ADHD and Purim: Medication, Fasting, and Focus

Ta’anit Esther and Purim raise practical halachic questions for people with ADHD. What should you do about ADHD medication on a fast day? How do you handle difficulty concentrating during the Megillah reading? Below are clear answers to common questions.

Ritalin on a Fast Day With Water

Question:
I have ADHD and take daily medication for focus, which I swallow with a little water. May I take it with water on fast days other than Yom Kippur, or should I avoid it?

The prophet says, “Thus said Hashem, the Lord of Hosts: The fast of the fourth, the fast of the fifth, the fast of the seventh, and the fast of the tenth will become for the house of Judah joy and gladness and good festivals” (Zechariah 8:19). These four fasts were instituted to remember tragic events and to inspire repentance and self improvement.

When eating and drinking are prohibited, the restriction applies only to things considered food or drink. Items that are not food, or quantities smaller than the halachic minimum of eating, are not included. A pill is not considered food and is swallowed rather than eaten. Therefore, it is permitted to take medication such as Ritalin on public fast days.

If swallowing the pill without water is difficult, this is comparable to what many halachic authorities permit for someone with a headache on a fast day, namely taking medication with a small amount of water. Since the intent is not to enjoy the water but merely to swallow the pill, it is permitted. This applies especially when the condition significantly affects daily functioning.

In short:
ADHD medication may be taken on the four public fasts. If needed, it may be swallowed with a small amount of plain water. On Tisha B’Av, be lenient only with slightly bitter water, such as water mixed with strong, unsweetened tea essence.

Ritalin on a Fast Day With Food

Question:
My 15 year old cannot swallow his ADHD medication with water and usually swallows it with a small piece of bread. May he do so on a fast day?

Swallowing medication with water is permitted on a fast day, but swallowing it with food is not. Drinking a small amount of water to help a pill go down is not considered enjoyable drinking. Eating, however, even when done only to swallow medication, is considered eating because the body derives nourishment.

This applies when the medication is primarily for focus during study or prayer. However, if the condition causes significant daily dysfunction, such as frequent conflict or inability to function normally, the child is considered ill without danger. In such a case, it may be permitted to swallow the pill with a very small amount of food.

In short:
A teen who needs ADHD medication may take it with water on a fast day, but not with food. If the condition causes serious impairment, he may take it even with a small amount of food, less than a kezayit. On Tisha B’Av, consult a rabbi.

Candy for Children on Fast Days

Question:
My ten year old loves candy. Since he is not obligated to fast, may I give him candy on a fast day?

Once a child is old enough to understand mourning for the destruction of Jerusalem, around age nine, it is proper not to give him candy on a fast day. This trains him to participate, at least partially, in the communal experience.

If the child takes candy on his own or buys it with his own money, there is no obligation to stop him. Since he is not obligated to fast, and the action was his own, the parents are not considered to have given it to him.

In short:
From about age nine, do not give children candy on fast days. If they take it on their own, you do not need to stop them.

Zoning Out During the Megillah Reading

Question:
I have difficulty concentrating and tend to space out during the Megillah reading. Have I fulfilled the mitzvah?

A fundamental rule is that if a person missed hearing even one word of the Megillah, he has not fulfilled the mitzvah and must go back to the point he missed and continue from there.

If someone fell asleep or even dozed, he must go back and hear from where he stopped hearing.

We distinguish between lack of attention and lack of hearing. If a person’s mind wandered but he could still say where the reader was up to, he has fulfilled the mitzvah, since hearing occurred even without focused attention. If he was so distracted that he could not say where the reader was, that is considered not hearing, and he must go back and listen from the point he stopped hearing. If he does not know where that was, he must go back to the beginning, without repeating the blessings.

Therefore, someone who knows concentration is difficult should follow along in a kosher Megillah or even a Chumash. If he sees where the reader is up to, that is a sign he has heard until that point.

In short:
If you heard the Megillah but your mind wandered, and you could still track where the reader was, you fulfilled the mitzvah. If you could not, you must go back and hear again. Following along in a text is strongly recommended.

Medication Before the Megillah Reading

Question:
I am over bar mitzvah and have ADHD. Am I obligated to take medication before the Megillah reading?

A person must exert reasonable effort to fulfill a mitzvah. This includes preparing the body, such as eating or sleeping when necessary. Medication is more complex, since it is not ordinary nourishment but is taken to address a functional difficulty.

Many contemporary halachic authorities rule that since a person can read the Megillah himself from a kosher scroll, thereby fulfilling the mitzvah even with limited focus, one who does not do so must make other efforts to fulfill the mitzvah. Therefore, someone who regularly takes ADHD medication and cannot concentrate sufficiently during the public reading should ensure that he is under the medication’s effect during the reading.

In short:
If ADHD prevents you from fulfilling the mitzvah and you routinely take medication, you should ensure it is effective at the time of the Megillah reading. Alternatively, you may read the Megillah yourself from a kosher scroll, though a public reading is preferred.

Medication for a Child Under Bar Mitzvah

Question:
My twelve year old has ADHD and struggles to concentrate during the Megillah reading. Should I give him medication beforehand?

Parents are obligated to educate children in mitzvot. Education begins when the child can perform the mitzvah in a way that would fulfill an adult obligation. For the Megillah, this means hearing the entire reading from beginning to end, which is usually around age nine or ten.

Even if a child with ADHD finds this difficult, training must begin at the appropriate age. Otherwise, he will never become accustomed to it.

Therefore, if the child routinely takes ADHD medication, it is appropriate to ensure he is under its effect during the Megillah reading. However, if the medication causes low mood or suppresses appetite, it should not be given before the reading, as this would diminish Purim joy. In such cases, some suggest that the father read the Megillah to the child in a quiet setting, even with breaks. The child should recite the blessings before the reading, while the father should not.

In short:
From about age nine or ten, children should be educated to hear the Megillah. If medication is necessary and does not diminish Purim joy, it should be used. Education should always be tailored wisely to the child.

Rabbi Moshe Shmuel Dayan is the author of Keshev Rav: ADHD in Halacha and Aggadah.