Israel has become a hub of research on the disorder

Starting around fourth grade at my daughter’s public school in Philadelphia, I noticed that her math tests included not only problems to solve but also a checklist at the end with questions like, “Did you review your work?” and “Did you label your answers properly?”

I soon learned why: A quarter of the school’s students have attention-deficit/hyperactivity disorder, or ADHD. The neurodevelopmental syndrome, traditionally diagnosed during childhood but increasingly identified for the first time in adults, is associated with traits that explain the need for the checklists. These traits include impulsivity, inattention, difficulty focusing and an overabundance of energy.

One fellow parent confided that her daughter’s ADHD challenges went far beyond absentminded math mistakes. “It’s everything, all day long,” she told me of her fifth grader, who recently joined the school’s social worker-supervised organization club. “She’ll forget to bring books home. Or hand in her homework—she’ll be doodling and not even notice the teacher.”

It wasn’t just schoolwork, either. Before her mother hung a checklist in the shower, the daughter often forgot to use soap or rinse out the shampoo.

This family is far from alone: Reported diagnoses of ADHD have skyrocketed in recent years. A 2022 report—the latest figures available—revealed 7 million pediatric ADHD diagnoses in the United States, a rate of roughly 11 percent and an increase of 1 million in just six years, according to the Centers for Disease Control and Prevention. Meanwhile, an estimated 6 percent of American adults have an ADHD diagnosis—equivalent to one in 16, or approximately 15.5 million adults—with around half of them diagnosed in adulthood, a rate that is steadily rising as awareness of ADHD in adults has increased. (There are no statistics on rates of ADHD in the American Jewish population.)

Halfway across the world, Israel has among the highest rates of childhood diagnosis of the disorder—a little more than 14 percent of Israelis ages 5 to 18, according to a 2016 report, the latest figures available.

The report, spearheaded by Dr. Michael Davidovitch, a developmental pediatrician with Israel’s Maccabi Healthcare Services, also showed that the rate among children had essentially doubled since 2005.

While the debate over the reasons for the climbing numbers remains unsettled, most experts attribute the rise in reported ADHD cases to a combination of increased awareness, reduced stigma and a genuine increase in the disorder’s prevalence.

Causal evidence for the rise is also unclear. Researchers interviewed for this article have a variety of theories to explain the diagnosis rates in the United States and, especially, in Israel. One theory suggests that those with ADHD are more likely to seek new places and emigrate if the need or desire arises (both countries have significant immigration populations). Another theory connects the high level of stress in Israel, a country perpetually at war, with ADHD, since stress can cause inflammation, a known risk factor for ADHD.

With skyrocketing rates, both Israel and the United States have become global leaders in ADHD research. Israel, for its part, is focused on leading investigations into the disorder’s prevalence and impact as well as developing therapies that help both children and adults.

People with ADHD have impaired executive function, which means they have difficulty managing skills such as planning, organizing, time and financial management and self-regulation. Their impulsivity—and the need to find workarounds to compensate for cognitive challenges—can also spur creativity. While they might find it impossible to complete tasks they find boring, those with ADHD can concentrate intently on what interests them.

Without proper treatment, however, the disorder can mean a lifetime of forgetfulness, missed deadlines and zoning out in class, meetings or even while driving.

“In the last decade or so, it’s more and more understood that ADHD is a disturbance that goes with a person throughout his life,” observed Dr. Shlomzion Kahana, a neurologist at Hadassah Hospital Mount Scopus in Jerusalem. (Israel’s medical community places ADHD within the field of neurology rather than psychiatry, where it is classified in the United States.)

“The fidgety child becomes the distracted, inattentive adult causing problems in work, family relationships, maintaining jobs,” She added. “It’s really a pervasive disorder.”

Yet thanks to a groundswell of awareness—people these days openly discuss and share tips for managing ADHD on TikTok and other social media, for example—those with the disorder are far more likely to be diagnosed than they were in previous generations. And there are established protocols for treatment, largely a combination of medication, such as the stimulants Ritalin and Adderall, and behavioral therapy.

“There’s a lot of evolution in this field,” said Dr. Gabriel Vainstein, a neurologist with Maccabi Healthcare Services and the chair of the Israeli Society for ADHD (ISAD), a nonprofit group that shares information about the disorder as well as organizes conferences and events.

Drawing on their country’s centralized and highly developed health care system and its national electronic patient database—and often in collaboration with American counterparts—Israeli scientists have furthered that evolution.

In one example, in a study published in 2023 that followed more than 100,000 Israeli adults in their 50s and 60s over 17 years, Rutgers Brain Health Institute in New Jersey and Israeli scientists at the University of Haifa and Meuhedet Health Services found that those with ADHD are three times more likely to develop dementia than those without the disorder. The study also suggested that early treatment with stimulants may reduce that risk.

Israeli researchers frequently draw on American data. A 2020 study led by Dr. Eugene Merzon of Leumit Health Services, in collaboration with colleagues from Hebrew University and other Israeli institutions, analyzed data from across the United States and found higher rates of Covid infection among individuals with ADHD, along with an increased probability of recovery.

The researchers hypothesized that people with ADHD may have inherited genetic advantages that enhance their immune system’s ability to fight Covid.

Indeed, in studies over the past five years, Israelis have discovered connections between ADHD and a host of medical issues, including childhood infections. They also found higher rates of obesity, substance abuse, eczema, lupus and even allergies among those with ADHD.

“It’s unbelievable how much of ADHD is a medical problem,” observed Dr. Iris Manor, a psychiatrist and assistant professor at Tel Aviv University who collaborates frequently with colleagues at Mount Sinai’s Icahn School of Medicine in New York City and is a member of the ADHD professional societies in both Israel and the United States.

“But we don’t know what the mechanisms are,” she added, “just that there are associations—and mechanisms that don’t work as they should.”

Israeli therapists and researchers have created ADHD behavioral therapy techniques that have become global models. There is even a new Israeli-made app, Pery, that uses artificial intelligence to help parents navigate their child’s ADHD symptoms. 

One of the best-known therapies for the disorder in Israel may be Adina Maeir’s cognitive-function intervention, known as COG FUN. Maeir, a professor at the Hebrew University-Hadassah School of Occupational Therapy, pioneered the application of occupational therapy to the disorder.

In 15 to 30 sessions, depending on the patient’s age, COG FUN tackles the practical challenges of living while distracted. Teaching patients to understand “the connection between cognition and everyday functioning,” Maeir said, is a departure from the blame most patients are accustomed to for failures that feel beyond their control.

For example, therapists simulate routines or activities like meal preparation and homework, pausing to evaluate the demands of each task and evaluate strategies in an environment free of judgment.

“That’s important, because at home or in school, the context is demanding,” Maeir said. “And because they’re so overwhelmed, patients don’t have an opportunity to learn from those experiences.” She theorized that the high executive-function demands in developed countries like Israel and the United States, where several ADHD clinics run programs similar to COG FUN, could help explain high diagnosis rates in those countries.

In recent years, behavioral therapy in both Israel and the United States has been tweaked to accommodate the growing number of adult patients “who come usually much more impaired, and with a lot more emotional baggage,” Maeir said. “It’s, ‘I’m a mess. I’m late to everything. I’m about to be fired from my job. My wife is about to kick me out. My relationship with my children is terrible.’ You know, challenges in every area of life.

“So after years of failure and poor performance, feeling inadequate and not understanding why, we try to help them discover what works and what doesn’t—what’s biological, what’s psychological, what’s actually stigma.”

With increased awareness and resources, it’s a very different landscape than the one Dr. Merzon, who also teaches at Ariel University, navigated during his childhood in the Soviet Union. It wasn’t until Dr. Merzon left Donetsk, Ukraine, for Israel in the 1990s—and, at 32, was diagnosed with ADHD during his pediatrics training—that he understood there was a name and treatment for his lifelong difficulties with organization. 

Growing up as the low-achieving son of a professor of medicine, “everyone said I was lazy,” he recalled. ADHD “was not something that was known or talked about.” Dr. Merzon said that he overcame his deficits out of a desperate fear of failing to secure one of the few university spots available to Jews, as opportunities were limited due to pervasive antisemitism. The alternative, the Soviet Army, “was not a good place for Jewish kids,” he said.

Beth Krone, a clinical psychologist who teaches psychiatry at the Icahn School of Medicine and has worked with Israeli researchers, got her first view of ADHD as a young Montessori teacher. “I had kids that would only do their math as long as they were standing up,” recalled Krone, a Hadassah life member. “As soon as I told them, ‘Sit still,’ they couldn’t focus to do the math. Their brains were all over the place trying to focus on sitting still.”

Both Drs. Merzon and Manor, who have collaborated on ADHD research, theorize that ADHD is more prevalent in countries with higher levels of immigration, such as Israel and the United States. “People with ADHD need novelty,” Dr. Merzon said. “We’re easily bored. We need something new to do.” Tackling a new culture, he explained, is the ultimate challenge.

In his view, those with ADHD, which he believes is largely hereditary, are more likely to immigrate, and high immigrant populations perpetuate incidence of the disorder by passing it down.

For her part, Dr. Manor has found connections between trauma-and stress-hormone-induced inflammation and the emotional dysregulation and hypersensitivity associated with ADHD, suggesting that environmental considerations are a contributing factor.

For example, her research has uncovered an association between stress in pregnant women and higher rates of ADHD in the children they birth. “And Israel has a lot of wars, so a lot of women are pregnant during times of tension and conflict,” Dr. Manor said. She predicts that in roughly six years, Israel will see a surge in ADHD diagnoses among children born to families in the southern Israeli communities most traumatized by the October 7 Hamas massacre.

The lack of clear causal evidence around ADHD leaves Krone reluctant to speculate about theories like Dr. Manor’s. “Things play out differently for different people, sometimes along heritable lines, sometimes not along heritable lines,” said the psychologist, who has studied ADHD from the perspective of epigenetics—the science of how lived experience alters the expression of genes, including from one generation to another.

Speculation, she added, “can draw stigma to immigrant communities, or Jews or people who are stressed or traumatized.”

For his part, Dr. Davidovitch, the Israeli developmental pediatrician,  attributes higher rates of diagnosis to both greater awareness and greater open-mindedness on the part of physicians and parents. “Israel is a very highly competitive society. Parents want their kids to have every advantage,” he said, explaining the new willingness to medicate a child who might be lagging in school.

Dr. Davidovitch is currently researching the impact of rising screen use—“the tablets and the iPhones and all these computers that take children’s attention from the morning to the evening”—on aggravating ADHD severity. “Of all the external factors that I believe are crucial, it’s the screens,” he said.

From New York City to Tel Aviv, the millions of successfully treated patients are testament to the modern understanding that ADHD, while not curable, is usually manageable. Indeed, Dr. Merzon points to himself as proof, and even credits the disorder for inspiring his career.

“If I didn’t have ADHD, I don’t think I would’ve become a researcher,” said Dr. Merzon, who uses Ritalin to stay focused. “I was so interested in the topic, so patient to understand how it worked and how it influenced my adult life.” Now he explains to his juvenile ADHD patients that “you don’t have to blame yourself—you have to turn that weakness into a strength.”

“One of the strengths of people with ADHD is that they can think along a different angle,” he said. “Your struggle with your weakness prompts creative decisions, unique strategies to cope. And that’s how it can become your superpower.” 

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Hilary Danailova writes about travel, culture, politics and lifestyle for numerous publications.