicate. You must intervention has a line, right? >> Intervene. We can get to what the interventions are, but you must intervene. You can't ignore the lack of confidence, >> right? >> Could they just say they'll grow out of it? It's normal. >> All kids suffer a little. It's okay. I did it. You did it. We did it. >> Maybe. Yeah. I mean, you're a principal. From what you see, the kids who have no self-confidence and are not doing well in school, do they start all of a sudden turning and thriving at some point? Some turn it around like towards the end of high school or you know >> I love your confidence. >> Yeah, some do. I definitely don't think you're setting them up for success. That's for sure. >> So, here's the problem. It's a good problem. Parents are looking, you know, as much as sometimes they they can drive some of the the Rebean principles nuts. Most parents are looking out for their kids, they are trying to do what they perceive as best for their kids, >> right? So, it's not like he's just trying to be oppositional. parents are just I don't want to medicate. It's a good thing not to medicate. We should point out medication is not a good thing. >> Why not? >> Cuz everything has side effects. Everything costs money. Remember getting those calls. I don't know if you guys used to get the calls for the free condo in Miami. >> I didn't get that call, but sounds like a good call to get. >> Yeah. What phone number? >> Maybe I should tell them to call you. You take the call. When I was married, just a side story with Sha Risha, I got one of those emails that you won like a a yacht trip and all it cost is $100 and I I fell for it. By the way, >> Yep. Uh >> oh. >> Yeah. So, nothing is free in life. That's one thing we knew. >> Everything costs money, right? So, every medication you're ever going to take will have side effects. Absolutely. But the question always is risk and benefit. And we do this every day. I don't know about you guys. I don't walk around cuz I got $20 bills. Maybe I should, but I, you know, I don't throw around money, okay? But I walk into a store and all of a sudden I'm paying $ 20, $40 for cheese. Why in the world? Because I don't like to give away money, but I do like cheese. And when I balance the risk and benefit, I say, "Well, it's worth it." It's never a question of is medication good. Medication is not good. But neither is a kid with no confidence, right? Think chemotherapy, by the way. Is chemotherapy good? No. It's terrible. But cancer is even worse. So, >> so the parent, but to your point, that's why parents say since medicine isn't good, it just might be necessary. I would rather do everything I can in the intervention world, whether it's getting him a tutor, right, and getting him, you know, maybe a basketball coach so he builds self-confidence and working on his kria and getting him after school and pulling and getting a pull out, right? And working on his diet. All of that are interventions, of course, to avoid the not good choice of medication. Correct. Yeah. So, two points to that. I wish we could have Montasuri schools in from world. Now, here's the problem. We don't want mastori because in our world, we all need to be able to d and you need to be able to read and need to be able to inas who can't do dafi. You need to be able to do a lot of the basic things especially elementary school. It's about fundamental skills. We need all these fundamental skills and every Jewish parent wants the kid to have those fundamental skills. We don't want to miss out. Oh, my kitty can't really read Hebrew. It's okay. >> Nope. Most decent parents who are sending to the from schools want their kids to grow up to be anas to them and so we need those skills. So that's step number one. And number two, so the main answer to that question is really this. You know, let's say making a wedding nowadays is very expensive. I've heard, right? So let's make believe. I can make a wedding in Toronto for $50,000. Let's make believe. You can't, but let's make believe. Right. 50 or5 >> 50,000 50 >> Canadian, >> right? So, let's make believe I can make a wedding for $50,000. Here's the problem. I don't have any money. I'm broke. Remember, I work in Canada. So, what am I going to do now? So, now you know, Rabbi and both both very nice people. And I get I tell you, I got two texts from both of them and they both said, "Oh, I heard you're making a wedding. Here is $1,000 for you." I have a question for you. Is $1,000 a lot of money? Yes. Is $1,000 helpful? Absolutely. But then when my father-in-law comes in and says, "Mayor maz." And he puts a $36,000 debt on the table. That's helpful, right? What is the $36,000 check? Meds in this. [laughter] >> Is it? Wow. That is that Rabbi Garfield, that is going in the promo. >> Yeah. What percentage of students who come to you, parents, do you end up medicating >> with a diagnosis? I mean, >> they come to you with a problem, meaning they're sent to you, my kids are misbehaving, la. What percentage walk out not right away necessarily but after your process with meds? Would you say 90%. >> No. No. Because like a lot of people end up coming because they just want to know what's going on. But for the I have a good success rate of parents of children who need meds will often get them on meds because we work with parents and I understand them and we're just trying to get the kid to a place where it needs to be. >> So what is the answer to that? What percentage of people that come through the door of the cogent healthcare clinic end up being medicated? And I guess the question maybe is not almost about you but about our society. Like what percentage of people who are coming and are afraid of their child really have a child that needs medication? >> The ones who are coming for behavioral complaints usually there's something to it. I don't know uh 60 80 70 80 I don't I don't I never >> right >> a relatively high percentage end up with something. come in or because we also have a different problem by the way of let's say even the kid here's an interesting point uh uh uh uh type of kid a kid who comes in we did let's say the academic testing right and the IQ is a little low what do you do with a kid like that how can I make this kid feel successful in a school which he is truly the bottom of the class >> medicate him [laughter] >> yeah I'm not sure that works right >> an interesting question it's an interesting I'm There's a real challenge there's a real challenge in yeshiva. >> Yeah. So I'm not coming to pas and this I'm afflicted by the way between a bunch of the rest of yeshiva. Let's say I've I'm not sure if I should say then it I've [snorts] >> heard that elephant has said publicly that a kid who's struggling get him at all because if it'll make him feel successful he'll be successful heard. And by the way, especially nowadays, there's the world is so it appears so fun. There's so many things out there to distract us, right? So what's going to keep someone in yeshiva and involved? Means we all like what we're good at, right? This is success breeds success. No, if we're good at it and we're doing well, we enjoy it. The thing you're not good at, how long do you want them to sit in yeshiva doing all the things they're not good at and not enjoying and not being successful is not going to last that long, >> right? So to some degree you can argue do what you need to do to get the kid to a point of success. So there is an argument to be made. I can take this kid with a lower IQ. I can't fix his IQ. There's no fixure his IQ. What I could do is let's say a regular person is able to focus 45 minutes an hour. And now I take this kid I give him a stimulant. Let's say and now he can focus 50 minutes an hour. I just give him 10% more time to make up for his 10% lost IQ. >> Does that work? >> Now he's in that way. It works for everyone. It's a It's coffee. It's >> But I wonder if it works that way. Meaning, if you can't add five digits together, it's not because you can't focus. It's because your brain can't, you know, keep that kind of high sophisticated processes. You know, >> when you're dealing with an IQ of 80, correct? I mean, even the military want to take someone with IQ of 80, but like we're talking about >> Okay. Nebucha 100 105 Neba. >> Yeah. >> Wow. All right. This is really wonderful. Well, one one last thought and we want to certainly let you finish if you have anything else that you wanted to say. >> I have many. >> Okay. Well, one last thing I wanted to say is to that parent that's skeptical that saying to themselves, you know, I don't want to medicate my kid. They're going to get stuck on it for a life and it will lead them to a life of dysfunction, drug use, they'll be dependent >> orim and stigma and label. That's another thing about No. and the [clears throat] mood the mood side effects that you spoke about like that for good reason. You know, how do you talk that parent through when you as a doctor have reached the consensus that they should be medicated? How do you talk to that skeptic? What do you say to them? >> Okay, so a few points. Okay. So number one, so a parent comes in. You can always do this by the way with a kid who you know I hesitate to say you should do this with a kid because especially when we talk to our we try to make sure like you don't you can't say a diagnosis right say what you see you never say a diagnosis but let's say here in the office. So I bring the kid in for a few minutes and then at one point we start saying and by the way does your rebby like you? Oh yeah my I think my rebby likes me. Yeah. Yeah. Do your friends like you? Yeah my friends like me. And what do you think you have a pretty good personality? Yeah. Okay. Do does your rebby think you're smart? Now, let's say if especially if you have a good rebi. So, usually very quite often the kid says, "Yeah, my reb thinks I'm smart." Okay. Do your friends think you're smart? I don't know. And do you think you're smart? And it gets quiet, right? And that's when we can say, "How far are you going to take this?" You know? So, you're going to have this kid who thinks he can't do anything and he's coming apart and he's 7 and a half years old, right? What are you going to do? Therapy with this kid at eight. It's hard enough for me as an adult to try to change my mid. You're going to take a kid who's impulsive and gets angry really quickly. You're going to send to a therapist who's going to tell me when you start getting angry, count to 10. I mean, I can hardly do it, right? Apparently, I get angry a lot. I So, it's means therapy doesn't really work. Behavioral therapy. And I'll get more trouble for this is it won't really work until around the age of 12. It means for an 8-year-old kid, let's give a better example, right? A Ferrari >> is getting cut. So you could keep going. >> Why? >> Yeah, >> this is great. >> Why would it be cut? >> I mean, I mean, because play therapy is something that we suggest to so many. >> Well, we'll let him finish his point. He didn't finish. >> No, no, I didn't mean to get cut. This is just fun. >> Let me get cut. >> Play therapy for ADHD. >> No, no, no, no. You are you talking about specifically ADHD? >> ADHD? I'm talking about ADHD, a skill therapy for ADHD to help you manage your impulsivity. >> Right. Okay. Good. Okay. Good. >> No, I'm not an idiot. [laughter] >> That might get caught a little bit back to the show. >> We have to wrap up soon, so let's Okay, go ahead. >> So, you know, let's even go back. Is ADHD a medical problem? I ask you, >> what do you say? >> No. >> My answer is no. >> No. >> It's a personality more than anything else. Half the people you know successful like the ones who's running four businesses the guy who's half the principles out there because you're managing 17 different things at once more than half more than threequarters of the people on this meeting right now probably could diagnose with ADHD >> here and then so you're running that the guy who's learning formulas at once in all likelihood then elements of ADHD it's a good thing >> right your mind is racing you're you have a lot of energy you think uniquely You can conquer the world. You have to have a high IQ to be able to manage a brain that's always processing everything. It's an absolute superpower. Here's the problem. I take a Ferrari and I have to admit I'm not a very good driver. So far, I've admitted that I have no money and I'm not a good driver. Right? Okay. So, now I'm not a good driver. I get into Ferrari and I touch the pedal. Boom. I just went through four lanes of traffic. I got to 17 car accidents. Big problems. Is the problem me or the Ferrari? >> Wait, you? >> It's It's me. I don't know how to I can't manage the car. What was happening is the car was driving me rather than me driving the car. If I learn how to drive the car, what am I driving? A Ferrari. It's a million-dollar car. You can conquer the world. You will beat everyone with it. >> Wow. >> Right. So, this is what's going on over here. An 8-year-old is being controlled by his personality. And he's not big enough to manage it. When he gets to around the age of 12, he can learn how to manage a personality and he will do great. >> Do you find off medicine as they get older? I need him to maintain his three years, medicate for three years and then like re and then let's reassess >> at the age of 12 to 14 you reassess. Most of our bakum if when they end up in yeshiva often they want the medication then they can focus better for seder and yeshu but the if you really don't want medication get them at least the age of 12 or 14 help them maintain their confidence get them to a point where they can develop the skills of learning how to manage that personality and they will do great. >> Dr. Grenfell, this was insightful, incredibly clear, and I think I learned a lot. We learned a lot. Entertaining at the same point. How do you know? You could have doctors that are that are entertaining. Now I know why your mother is upset that you didn't go into, you know, you're great. But this was my goal over here. I get to come and and be part of like >> really special. And I know you and we thank you for joining us and for teaching us. So, thank you. >> Thank you so much. >> Oh, that was fun. >> Yeah, he was great. >> Yes, he was. Dr. Grimfield was. I think there's a tremendous mila not all therapists can be one of us so to speak but when you have yeshiva guy went to the ra yeshiva system and you understand the the nuances of what it means to be a yeshiva boy yeshiva girl within our um society there's a huge mile to that but but more than anything else which is what it was to me was like going to a shear I felt like there was a certain >> understanding for parents of what is the ADHD mind of of what your child looks like of what what we can do for him, you know, to me, insightful and entertain at the same time. I wanted to hear more. >> Yeah. And I also think like in the end of the day, people in the field, and it's hard for parents to hear this, but you know, it's a podcast, so we're speaking anonymously to an anonymous group. >> It's like it's not to try medication if it could work. It doesn't always work, but like for people who need it, why wait three years and have the kids suffer and go through all these difficulties and everything like that, you know? Basically he was saying like you know you owe it to your kid to give him or her the best shot they could have >> right and one thing that I think I speak on behalf of all of Manalin and Rebim and yeshivas today none of us are doctors >> and none of us will ever tell a parent to medicate all we will tell a parent exactly that was articulated in the last you know conversation was these are the struggles your son or daughter are having >> get it checked out >> right >> right get it get a diagnosis maybe and you're right maybe the answer is that it's something we should medicate for and maybe there's a million other things but to just say yeah my son is my what I won't medicate I won't go there I won't have that conversation um I think you're just hurting your son and it's interesting you said medicate till the age of 12 and then reassess >> interesting but the amount of stories that kids get such success from therapy I don't just mean medication >> intervention >> inter a better word thank you intervention it's a therapist, it's a tutor, >> it's it's just learning how a new way to process audio processing. All of a sudden, the kid learns how to create pictures in your mind. All of the different the world out there has incredible resources, right? >> Don't be afraid. We're not This is not should your son's not get a daughter not getting married tomorrow. She's not coming back from seminary. We'll figure that out. Then, by the way, when they come back from seminary, every guy she's read to also have went through the same thing. Like, let right now we want to get your daughter and your son to be the best they can be. Uh, don't be afraid of the journey. >> All right. Well, thank you for joining us, the Learning Curve Podcast. Let's remember that episode 15 will be our live podcast May 17th, 8:00 PM Eastern. You could submit questions in advance if you'd like through email at the learning curve.com or by calling our hotline number. Just made that up. 443-686-9339. That's 443-6869339. We're going to be choosing some audio and written comments and questions that we've gotten, plus some live ones. >> It's going to be vile. It's gonna be wild. Can't wait. >> All right. All the best everyone. >> See you then. See you then.