Beyond Ritalin and Still Within Reach

Yoni's mother is standing outside a small room in the Yeruham branch of Nitzan, the Israeli Association for Children with Learning Disabilities. She's waiting for her son's evaluation to end. The school first alerted Yoni's (whose real name is withheld) mother that her son may have attention-concentration problems at the end of the previous school year. "He wants to learn and he likes school, but it's hard for him to sit in class for a long time," she says.

The other mothers waiting in line for their children's evaluations tell similar stories: One child has outbursts of rage and another has difficulty following material in the classroom.

Some mothers do not understand what the staff's excitement is about. But in fact, this is the first time that a multidisciplinary evaluation of children with attention-concentration problems has been conducted here. The tests are administered by a children's and adolescents' psychiatrist, a representative of municipal psychological services, and a local pediatrician. Until now, families would have to travel to the center of the country to obtain such services.

In Yeruham, as in many other places in the Negev, schools first refer children with suspected such disorders to a family physician who then sends them to a neurologist or a psychiatrist in Be'er Sheva (some families seek private evaluations, which cost NIS 1,500).

Between 3 to 7 percent of school-age children suffer from attention disorders. Current research indicates that 30 percent of those children also suffer from some type of learning disability. "Ritalin can help attention disorders, but not necessary learning disabilities," explains Dr. Tami Moses, director of the Nitzan multidisciplinary center. "You can't give one pill or another and expect problems to disappear or be solved. This is not a passing headache. Treatment of attention concentration disorders must be integrated: Parents assist the child under the school's guidance. Pharmaceutical treatment does not solve everything."

Yoni's recent behavior in school had high and low points, moments of quiet punctuated by outbursts. "He even makes me dizzy, at this point," his mother says. "We and the school don't really know how to cope with these problems. These problems didn't exist in the past. Everything was simpler."

Amram Mitzna, chairman of the Yeruham local council, comes to visit. "Current manpower allocations are far from meeting the pace of demand," he says. "Government involvement in treating learning disabilities is limited. In communities with strong socioeconomic populations, it's still possible to cope with the problem, but in peripheral communities, like Yeruham, there is almost no institutional intervention, and the neglect is horrible."

Payment for an evaluation at this center is NIS 120. According to Nitzan CEO Mali Danino, a similar evaluation, in Tel Aviv, costs NIS 500. The evaluation and treatment available in the nation's periphery and the rush to private institutions in more established areas demonstrate access and availability discrepancies among rich and poor.

One way to curb the power of private institutions is to conduct screening tests in schools to identify children with learning disabilities.

And in fact, just this year, a team at the University of Haifa, led by Professor Zvia Breznitz, created an exam to test pupils' performance against national norms in the areas of reading, writing, mathematics, second languages, and intelligence.

The Education Ministry is currently investigating the feasibility of administering these tests in a variety of classrooms.