'I didn't want my son on drugs'

Ritalin was hailed as a wonder drug for hyperactive children. Now parents and professionals are starting to have their doubts. So what are the alternatives? By Tara Mack

Elaine Walden nearly gave in after her eight-year-old son Thomas was suspended from school. Thomas, who had been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) a year earlier, had thrown sand at a girl in the playground during lunch. She was rushed to hospital to have her eyes flushed out with water. He was excluded for two days. And Elaine Walden began taking him home every day at lunchtime.

His teachers, she says, had been trying to talk her into giving him Ritalin to get his wild, sometimes violent behaviour under control. She didn't like the idea, but as she began shuttling him back and forth to school during lunch, her conviction started to waver.

"Going through the normal routine - the NHS - there was only one option and that was to put him on Ritalin," she says. "But I'm opposed to Ritalin. I didn't want to change my child's personality so dramatically. And I can't seem to find very much research saying what the long-term effects of Ritalin are."

Instead she took him to a homoeopath and a reflexologist and made some drastic changes in this diet, cutting out colourings, preservatives, sugar and eventually dairy products and nuts. Later she even brought him to a cybernetic kinesiologist, and now his ADHD is assaulted daily with a barrage of alternative remedies including flower extracts and taurine, an amino acid.

After about six months of treatments, his behaviour began to improve. Even the school staff, who deny trying to convince Walden to use Ritalin, noticed the change.

Ritalin has taken a beating in the media recently. A study in the Journal of the American Medical Association reported last month that the number of two- to four-year-old children in America using Ritalin and other stimulants increased three-fold in the early Nineties. This despite the fact that the US government does not approve the drug for children under six.

The United Nations International Narcotics Control Board last year warned governments in countries such as the UK - where, in England alone, stimulant prescriptions increased from 3,500 in 1993 to 92,100 in 1997 - that doctors may be over-diagnosing ADHD and over-prescribing stimulants such as Ritalin. A BBC Panorama programme which is scheduled to be broadcast next month will delve into the Ritalin debate. Each new study or report kicks up a flurry of press coverage.

The bad publicity has made some parents nervous about giving their children Ritalin. But parents who start searching for other choices quickly find themselves navigating unmapped territory. The research on the effectiveness of these remedies is thin compared with the mountainous pile of studies that have been done on Ritalin. And parents are left to sift through a series of unproven possibilities - biofeedback, homoeopathy, osteopathy, vitamin and mineral supplements, evening primrose oil and diet restrictions.

Ritalin defenders say the alternatives are a waste of time and money. ADHD is a brain dysfunction characterised by an abnormal level of inattentive, impulsive and sometimes hyperactive behaviour. These behaviours are so excessive that they often prevent children from learning and socialising. Ritalin is not a cure. But for many children it peels off this layer of bad behaviour so that they can do their homework and make friends more easily.

The alternatives "can't hold a candle to the amount of research on stimulants or behaviour management on these children", says Russell Barkley, who is professor of psychiatry and neurology at the University of Massachusetts Medical School. "The evidence is not persuasive enough to move these up to first-line ADHD treatments."

The pro- and anti-Ritalin factions agree on one thing at least: the condition is real and not a fantasy concocted in the imagination of parents who cannot control their rambunctious children. And it not only afflicts the child, but puts tremendous stresses on parents who feel they are accused by teachers and social workers of causing their children's behaviour and vilified by the media if they put their kids on Ritalin - blamed for the problem and then blamed for the solution.

All the more reason to look for a different approach, says Sally Bunday, co-founder and director of the Hyperactive Children's Support Group based in West Sussex. She started the group in 1977, before the condition was even called ADHD, when she was searching for a treatment for her hyperactive son. She has spent the last two decades trying to pull people's attention away from Ritalin long enough to get them to focus on the relationship between nutrition and ADHD.

A few studies and her own experience show hyperactive behaviour may be linked to certain foods and food additives. The growth in ADHD cases could be connected to the increase in chemicals and pesticides used in foods, Bunday argues: "There are nearly four million-plus children on Ritalin. Now what on earth is happening to the biochemistry of the children to warrant such large numbers being on medication?" Parents who call her are told to start cutting down on junk food and citrus fruits.

Tracy Dean stumbled across the organisation by accident when her son, Jordan, was two. An educational psychologist told her that Jordan, who used to shake the shelves, bite his mother and wake up five or six times a night, most likely had ADHD, although he was never officially diagnosed. "One day I was looking in the phone book for something else, and I came across Sally's number. And it was like she knew Jordan the way she was telling me what he was like," she says.

She tried the diet Bunday recommended, combined with some osteopathy and saw results within a few days. "My husband and I could have a conversation while he was around, and that was something we couldn't do when he was hyperactive because he made so much noise," she says.

Jonathan Brostoff, professor of allergy and environmental health at University College London, says the reason diet modification has not become a mainstream approach to ADHD is that people don't appreciate the ways in which nutrition affects health. "And giving a tablet is much easier than putting a child on a diet," he adds.

One of the remedies Bunday has championed is finally getting more attention from researchers. Alex Richardson, a senior research fellow with the Imperial College School of Medicine, and Harry Zeitlin, professor of child and adolescent psychiatry of University College London, are leading a study in Harlow on a product called Efalex. Their theory is that hyperactivity might be the result of an abnormality in the way the body metabolises fatty acids. Efalex combines several fatty acids as well as antioxidants and vitamin E.

Scientists and researchers who support these theories note that they won't necessarily work for all children with ADHD, and perhaps only help a minority. Parents add that they are not a miracle cure-all.

Walden says that her son's schoolwork is still erratic. Heather Clark, head teacher at his school, says she doesn't know how much of the change in his behaviour can be attributed to the alternative treatments and how much can be attributed to the extra support Thomas now gets in school. And another mother says that the restricted diet didn't prevent her son from tying some dressing gowns together and abseiling down the stairwell.

Some people who have tried these approaches say they just don't work. "Everybody I know who's tried something alternative has failed," says Andrea Bilbow, charity director of ADD Information Services and Support and mother of a 13-year-old son with the condition. When her son was 12, she reduced the Ritalin for six months and gave him a supplement she got from America that contains natural stimulants. "He just went downhill completely," she says. "All the problems that he had came back - the self-esteem problems, the impulsivity, the shouting out in class, the irritability. He went into total shut-down and refused to work."

The problem with these alternatives, says Barkley, is that they simply don't match what scientists know about ADHD. The cutting edge of ADHD research, he says, is molecular genetics, not homoeopathy and nutrition. And without more proof, the research community is in no hurry to drop what it is doing to start testing these alternatives. "We're not going to waste our time chasing after every alternative treatment that somebody makes a claim about," he says.

Alternative remedy enthusiasts hoping for more scientific attention are fighting a David and Goliath battle. The Bunday's organisation is trying to set up a research foundation to explore nutrition and ADHD. "It needs to be looked at," she says. "Nutrition should not be dismissed as some sort of willy-nilly, laughable nonsense."