Ritalin, the controversial drug used to calm hyperactive children, should not be routinely prescribed by doctors and never be given to under-fives, experts said this week. They also advise that it should be given to older children only if other interventions have failed.
The use of Ritalin and similar drugs is extensive and, some argue, employed indiscriminately for children diagnosed with attention deficit hyperactivity disorder (ADHD).
The guidance says it should not be used at all in children under five and used for older children only when they have severe ADHD or as a last resort.
Guidance issued by the United Kingdom’s National Institute for Health and Clinical Excellence (Nice) instead recommends training for parents as a first step towards helping children.
About 55 000 children in the UK are thought to have been prescribed drugs for ADHD. The numbers have been soaring; prescriptions almost doubled between 1998 and 2004.
Some parents and teachers say the drugs have transformed children unable to learn and causing huge difficulties for themselves and others. But there have been widespread concerns that they are over-used.
They also have side-effects, including stunting growth.
The Nice guidelines say drugs, where they are given, must be used alongside psychological therapy and support. They rule out, however, omega 3 fish oils and say that while children need a good nutritious diet, adding special foods or avoiding others makes no difference.
The new guidelines for the first time attempt to get help for children in both the classroom and at home. They advise that teachers should training to support children with ADHD, a condition thought to affect up to 3% of the school-age population.
Christine Merrell, an education specialist and guideline group member, said affected children could be disorganised and forgetful and find it hard to make friends because of their apparent lack of consideration.
“They won’t have pencils, pens, exercise books or their PE kit. You lend them a pencil and it comes back broken. They disrupt other children, have quite short attention spans, push into queues and butt into conversations.
“The child with ADHD will blurt out the answer before anybody else has had a chance.”
Parents will be offered education and training programmes lasting eight to 12 weeks to enable them to help children, some of whom will have been hyperactive since learning to walk.
Tim Kendall, joint director of the National Collaborating Centre for Mental Health, said training would enable parents to understand what ADHD was and was not, and what could “focus the child and manage the child’s behaviour without getting locked into big battles”.
If consistent help from parents and teachers did not work or the ADHD was severe, children could be given methylphenidate (Ritalin), the guideline says. But they still had to be continuously monitored and assessed.
The guidance, however, is controversial. Sami Timimi, child psychiatry professor at Lincoln University, England, said there was no evidence that stimulant drugs worked in the long term for those with severe ADHD.
The guideline group had classified ADHD as a neurological disorder, a problem in the development of the brain. This meant the condition would continue to be treated by paediatricians, who were prone to prescribing drugs, rather than by psychiatrists who might tackle it as a behavioural disorder. —