Many Children With ADHD Are Overtreated, Israeli Study Says

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Much of the rise in the number of children diagnosed with attention deficit hyperactivity disorder is due to misdiagnosis, leading to overtreatment for kids with learning disabilities such as dyslexia and mild ADHD.

That was one conclusion in a seven-year study at my clinic for treating ADHD. The results were presented in Tel Aviv last month at the annual convention of the Israel Pediatric Association. The study involved 2,600 children 5 to 18 who were diagnosed with ADHD, most of them from central Israel

ADHD is an emotional-behavioral disorder characterized by a difficulty maintaining a focus, and/or impulsive and hyperactive behavior. The disorder is expressed differently in each patient.

There is also a broad range of severity; the most mild form is the kind that often hampers college students' studies. The most severe form is often accompanied by violent behavior, abuse of drugs and alcohol, and criminal behavior. In between are types that feature rebellious behavior and high impulsivity, as well as types that include learning difficulties, mood swings, anxiety and compulsive behavior.

Accurate diagnosis is key to determine whether medication is indicated, and if so, what type. For example, treatment of a child with severe ADHD must include drugs, while a child with mild ADHD or learning disabilities may respond well to art therapy, sports, cognitive-behavioral therapy or one-on-one or small-class study.

Three-quarters of children with the disorder are diagnosed with milder forms; only 3 percent are diagnosed with the most severe form. Many receive inappropriate treatment. For example, nearly a quarter do not respond well to Ritalin and might do better with treatments not found in Israel’s state-subsidized “basket” of drugs and health services.

Of the 33 percent and 67 percent, respectively, of children in the study from Mizrahi and Ashkenazi backgrounds with mild forms of the disorder, 39 percent and 61 percent, respectively, were treated with drugs. Thus some of them took drugs needlessly.

Of the children diagnosed with severe ADHD, 82 percent were Mizrahim – Jews with roots in the Middle East and North Africa – and 18 percent were Ashkenazim, Jews with roots in Europe. Of these, 8 percent and 9 percent, respectively, were not treated with drugs, even though without drugs they were at high risk of worse ADHD and destructive behaviors including drug-and-alcohol abuse and criminal activities.

In the end, every child with ADHD must be understood and treated individually. In addition, the health, education and social affairs ministries should consider increasing allocations for diagnosing and treating the disorder, especially in poorer communities.

Shlomi Antebi  is a pediatrician specializing in ADHD and a former director of Kaplan, Meir and Haemek hospitals.

Children dancing. But how many will be misdiagnosed for ADHD?Credit: David Bachar

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