Sunday, October 21, 2018

Dr. Doron Gothelf

Dr. Doron Gothelf’s Sheba medical center office.

Medical professionals are currently being caught up in a wave of negative headlines in the USA, UK and Israel, which suggests that Ritalin, a drug developed over 50 years ago to treat ADHD (Attention Deficit Hyperactivity Disorder), is being overprescribed and in many cases being abused by youngsters and adults alike.

According to the Washington Post, the Centers for Disease Control & Prevention (CDC) have recommended to parents of preschoolers with ADHD to try behavior therapy first before trying drugs. According to the CDC, 75 percent (or about 2 million pre-school children) diagnosed with ADHD are currently receiving drugs as treatment. The paper reported that this spike has created, “impassioned debate about whether this represents a true rise in the prevalence of the condition or the diagnostic pressures on doctors due to unrealistic demands in schools or stressed-out parents obsessed with having a perfect child.”

The London Guardian (UK) revealed that nearly a million prescriptions for Ritalin and related drugs for ADHD were dispensed in the UK during the past year, “more than double the number of a decade ago.” The paper maintained that the figures have prompted, “a damning indictment of the system from experts who claim that the running down of mental health services has led to children being misdiagnosed and inappropriately prescribed drugs.”

Recently, Yediot Aharonot, a leading Israeli newspaper, featured “The Country on Ritalin” as its cover story. The country’s leading HMOs (health maintenance organizations) reported that prescriptions for Ritalin amongst children/teens ages 5-14 years old were up 14 percent, ages 15-24 up 26 percent and adults ages 35-44 years old up 125 percent, during the past four years alone.

This trend has not gone unrecognized by Israel’s top psychiatrists and medical experts.

“Yes, there are many worrying headlines about ADHD and use of Ritalin but the reality of what is going on is much more complex. In some instances Ritalin is indeed being over-prescribed but there are just as many children and adults who absolutely need the drug and are not getting proper treatment,” claimed Dr. Doron Gothelf, one of Israel’s most renowned child and adolescent psychiatrists, who heads both the Child Psychiatry and Behavorial Neurogenetic Center at Sheba Medical Center in Ramat Gan, Israel. The Child and Adolescent Psychiatry Division at the Sheba Medical Center is the first such unit of its kind in Israel to provide mental health services to children and their families in a pediatric rather than in a psychiatric setting.

“Many children were under diagnosed in the past and as ADHD is very hereditary, many of the parents of children with ADHD report to me that they were never properly diagnosed. Today, there is much more awareness,” explained Dr. Gothelf. “In the past, teachers would tell someone that they were either lazy or disturbed and many people would have low self-esteem believing that they were perhaps lazy or disturbed, when in fact they had ADHD and could have been treated. Consequently, many untreated people with ADHD avoided going to college and ended up living as underachievers. This does not have to be the case today.”

Dr. Gothelf stressed that it is imperative for parents to seek out a qualified child psychiatrist in order to discern whether a child has ADHD or has a different emotional disorder, where Ritalin should not be prescribed. “Sometimes, there is tension between school teachers and parents, where some teachers will demand that a child must receive Ritalin in order to continue with their education. The psychiatrist should reach the diagnosis and recommendations and the parents should decide whether to give medication to their child based on the psychiatrist recommendation,” professed Dr. Gothelf.

Shira Goldfischer, an occupational therapist who works with special needs children at Seeach Sod in Jerusalem, concurred. “Often a sensory issue can look like an attention disorder, which is why it’s very important to get professional diagnosis from someone with a very experienced eye. The most important thing in noting difficulties in children is to figure out the underlying issue; the ‘why’ is extremely significant when diagnosing and treating behavioral issues,” said Ms. Goldfischer.

Dr. Gothelf admitted that Ritalin has side effects but is an important treatment that can have positive results on cognition and behavior. “It’s almost as effective as most effective treatments in medicine such as antibiotic medications and can assist in concentration, and reduces hyperactivity and impulsive behaviors” he said. “Because of the stigma attached to Ritalin usage, some parents actually go out of their way to avoid its usage and search for natural means to deal with their child’s ADHD, which is a mistake. Some parents will give their child Omega 3, a natural vitamin that is effective for depression but has minimal effect on children or adults with ADHD.”

By Steve Walz

 Dr, Gothelf reiterated that the bottom line in dealing with and treating ADHD is “finding a good, qualified child psychiatrist who can make a proper assessment.” He added, “The sobering reality is that up to 10 percent of all school-age children have some form of ADHD and until a better drug is developed, Ritalin offers the best solution for now.”