Boom in ADHD drugs for children is a bitter pill

Experts launch inquiry as funding cuts lead to overprescription

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Pressure on local authority and medical budgets is leading to the overprescription of drugs to treat children who have conditions such as attention deficit hyperactivity disorder (ADHD), experts have warned.

Psychologists want to see tougher regulations and a significant reduction in the prescription of psychotropic drugs, including Ritalin, after a boom in their use over the past decade. There is evidence that the drugs are being given to children as young as 3, in contravention of health guidelines.

The British Psychological Society (BPS) has launched a major inquiry in the UK, amid fears that cuts in funding for recommended treatments for children with ADHD, including counselling, are leading to the increased prescription of drugs. Meanwhile, in the US, Professor Allen Frances, an expert in mental health diagnosis, warned that excessive use of ADHD drugs had been exacerbated by "aggressive and misleading marketing by drug companies".

National guidelines in England and Wales say that children with ADHD should receive "comprehensive" treatment, including psychological, behavioural and educational help. But Vivian Hill, chair of the BPS's medicalisation of childhood working group, told TES that this did not always happen.

"We are responding to a high level of concern with regard to children's mental health and the prescription of psychotropic drugs," she said. "Budgets have been cut and psychiatrists feel they can't follow the official guidelines, which recommend therapy before drugs are prescribed. In the UK, often the first response now is to issue drugs, not offer therapeutic help."

The group will speak with teachers, psychologists, psychiatrists, parents and young people about the support available for children with mental health needs, including ADHD. The inquiry will also aim to discover why children from poorer backgrounds seem to be more likely to be prescribed drugs.

Official advice says that the drugs are unsuitable for those under the age of 6, but Ms Hill estimates that "hundreds" of younger children are being given medication for ADHD.

Ms Hill, who is director of professional educational psychology training at the University of London's Institute of Education, said that children as young as 3 were being given the drugs. Without therapy or other support, which addresses the cause of problems, drug treatment could have little impact, she added.

Figures released last year showed that prescriptions of Ritalin in the UK had quadrupled in little over a decade, from 158,000 in 1999 to more than 661,000 in 2010.

In the US, Professor Frances is a former chair of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, an influential guide to diagnosing mental health conditions including ADHD (see panel, page 8). He told TES that the use of psychotropic drugs to treat children had got "out of hand".

"Some of the medication use is necessary but much of it is stimulated by aggressive and misleading marketing by drug companies," said Professor Frances, emeritus professor at Duke University in North Carolina. "Except in the clearest or most urgent situations, the best policy with kids is watchful waiting to see if things get better on their own. Excessive medication for kids constitutes a public health experiment without any data on long-term outcome and without informed consent."

Professor Tim Kendall, director of the UK's National Collaborating Centre for Mental Health, which produces guidance on the treatment of mental health conditions, said parent training programmes, which help to manage ADHD, were being cut.

"There was an increase in access to parent training programmes, but with the squeeze on local council budgets and social care, and the pressure on (National Health Service) budgets, I have become aware that they are now more difficult to access," he said. "There has been a rise in the use of methylphenidate (Ritalin) on the basis that there hasn't been much else available."

Professor Kendall said that the medical profession did not have evidence of the long-term effects on young children who take these drugs, but he thought there was a "significant chance it would cause them damage".

A spokesperson for the National Institute for Health and Care Excellence, which advises the National Health Service on treatment, said: "Drugs have a role to play in the treatment of ADHD, but psychotherapy is central in its management. These drugs are not recommended as first-line treatments for young people with mild or moderate ADHD. They are recommended as first-line therapy for school-age children and young people with severe ADHD."

Medical guidance

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the US, listing every psychiatric disorder recognised by the country's healthcare system. A fifth edition was released in May.

The National Collaborating Centre for Mental Health in the UK has advised the medical profession not to use DSM-5. Some critics say that it medicalises normal behaviour.

Guidance in the UK says that children diagnosed with mild ADHD do not need drug treatment, but that medics should be prepared to offer parent training or psychological help if needed or if the disorder worsens.

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