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Parents of children with attention deficit disorder are struggling to pay the full cost of medications that last longer than four hours.

The state pays most of the cost of regular four-hour Ritalin, but doesn't subsidize longer-acting drugs, like a sustained-release form of Ritalin that lasts six to eight hours or Concerta, which works for 12 hours. And many say those four hours of calm are just not enough.

"Giving the medicine became so expensive we just couldn't bear it financially any longer, even though the longer-lasting medicines make a world of difference," said Michal, whose 12-year-old son has ADD.

"The regular Ritalin doesn't really help a child who's attending school," she said. "It lasts for just over three hours while he's there, and then you need the help of some teacher to ensure he takes the next pill. Not all teachers agree to do it, and some who do agree think that nothing will happen if he's half an hour late in taking it. They don't seem to understand that this delay can result in outbreaks that put the student in a difficult situation and undo all the hard work of the previous few months."

Michal's son is among the 3 percent to 4 percent of Israeli children between the ages of 6 and 18 who use Ritalin.

Dr. Iris Manor, director of the attention research center at the Geha Psychiatric Hospital in Petah Tikva, said the longer-lasting drugs are "an essential component of optimal performance" for hyperactive children or those with attention deficit disorder.

"Treating the children with short-term medicines with a lot of side effects is not only ineffective, it's damaging," she said. "If you decide to medicate your child, it's better to do it properly."

Because attention deficit disorder can be hereditary and affect several children in the same family, the costs of longer-lasting drugs may rise so high that parents have to choose which child gets the better medicine, Manor said.

"Most children would need more than one pill a day, many would have siblings with similar disorders and the medical treatment lasts a long time," she said. "A lot of families in the economically weaker areas of the country can't bear the costs."

Parents said the cost of the non-subsidized drugs came to about NIS 1,000 a month for families who need the medication for more than one child.

As for Michal, her son took regular Ritalin for several years, then switched to Concerta and then to timed-release Ritalin.

"The long-term pills save lives," said Michal. "They affect not only the child who's taking them, but the entire class. The trouble is that they are considerably more expensive. But the difference in their effectiveness means that parents can't stand by and not use them, and end up denying themselves basic things to make sure their children are better medicated."