Theresa May: Ritalin - the easy option?

Not a subject which you might expect me to write about but one on which I feel strongly.  This week I released research on the use of methylphenidates, of which Ritalin is one of the most commonly used types, to treat ADHD a neurobehavioral disorder which affects up to one in 20 of our children.

The results of the research are disturbing, the number of prescriptions for methylphenidate has risen by 156% over the last six years and under this Government NHS spending on methylphenidate has risen by 975%.  The Government doesn’t give figures for the number of children being given these drugs, but if the number of prescriptions has risen that fast then it’s pretty clear that the number of children being given the drug has risen too. Yet we really don’t know what the long term effects of using these drugs are.

NICE states that drug treatment of ADHD is not always necessary. The decision to prescribe should be based on a range of factors including the presence of other conditions, the potential for drug misuse and the preferences of the parent and child. Drug treatment should only be initiated by a healthcare professional with expertise in ADHD and should be based on a comprehensive diagnosis. Continued prescribing and monitoring of drug therapy may be performed by GPs under shared care arrangements.

But these drugs can have serious side effects.  In 2000 there were 50 adverse reactions to methylphenidate in the UK. However in 2006 there were as many as 95 reactions. Nine reactions have been fatal. In the US methylphenidate has the highest level ‘black box warning’ indicating that the drug may have serious side effects and potentially life threatening effects. In France methylphenidate is classified as a narcotic and its initial prescription is always made in a hospital.  We desperately need more research on the long term impacts of these drugs.

The enforcement of NICE guidelines is a problem. According to a survey of children being treated for ADHD at one doctor’s surgery, only 42% of the patients prescribed methylphenidate had a clearl diagnosis of ADHD. Only one patient at the surgery on Methylphenidate had the shared care arrangement recommended by NICE. Worryingly one patient prescribed methylphenidate was only 5 years old. Although this is against NICE guidelines, the Government permits GPs to prescribe methylphenidate to children younger than six through ‘off label prescribing’ – yet it fails to monitor how often this occurs.

I don’t doubt the existence of ADHD nor that for some children treatment with Ritalin or some other methylphenidate is right. But this drug must not be seen as the easy option for treating children with behavioural difficulties. It should only be used where it is the most suitable treatment for children clearly diagnosed with ADHD.

That’s why we need a review of NICE guidelines and their enforcement, a review of the use of these drugs and research into their long term effects.

Comments

[Tony Makara]

I must say that I question the idea that 5% of our children suffer from ADHD. Children are bt nature very egocentric and often are locked into their own little world. That of course doesn't mean that these children are attention deficient. Children are often very finicky and frenetic, but again that doesn't mean they are hyperactive. Sadly, there is a trend among certain parents, backed up by health officials, that believes a child should be compliant at all times. Such an attitude does not accept or understand that egocentric behaviour in children is normal and needs to run its course. I am completely opposed to the doping of our children.

[eugene]

I have taught many kids that take Ritalin. I can honestly say it leads to dramatic improvement in only few cases.I am no doctor. However, I assume that in the cases where it does work well, it is a genuine need. In other cases, it is seen as 'doing something' about a good behavioural barrier.

Money is better spent 'doing something' by not dumping all kids in the same education system. More specialised schools, more special needs schools, more appropriate curriculums, more parental responsibility- that is where the answers lie. The Conservatives now potentially have the answers- do not let us down.

[Chris Palmer]

Surely this is one of the symptoms of the 'broken society' which David Cameron says he wants to heal: that instead of understanding why children behave badly (due to a lack of a proper upbringing and discipline within the family), society just pumps children full of drugs without thinking of the effects.

I suspect that in a very large number of cases, 'ADHD' is not the cause of children's behaviour and is just an easy excuse.

It is a sad reflection on our society that people have resorted to using mind altering drugs to curb something which is not the real problem. I hope that David Cameron will propose proper measures to do something about it.

[16words]

Perhaps Ritalin should be thought of in the same way as Cocaine, or vice-versa:

http://jpet.aspetjournals.org/cgi/content/abstract/193/2/676

[James Maskell]

This argument has been made numerous times before, that ADHD is very often an excuse for simple bad behaviour. ADHD is such an easy one size fits all excuse. A child being a misbehaved little s*** is perfectly normal and doesnt always mean it has ADHD.

Unfortunately, its harder and harder to discipline a child now smacking is illegal and shouting is a form of verbal abuse. Pumping them with Ritalin seems to be one of the few remaining options...

[Matthew Scott]

Peter Hitchens has tried to tackle the issue of ADHD but from the other angle - that it just doesn't exist.

His posts on it are here:

http://hitchensblog.mailonsunday.co.uk/2007/05/the_adhd_fantas.html

http://hitchensblog.mailonsunday.co.uk/2007/05/attention_defic.html

[Carolyn]

The use of Ritalin places too much responsibility on the school where the school secretary or other member of staff has the responsibility for giving the child their prescription each and every day. This is not just a problem in Britain. My nephew was prescribed it in Norway well into his late teens and now after an incident which could well have been related to this is only partially sighted and walks with a crutch. A young man who had an excellent career ahead of him now is registered disabled and does not work!

[Yet Another Anon]

Use of medication in an attempt to solve every problem is very worrying and doomed as a solution, everytime someone has a problem the reply from the authorities and society seems to be that the answer is to take pills of some kind and that it's a medical problem not a social problem that should be dealt with by non-medical means - many problem children just don't eat properly or don't get a proper cultural input.

In New Scientist recently I was reading that there is now a huge upsurge in children being diagnosed with Bipolar Disorder even as young as 3 and being put on things such as Lithium, Halperidol, Valium and Anti-Depressives and the probable cause was side affects of medication that either their mothers had been given when pregnant or they had been given - Bipolar Disorder used to be virtually unheard of in people under the age of 16, equally the upsurge in Hayfever (something which didn't exist before the Industrial Revolution and now seems to be a conversation topic even among small children) and eating disorders such as anorexia and bulimia which are very much a product of modern lifestyle.

[Annabel Herriott]

I qualified as a Health Visitor in 1960. At no time was ADHD mentioned. Did not exist. I did not really notice when it was invented, probably about 5 years before I retired. I remember a Health Visitor I worked with doing a project on it, but she was working with the MOTHERS!!! It is all a little strange methinks.

[Didactophobe]

I wonder what proportion of children with ADHD live in two-parent families; eat healthily without consuming a vast array of artificial additives; receive love, affection and appropriate parental time at home and take regular exercise.

I suspect that in the majority of cases the solutions are relatively simple.

[Lyle]

I agree with most of the article. I disagree with many of the comments. I am so tired of people giving their opinion on ADHD and other mental illnesses without first getting some info on it from a reliable source.

[Ritalin Side Effects]

My name is Lance Burnet and i would like to show you my personal experience with Ritalin.

I am 56 years old. I have taken Ritalin for 30 years. I have been diagnosed with a mild form of narcolepsy. I use 4 (10 MG ) pills per day. The drug ahs worked wonders and eliminated the drowsiness and sleep attacks. My concern now is the length of time I have been on it. When taking a "drug holiday" it seems like my symptoms are worse.

I have experienced some of these side effects-
rebound effect when dosage wears off.

I hope this information will be useful to others,
Lance Burnet

[coach outlet]

I wish you great blessings and love.*