Israeli educators and mental health diagnosticians have in the recent decades become convinced that ADHD and ADD are much more prevalent than had been traditionally diagnosed. In recent years, many more school children in Israel have been diagnosed and treated for the disorder with Ritalin, a medication that is already restricted in its prescription by doctors.
Labor MK Yoram Marciano, presenting his proposal to the Knesset this week, claimed that increased marketing activity by drug companies was responsible for the resulting upswing in use of the medication for children diagnosed with ADHD.
If passed, the bill would severely restrict a doctor’s ability to prescribe Ritalin - the only first-line medication available in Israel to treat the symptoms of ADHD in both the inattentive-passive type and the impulsive-hyperactive type of the disorder.
Ritalin, also known by its generic name, methylphenidate, is a stimulant-class medication which comes in short and long-acting forms and has been used to treat ADHD for more than 50 years. Literally thousands of research studies have been conducted for decades to determine the efficacy and side effects of the medication, used to treat both children and adults.
At least 20 percent of those who are diagnosed with ADHD cannot use methylphenidate because their system doesn't respond to it, or responds negatively with side effects including gastric disturbance, headaches and loss of appetite.
ADHD in the Classroom
Untreated ADHD results in learning difficulties, serious behavior problems, social skills issues, problems with organization and low frustration tolerance. Research studies show that some 40 percent of ADHD children who do not receive therapeutic and medical support grow into at-risk teens – and eventually into ADHD adults who face serious problems in attaining the post-secondary education necessary for success in finding and keeping a job. The social skills issues associated with the disorder also result in marital and parenting problems, which often lead to serious complications in the household and in the children's upbringing.
Research studies have indicated that some 10 percent of school-age children have ADHD and there is some indication that the condition is genetic. Experts say the condition is both under-diagnosed and over-diagnosed in children – in short, misdiagnosed both ways, further complicating the situation.
Few teachers are able to contend with the ADHD child in large classrooms due to lack of appropriate support and knowledge of the condition. There are few if any in-service training programs for mainstream and special education teachers to help them spot children who may be displaying its symptoms, rather than simply behaving badly or choosing not to pay attention. Teachers are also largely unaware of resources available for parents and do not know to whom to refer the families for evaluation and treatment, let alone how to manage the ADHD child’s behavior and learning issues in the classroom.
Extremely Limited Treatment Options
Treatment for the condition in the Jewish State is as yet in its infancy, with extremely limited options.
The specially trained psychotherapists who can address the issues presented by ADHD are also in short supply. Psychotherapists are often untrained in specific treatment methods for the disorder, with most as yet inexperienced in diagnosing and differentiating symptoms that may appear to be ADHD from other conditions.
Few behavior therapists exist in Israel and methods of combining behavior therapy with other forms of psychotherapy to treat the ADHD child and his family are rarely addressed in Bachelors degree programs in social work – the programs which generate the lion’s share of social service workers in Israeli municipalities and boarding schools.
Ritalin is the only medical option that exists in the health basket to treat the disorder. Other medications commonly used in the United States, either alone or in combination, are extremely expensive and thus unavailable to the average, low-income Israeli. Some of the newer medications are simply unavailable.
Neurofeedback, an alternative treatment which involves the use of biofeedback to train the child to consciously manipulate his brainwaves in order to correct attention problems, is extremely expensive and rarely available.
Recent functional MRI studies have documented the structural differences in the brains of children and adults with ADHD and those of individuals who do not have the disorder. Other neurological studies have found neuro-chemical differences as well, documenting the need for physical as well as therapeutic treatment.
A five year multi-modalmulti-site research study conducted by the U.S. National Institutes of Health several years ago also found that stimulant medication used together with behavioral intervention is the most effective way to correct the behavioral and learning difficulties that plague ADHD children.
Issues to Consider
If Marciano’s bill is passed, Health Ministry regulations would require a lengthy registration and supervision process which could mandate trials of other methods of treating the condition, making it extremely difficult for doctors to treat their patients with the medication most often used to address the symptoms of ADHD.
Psycho-pharmacologists – psychiatrists specializing in the use of psychotropic medications – contend that the increase in the number of patients being treated with Ritalin has more to do with better training of clinicians to recognize and diagnose ADHD.
Marciano does not agree and insists it all comes down to money.
“The drug companies have launched a massive campaign recently to convince psychiatrists, doctors, teachers and parents of the wonders of Ritalin – while many experts in countries around the world believe there is nothing wonderful about this drug at all,” he said.
Not so, contends one parent who spoke on condition of anonymity due to the lingering stigma associated with ADHD and learning disabilities. “Before my child was diagnosed, he was bounced from one school to the other,” he said. “I cannot begin to describe the havoc in our home, the way he was treated by teachers at school, the way other kids ridiculed him... When he was finally diagnosed and started on the medication, we could not believe the difference. Neither could he – by then he was 10 years old, and it was the first time he was actually able to stay focused long enough to read a word from the first letter to the last. It changed his life.”
Claims that methylphenidate is addictive have been raised periodically by various groups, most of whom oppose treatment of the condition with any medication at all. ADHD adults and parents of ADHD children say that Ritalin is no more addictive that insulin, pointing out that both conditions require medical support that, if stopped, would cause a myriad of difficulties.
There is truth to the claim, however, that stimulants such as Ritalin are sold on the street and abused by those who do not need them. College students who have not been diagnosed with ADHD have been known to obtain the medication on the black market or from friends in order to increase their ability to focus while cramming for exams.
For those who have ADHD, however, Ritalin can be a boon to improving their ability to function in the classroom as well as at home and in social situations by increasing focus and concentration while reducing impulsivity.
At present, the only medications approved in Israel to treat ADHD are Ritalin and Concerta, a longer-acting form of methylphenidate. Neither has been shown to be dangerous or result in long-term negative side effects when properly prescribed and monitored by a qualified physician.
The first new medication to hit the market in 50 years that is specifically developed to treat ADHD is Strattera (generic name: atomoxetine). Strattera is not available in Israel and children who are unable to take Ritalin - as well as their families - are thus still forced to contend with the devastating social, educational and sometimes physical issues that result from untreated ADHD.
“If Ritalin becomes impossible to obtain, what will happen?” asked the parent. “Will my son’s ADHD go away? No. Will his grades improve? No. What are his chances of managing to get through college, hold a job, contend with marriage and children if he can’t control his impulsive behavior, keep himself focused on what he is doing... or for that matter, keep his mouth shut long enough to learn something from others?”
“Maybe those who criticize the only low-cost medical treatment available to us should consider the price Israeli society will pay later,” he added.
Labor MK Yoram Marciano, presenting his proposal to the Knesset this week, claimed that increased marketing activity by drug companies was responsible for the resulting upswing in use of the medication for children diagnosed with ADHD.
If passed, the bill would severely restrict a doctor’s ability to prescribe Ritalin - the only first-line medication available in Israel to treat the symptoms of ADHD in both the inattentive-passive type and the impulsive-hyperactive type of the disorder.
Ritalin, also known by its generic name, methylphenidate, is a stimulant-class medication which comes in short and long-acting forms and has been used to treat ADHD for more than 50 years. Literally thousands of research studies have been conducted for decades to determine the efficacy and side effects of the medication, used to treat both children and adults.
At least 20 percent of those who are diagnosed with ADHD cannot use methylphenidate because their system doesn't respond to it, or responds negatively with side effects including gastric disturbance, headaches and loss of appetite.
ADHD in the Classroom
Untreated ADHD results in learning difficulties, serious behavior problems, social skills issues, problems with organization and low frustration tolerance. Research studies show that some 40 percent of ADHD children who do not receive therapeutic and medical support grow into at-risk teens – and eventually into ADHD adults who face serious problems in attaining the post-secondary education necessary for success in finding and keeping a job. The social skills issues associated with the disorder also result in marital and parenting problems, which often lead to serious complications in the household and in the children's upbringing.
Research studies have indicated that some 10 percent of school-age children have ADHD and there is some indication that the condition is genetic. Experts say the condition is both under-diagnosed and over-diagnosed in children – in short, misdiagnosed both ways, further complicating the situation.
Few teachers are able to contend with the ADHD child in large classrooms due to lack of appropriate support and knowledge of the condition. There are few if any in-service training programs for mainstream and special education teachers to help them spot children who may be displaying its symptoms, rather than simply behaving badly or choosing not to pay attention. Teachers are also largely unaware of resources available for parents and do not know to whom to refer the families for evaluation and treatment, let alone how to manage the ADHD child’s behavior and learning issues in the classroom.
Extremely Limited Treatment Options
Treatment for the condition in the Jewish State is as yet in its infancy, with extremely limited options.
The specially trained psychotherapists who can address the issues presented by ADHD are also in short supply. Psychotherapists are often untrained in specific treatment methods for the disorder, with most as yet inexperienced in diagnosing and differentiating symptoms that may appear to be ADHD from other conditions.
Few behavior therapists exist in Israel and methods of combining behavior therapy with other forms of psychotherapy to treat the ADHD child and his family are rarely addressed in Bachelors degree programs in social work – the programs which generate the lion’s share of social service workers in Israeli municipalities and boarding schools.
Ritalin is the only medical option that exists in the health basket to treat the disorder. Other medications commonly used in the United States, either alone or in combination, are extremely expensive and thus unavailable to the average, low-income Israeli. Some of the newer medications are simply unavailable.
Neurofeedback, an alternative treatment which involves the use of biofeedback to train the child to consciously manipulate his brainwaves in order to correct attention problems, is extremely expensive and rarely available.
Recent functional MRI studies have documented the structural differences in the brains of children and adults with ADHD and those of individuals who do not have the disorder. Other neurological studies have found neuro-chemical differences as well, documenting the need for physical as well as therapeutic treatment.
A five year multi-modalmulti-site research study conducted by the U.S. National Institutes of Health several years ago also found that stimulant medication used together with behavioral intervention is the most effective way to correct the behavioral and learning difficulties that plague ADHD children.
Issues to Consider
If Marciano’s bill is passed, Health Ministry regulations would require a lengthy registration and supervision process which could mandate trials of other methods of treating the condition, making it extremely difficult for doctors to treat their patients with the medication most often used to address the symptoms of ADHD.
Psycho-pharmacologists – psychiatrists specializing in the use of psychotropic medications – contend that the increase in the number of patients being treated with Ritalin has more to do with better training of clinicians to recognize and diagnose ADHD.
Marciano does not agree and insists it all comes down to money.
“The drug companies have launched a massive campaign recently to convince psychiatrists, doctors, teachers and parents of the wonders of Ritalin – while many experts in countries around the world believe there is nothing wonderful about this drug at all,” he said.
Not so, contends one parent who spoke on condition of anonymity due to the lingering stigma associated with ADHD and learning disabilities. “Before my child was diagnosed, he was bounced from one school to the other,” he said. “I cannot begin to describe the havoc in our home, the way he was treated by teachers at school, the way other kids ridiculed him... When he was finally diagnosed and started on the medication, we could not believe the difference. Neither could he – by then he was 10 years old, and it was the first time he was actually able to stay focused long enough to read a word from the first letter to the last. It changed his life.”
Claims that methylphenidate is addictive have been raised periodically by various groups, most of whom oppose treatment of the condition with any medication at all. ADHD adults and parents of ADHD children say that Ritalin is no more addictive that insulin, pointing out that both conditions require medical support that, if stopped, would cause a myriad of difficulties.
There is truth to the claim, however, that stimulants such as Ritalin are sold on the street and abused by those who do not need them. College students who have not been diagnosed with ADHD have been known to obtain the medication on the black market or from friends in order to increase their ability to focus while cramming for exams.
For those who have ADHD, however, Ritalin can be a boon to improving their ability to function in the classroom as well as at home and in social situations by increasing focus and concentration while reducing impulsivity.
At present, the only medications approved in Israel to treat ADHD are Ritalin and Concerta, a longer-acting form of methylphenidate. Neither has been shown to be dangerous or result in long-term negative side effects when properly prescribed and monitored by a qualified physician.
The first new medication to hit the market in 50 years that is specifically developed to treat ADHD is Strattera (generic name: atomoxetine). Strattera is not available in Israel and children who are unable to take Ritalin - as well as their families - are thus still forced to contend with the devastating social, educational and sometimes physical issues that result from untreated ADHD.
“If Ritalin becomes impossible to obtain, what will happen?” asked the parent. “Will my son’s ADHD go away? No. Will his grades improve? No. What are his chances of managing to get through college, hold a job, contend with marriage and children if he can’t control his impulsive behavior, keep himself focused on what he is doing... or for that matter, keep his mouth shut long enough to learn something from others?”
“Maybe those who criticize the only low-cost medical treatment available to us should consider the price Israeli society will pay later,” he added.