Do we need to drug our children?

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The Independent Online

By the year 2007, according to Department of Health research, one in seven British children will be taking prescribed drugs to control their behaviour. The statistic is chilling, and doesn't say much that is positive about the state of our culture.

By the year 2007, according to Department of Health research, one in seven British children will be taking prescribed drugs to control their behaviour. The statistic is chilling, and doesn't say much that is positive about the state of our culture.

Other statistics are just as disturbing. At present, it is estimated, one in five children has a mental or emotional illness at any given time, while one in 20 suffer from depression. Dutch research has found that a large proportion of children have trouble sleeping, which in turn adversely effects their development.

New guidelines issued yesterday by the Government's medicines watchdog, the National Institute for Clinical Excellence (Nice), contained further disturbing news about the mental health of the nation's children.

Commissioned to look into the prescribing of the drug Ritalin as a treatment for attention deficit hyperactivity disorder (ADHD), Nice has reported that far from being overprescribed, as many critics allege, the drug is underprescribed.

In 1994, 4,000 prescriptions for Ritalin were made out to children. Since then, the amount of prescriptions has been doubling every year. Last year, it levelled off, increasing from 126,500 prescriptions to 157,900. But Nice suggests that in England and Wales, there are another 48,000 children who should be on Ritalin.

Part of the controversy lies in the nature of ADHD itself. Some people say that Ritalin is merely a "chemical cosh" which irons out children's behavioural problems without getting to the root of the matter. Some even insist that there is no such thing as ADHD. However, there are brain imbalances common to children with the illness that suggest that it is a genuine clinical condition.

The report emphasises that Ritalin should only be prescribed in extreme cases of ADHD, to children over five, only by a child psychiatrist or paediatrician, and only within a comprehensive treatment programme with children, parents and health professionals involved in any decision to prescribe Ritalin.

This is hardly likely, though, to appease the many critics of the drug's use, who emphasise that Ritalin is chemically similar to amphetamines such as speed, and point to a host of reported side-effects including depression, lethargy, weight loss and sleep disruption. There are also unsubstantiated claims that the drug can stunt growth.

The Overload Network, which campaigns against the use of drugs such as Ritalin in the treatment of children, claims that the guidelines are biased, based largely on a study which was sponsored by drug companies, and making no reference to legal actions which have been taken against Ritalin's manufacturer, Novartis Pharmaceuticals, in the United States.

Other groups, though, insist that Ritalin is a wonder-drug. There is much testimony from parents who were in despair because of the erratic and frightening behaviour of their children, who found Ritalin to have entirely turned the situation around. Others, though, have been disturbed by the effect the drug had on their children, and commonly allege that it turned them into "zombies".

But while the controversy rages on, people seem rather shy of robustly discussing the real problem - which is, of course, establishing why it is that so many children are falling prey to ADHD in the first place. Thinking about how to tackle the prevalence of the illness, rather than simply controlling it, is not the job of the medical profession, but it is something that surely we should be scrutinising.

Two British doctors, Dr Basant Puri, a consultant in psychiatry at Hammersmith Hospital, and Dr Alex Richardson, a research fellow in neuroscience at Oxford, both seem convinced that some manifestations of the illness may be connected to an absence of essential fatty acids (EFAs) in the brain. A deficiency of these acids causes lack of concentration, restlessness and emotional outbursts.

These acids are gained by the body naturally and directly through eating fish or seafood, and can also be converted from the fatty acids in nuts, dairy products or green vegetables. Certain foods, burgers and chips being a prime example, actually inhibit the body's ability to make EFAs.

Many parents who have children who suffer from ADHD might dislike the idea that the disorder could be connected to poor diet. But while the disorder does affect all social classes, the fact is that it does seem prevalent among the poor.

In this country, the low-income parents of children on Ritalin are entitled to a weekly disability payment of £45. If their child receives an alternative treatment - such as "eye q", a supplement containing high concentrations of EFAs in marine fish oil, pure evening primrose oil and vitamin E - then they don't get this payment. Surely that cannot be right?

And again, while it is not by any means always the case that the symptoms of ADHD only appear in tandem with an EFA deficiency, it is noticeable that certain factors come up again and again in case studies of children with the illness. Often the really serious behavioural difficulties emerge when a child starts to become aggressive towards a new sibling.

Also, parents of children with ADHD often are hard-working and late-working, and through no fault of their own, may not be spending a huge amount of time in their child's company. There does seem to be a link to a lack of ongoing one-to-one attention. Behavioural approaches which have some success in combating the disorder include "parent training' - to help adults relate to their child in the manner they need - and special tuition for the child in one-to-one situations that make them feel more secure.

Again, in contrast to the current orthodoxy, children with ADHD also seem to respond well to being taken out of mainstream schooling, in which they are often disruptive, and placed in an educational establishment that is geared to their needs. Even special units within a mainstream school seem not to work well enough in dealing with ADHD children.

And if all this talk of lack of attention, lack of the right sort of attention, and poor diet, sounds like blaming the parents, then it is not meant to. Most parents know how difficult it is to get their children to eat oily fish and greens when the children are constantly bombarded with advertisements for things that are straightforwardly bad for them.

Most parents know, too, that despite the ongoing policy which seeks to get lone parents back to work, work does take parents away from their children a great deal of the time. This time cannot be recovered unless you have the privileges of high pay, such as cleaners, au pairs and gardeners to deal with the rest of the work while you spend time with your children.

In short, it is pretty clearly the way we are expected to live our lives now that is helping children to develop brain imbalances, and the way we live now that makes treatment through medication such an attractive first resort. Consumer culture always demands a quick fix, then wonders why it doesn't quite do the trick.

And perhaps the cruellest irony in this mess is that while we are all expected to work hard now to create massive wealth now, we are also expected to admire an undertaking from our wealthy government which does not see the need to stamp out child poverty for another couple of decades. Pills now, pay later.

d.orr@independent.co.uk

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