Ritalin over-prescribed to children

The controversial drug Ritalin is being over-prescribed to children to control their unruly behaviour and should be avoided in those aged under five, the Government's drugs watchdog said yesterday.

Instead of reaching for the prescription pad when confronted with a child who is inattentive, undisciplined and constantly on the move, doctors should refer parents for training in how to handle their children and alert teachers to provide support.

But at the launch of new guidance for the NHS on attention deficit hyperactivity disorder (ADHD), doctors warned that Ritalin and similar drugs were being under-used in some severely affected children, who may suffer lifelong psychiatric problems if left untreated.

An estimated 3 per cent of children and 2 per cent of adults are affected by the condition. The guidance issued by the National Institute for Clinical Excellence (Nice) says children suspected of having ADHD should be assessed by specialist teams to determine the most appropriate treatment.

The guidelines say parent training and education programmes should be offered first for ADHD – not drugs. The programmes show parents how to create a structured home environment, encourage attentiveness and concentration, and better manage misbehaviour. Research shows they can be highly effective, helping children do better at school and lead more normal lives. Teachers should also be involved.

Tim Kendall, joint director of the National Collaborating Centre on Mental Health and a consultant psychiatrist in Sheffield, said: "When you meet kids with severe ADHD, the long-term outcomes are not good. If left untreated they will probably end up with personality problems or continuing ADHD."

In a school of 1,400 pupils, there would be 10 to 15 children with severe ADHD who might need drug treatment, he said. But in many parts of the country, where support was lacking for affected children and their families, there was an "over-reliance on medication".

Ritalin is a stimulant, but when given to children with ADHD it has the paradoxical effect of calming them down. It has been sold as a recreational drug of abuse and as a slimming aid.

In the United States, an estimated 10 per cent of children have been prescribed the drug, arousing criticism from UK specialists who say the diagnosis has been overused.

Dr Kendall said that in genuine cases of ADHD, the symptoms of inattentiveness, lack of concentration and being constantly on the move resulted in impairment of school work and relations with friends or family. Where drugs were prescribed, they should be given in small doses and the effects monitored.

Nicola Salt, a GP in south London and member of the Nice guideline committee, said ADHD in a child could affect the whole family. When a parent said their child was hyperactive, the first question to ask was, what were they like at school? "If the child is OK at school, it is unlikely to be ADHD," she said.

The facts about attention deficit hyperactivity disorder

A child with ADHD is driven by a motor that cannot be switched off. Those affected are always on the move, running, climbing or jumping, and talking all the time. They find it almost impossible to concentrate, tend to push into queues, blurt out answers to incomplete questions, butt into conversations, and act without thinking, making them accident prone.

At school they are easily distracted, forgetful, unfocused, and disorganised. They may also find it hard to keep friends and suffer from bullying. The feature that distinguishes ADHD from normal childhood impulsiveness is that it is pervasive in all areas of life.

The causes of ADHD are thought to include both genetic and environmental influences. Diet has been implicated. Problems in the womb or birth trauma could also cause damage in the brain, leading to the condition.

j.laurance@independent.co.uk

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