Drug for 'difficult' children approved

Medical experts are criticised for sanctioning the widespread use of controversial treatment for thousands of hyperactive youngsters
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Doctors were given thego-ahead yesterday to use the amphetamine derivative Ritalin to treat young people with attention deficit disorder, reopening the controversy over the drugging of children to control difficult behaviour.

Doctors were given thego-ahead yesterday to use the amphetamine derivative Ritalin to treat young people with attention deficit disorder, reopening the controversy over the drugging of children to control difficult behaviour.

Attention deficit/hyperactivity disorder (ADHD), which is estimated to affect 73,000 children in England and Wales, 1 per cent of the school-age population, leaves sufferers unable to concentrate, prone to fidget and act impulsively, causing difficulties at home and school and imposing immense strain on families.

The Government's watchdog on new treatments, the National Institute for Clinical Excellence, said in new guidance that drugs "should be used as part of a comprehensive treatment programme" for severely affected children.

The ruling is likely to lead to thousands more children being prescribed Ritalin, which has suffered from widely variable availability around the country.

The institute said 48,000 of the 73,000 children who might benefit from the drug were not getting it. A year-long course of the drug costs £200 but specialist assessment and follow-up recommended by the institute would increase the cost to £500-£1,000, adding up to £37m a year to the treatment bill nationally.

The drug, whose chemical name is methylphenidate, has been available for 40 years but its use in children has grown sharply in the last decade from 3,500 prescriptions in 1993 to 157,900 in 1998.

The ruling has angered campaigners opposed to drug treatment of children. Jean Robb, educational therapist at the Successful Learning Centre, in West Kirby, Merseyside, an after-school unit for children with problems, and co-author of a book on ADHD, said: "It's ridiculous. What we need to be looking at is why parents have difficulty raising their children in today's society. It is dangerous to tell children they can only be handled through drugs - it gives them the wrong message and their parents too."

Janice Hill from the support group Overload, which campaigns against over-prescription of drugs for children, said: "We are disappointed with these guidelines as they do not address any of the safety concerns about Ritalin.These are things like amphetamines that we are giving our kids."

The evidence that methylphenidate, which is available in Britain under the brand names Ritalin and Equasym, is effective in ADHD is now overwhelming, according to experts. More than a dozen studies have shown that sufferers have a genetic abnormality of the dopamine system in the brain which can be corrected by the drug.

Professor Peter Hill, consultant in child and adolescent psychiatry at Great Ormond Street Hospital for children and an international expert on ADHD, said: "I don't think there is any doubt at all that in medical terms methylphenidate is an effective way of squashing the symptoms. The extraordinary thing is how effective stimulants are at dealing with them."

Professor Hill, who advised the institute on the guidelines, said the condition could have a devastating effect on families but doctors had a responsibility to ensure they were acting for the children and not colluding with parents and teachers.

"Kids with the condition often live their lives to the soundtrack of continuous criticism because they misbehave and are constantly told off," he said. "The child then starts to suffer low self-esteem and is less likely to respond to help and learn techniques to deal with the condition. If you can get a handle on that you can halt the damage and reverse it."

However, Professor Hill said psychological treatments, including measures such as anger management and educational therapy, should be the first line of treatment, a recommendation omitted from the institute's guidance which says treatment "could, but does not need to, include specific psychological treatments".

In the United States, where a broader definition of the condition is used, 4 to 6 per cent of the school population are estimated to be sufferers and drug treatment is widespread. "The idea that you have got one child in 25 needing treatment [in the US] is a bit alarming," Professor Hill said.

* A drug cocktail that could save the lives of thousands with hepatitis C - a virus that threatens to kill more people than Aids - was approved yesterday by the institute. Up to 400,000 people are estimated to be infected by the hepatitis C virus which is spread by blood-to-blood contact and, rarely, through sex. Although symptoms are mild or non-existent in the early stages, 85 per cent become chronically infected and up to one in three of those is expected to develop cirrhosis of the liver in 20 to 30 years.

Many health authorities have refused to pay for the drug cocktail - a combination of interferon alpha and ribivarin - which costs about £7,000 a year. The institute's recommendation means doctors have an obligation to use it for those in need. The guidance says about 7,000 patients could benefit from the drugs, which are only of proven effectiveness in severe cases, compared with fewer than 1,000 who get them now. The cost to the NHS is put at £18m.

The drug cocktail can cure about 40 per cent of cases. But treatment involves three injections a week and has unpleasant side-effects - chiefly flu-like symptoms - which cause one in five patients to drop out. In the US, 4.5 million people are estimated to be infected.