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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