• Published 02:37 10.03.10
  • Latest update 10:50 10.03.10

Study: Thousands of Israeli kids incorrectly prescribed Ritalin

Study found drug was prescribed without taking into account young patients' coexisting conditions.

By Dan Even Tags: Israel news

Thousands of Israeli children are prescribed Ritalin for attention disorders, but actually have undiagnosed psychological problems that necessitate different treatment, according to a study released this month.

Ritalin and the related drug Concerta are popular treatments for attention disorders including attention-deficit hyperactivity disorder.

The researchers found that professionals often prescribe these drugs without taking into account their young patients' coexisting conditions. This means that one in five children are receiving treatment they do not need.

The study was led by Dr. Shlomi Antebi, a pediatrician affiliated with the Maccabi health maintenance organization and a former director of Meir, Kaplan and Haemek hospitals.

Between May 2006 and May 2008, the researchers monitored 520 children between the ages of 6 and 18 from central Israel. All were receiving drug treatment for attention disorders.

Seventy percent of the patients were found to be suffering from conditions associated with ADHD, but were not receiving medical treatment for them. The coexisting conditions included oppositional defiant disorder (40 percent), mood disorders including depression and behavioral problems (18 percent each), and anxiety and learning disabilities (28 percent each).

A quarter of the patients over age 13 said they use alcohol and tobacco.

The study found that 13.5 percent of the children should not have been receiving Ritalin or Concerta. Moreover, in 8 percent of cases, treatment with these drugs had failed.

"Many children treated for attention disorders need a different kind of treatment, for a comorbid condition that has not been diagnosed," Antebi said. "When a doctor prescribes Ritalin to children, it must be his primary work. Administering Ritalin is not 'moonlighting' - a comprehensive examination must be conducted before a decision is made to start treatment."

The Health Ministry allows only psychiatrists and neurologists to prescribe Ritalin, as well as pediatricians who have undergone special qualification. Such courses, however, do not usually include instruction about conditions that commonly accompany ADHD.

"When there is no diagnosis of the coexisting condition - which is often actually the primary condition - both the child and the family are left behind," Antebi said. "The diagnosis process for conditions comorbid with ADHD must be improved, and must be taken into account when considering these drugs."

The study, released at a meeting of the Israel Society of Clinical Pediatrics, questions the widespread use of the Test of Variables of Attention for diagnosing attention disorders in children. The computerized test, often abbreviated as TOVA, seeks to measure a patient's sustained and selective attention to determine whether he or she suffers from an attention disorder.

"There is no need for these examinations, because they may in fact hamper the person conducting the diagnosis," Antebi said, noting, "Parents' cooperation is essential to the diagnosis process."

Giving Ritalin or Concerta to children who do not need them is also likely to exacerbate side effects. Antebi's study found a high incidence of stunted growth among Ritalin patients, as well as aggressive outbursts and erratic pulse.

Israeli pediatricians issued guidelines over a year ago requiring physicians to hold follow-up appointments with Ritalin recipients every six months to monitor height, weight, pulse and blood pressure.

Two percent of Israeli children - around 51,000 - are diagnosed with attention problems, and some 35,000 Ritalin or Concerta prescriptions are filled every year. Five percent of children with attention disorders do not respond to Ritalin or Concerta and need medications not included in the government-subsidized "health basket," including Adderall, Vyvanse and Strattera.

The Health Ministry said in a statement, "Diagnosis of attention disorders is first and foremost a medical matter, and the physician and diagnostician must be aware of the possibility of comorbid conditions, particularly psychiatric ones, and seek the assistance of mental-health professionals.

"The guidelines for attention-disorder diagnosis do not require the use of computerized equipment in diagnosing or deciding whether to administer drug treatment," it said.

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    This story is by: Dan Even
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  • 13. 0 0
    Does ADHD Even Exist? The Ritalin Sham
    • Anita
    • 11.03.10
    • 02:20

    http://www.naturalchild.org/guest/john_breeding.html

  • 12. 0 0
    More on "ADD"
    • Anita
    • 11.03.10
    • 02:09

    Interesting reading: http://www.naturalchild.org/guest/david_keirsey.html

  • 11. 0 0
    Never give your child Ritalin!
    • Anita
    • 11.03.10
    • 01:54

    Don't drug your child! Ever! Being hyperactive is NOT an illness. Just one example of information, read this: http://www.naturalchild.org/guest/robert_mendelsohn.html

  • 10. 0 0
    Towards a cure
    • Micah
    • 10.03.10
    • 23:37

    Experts in the psychology/psychiatry recognize a range of symptoms that need to be addressed and that sometimes medication helps. However, the goal should always be to diminish the drug intake and develop a better mechanism of addressing the symptoms. Dr. Amnon Gimpel has pioneered an approach to diminish the drugs and increase productivity through exercise and mental challenges. Worthy of further investigation...

  • 9. 0 0
    add--is it a real diagnosis or ?
    • doc daddy
    • 10.03.10
    • 16:13

    i wk'd in mental health in the states when these diagnoses came into effect. they are simply money makers for the drug companies which created institutions around them based on psychiatry's creation of the diagnoses. as noted above, parents, teachers, community don't have the patience to work w/ difficult kids so they drug them. no drug gets at why li'l moshe is anxious. it is globally psychoactive on moshe but never goes to the root of finding out what makes him buzz so fast, never plays w/ him at his speed and then gently guides him down, etc. psychiatry has been bought by the drug companies and it has become a norm. insurance companies know it's cheaper to give a pill then to give sessions of psychotherapy or play therapy. this scam has become instituionalized and this has infected israel. good to see from the article that people are awakening!

  • 8. 0 0
    Children are the future ...
    • Esther
    • 10.03.10
    • 15:41

    if this is the way they are treated what will happen to this country in next few decades ? There has to be a better way to treat such conditions , high time we think outside the box and stop making these helpless children victims to pill popping that just removes the symptoms but and does not take care of the root of the problem .

  • 7. 0 0
    Over diagnosis of ADD
    • Liat
    • 10.03.10
    • 15:31

    I'm studying education & I think that ADD is way over diagnosed. Every second kid seems to have it & then Ritalin is prescribed. Whilst there are those that genuinely need Ritalin, I believe that alot of cases are simply misbehaved children. Teachers, doctors and parents don't want to have to deal with a misbehaved children, so they write it off as ADD. That's why kids behaviour is going down hill. I swear kids are worse behaved now than 10yrs ago.

  • 6. 0 0
    On how to help these kids
    • Liza
    • 10.03.10
    • 14:55

    they need a special diet; especially decreasing their sugar intake into minimum would significantly calm them down. This will also help them sleep better. Sugar and a hyperactive child are an unmanagable combination! Do read carefully the ingredients of various products for their sugar, even beverages. The best is of course home made food made from scratch, of natural rawmaterials as much as possible.

  • 5. 0 0
    To No. 2
    • luisa
    • 10.03.10
    • 14:38

    Your niece is lucky: there's a nurse in her school!! I've seen dozens of schools, both elementary and high schools, in Tel Aviv and the central area where classes are equally large or even larger and there's no nurse. Tell your niece. Maybe it'll help her cope with all the difficulties she might experience in a work that is poorly paid and brings so many, complex problems.

  • 4. 0 0
    A Rush to Medication?
    • Iggy of Ophir
    • 10.03.10
    • 14:33

    The operative word here is "rush"--and being a non-professional, I meant to use a question mark. Having said that (a fancy way to say "but"), I wonder if sometimes medication is the first resort, not the last, because (a) it enables patients to be processed in greater numbers in a given period of time, and/or (b) the processor simply doesn't know what else to do?

  • 3. 0 0
    Ritalin
    • Irene
    • 10.03.10
    • 11:17

    My oldest son was on Ritalin when he was 8. A few month's after starting the drug he suddenly convulsed - Drs. were baffled and could not find out what caused it. We took him off the drug immediately and 13 years later he has never convulsed again. He says he gets the same reaction from a strong cup of coffee as from the Ritalin. My other son also was on Ritalin and after about 2 weeks his hands started shaking. We lowered the dose, but it persisted. We eventually stopped the drug and everything went back to normal. Yes, at times he is a handful but I rather cope with that than a child whose hands shake and he cannot even carry a drink.

  • 2. 0 0
    Classes too large.
    • Benjamina
    • 10.03.10
    • 10:08

    My niece is a teacher in an Israeli primary school. Her classes are large: 40 kids in a room. In each class there are kids on Ritalin. The kids need to go to the school nurse to check if they took their Ritalin dose of the morning before entering class. These kids need extra attention, an impossible task with such large groups. So easy to give pills.Both parents work, less attention at home too, so these kids are lost and doomed to enter criminal gangs when they turn 16/17. It has happened in Holland too, same story, same results. Only the class groups were smaller, but the ADHD kids got extra attention from remedial teachers, and extra supervision at home, to prevent them from entering the criminal network in their cities. A study showed that 80% of ADHD boys ended up doing criminal activities.

  • 1. 0 0
    I really don't think Ritalin's a good idea
    • Colin Wright
    • 10.03.10
    • 10:04

    Our second child -- aka 'The Boy,' 'Genghis Boy,' 'Attila the Boy' -- was described as 'the Ritalin Poster child' when he was about four. Unbelievable. The stories I could tell. I figured I should have gotten a double tax deduction just based on the sheer destruction in a typical year. However, no way I was going to drug him. He's fourteen now. Still QUITE a piece of work, but I'd say he's one strong person. Pretty high-maintenance, but he's a keeper. You gotta let kids come to terms with who they actually are. We all have to do that.