Drugs to treat ADHD should be a last resort

According to new guidelines in Britain on attention deficit hyperactivity disorder (ADHD), drugs should be the last resort in treating the disorder and parents need to learn how to cope with their child's unruly behaviour.

The guidelines from the National Institute for Health and Clinical Excellence (NICE) say drugs should be avoided if possible and never given to children under the age of five.

Experts say most primary school classes have a child with ADHD and teachers too would benefit from training in how to recognise and help children with this condition.

According to Dr. Tim Kendall, a consultant psychiatrist who helped write the guidelines of the estimated 365,000 children in Britain with ADHD, most receive no treatment at all and those who do - about 37,000 - are usually prescribed stimulants such as Ritalin (methylphenidate).

Children with ADHD have extreme difficulty sitting still, learning or concentrating and at school may find it hard to keep friends. They are often the victims of bullying because of their behaviour and both teaching and caring for such children can be demanding and exhausting.

The new guidelines say parent training and education programmes should be offered as a first-line treatment for ADHD, both for pre-school and school age children, where parents learn how to create a structured home environment, encourage attentiveness and concentration and manage misbehaviour.

The guidelines say while drugs remain a first option for children over five and young people with severe ADHD, they should be part of a comprehensive treatment plan that includes psychological and behavioural interventions and include continuous monitoring and assessment.

Dr. Kendall who is joint director of the National Collaborating Centre for Mental Health says there is an over-reliance on medicines.

ADHD symptoms include being easily distracted, restlessness, difficulty remaining seated when required, difficulty awaiting turn in group situations, difficulty following instructions, difficulty playing quietly, often shifting from one incomplete activity to another, often interrupting others and often engaging in physically dangerous activities without considering the consequences.

Dr. Kendall suggests it is too easy to prescribe the drugs and often there is not a balance between the risks and benefits and because the child has what appears to be ADHD it is often easier to prescribe a drug when other options like parent training programmes are not available.

Dr. Kendall says it is important to diagnose ADHD correctly, rather than label all bad behaviour as ADHD and in genuine cases the symptoms of ADHD persist in all settings - both at school and at home - and cause real impairment.

The use of Ritalin and similar drugs is extensive and common in many developed countries and has soared in the last decade.

Some experts believe they are used indiscriminately for children diagnosed with attention deficit hyperactivity disorder (ADHD) and while they help some children they are powerful drugs which are not without serious side-effects.

Side effects can include psychosis (abnormal thinking or hallucinations), difficulty sleeping, mood swings, mood changes, nervousness, stomach aches, diarrhea, headaches, poor appetite leading to weight loss, gum and skin bleeding, dry mouth, and irritability - less common side effects include palpitations, high blood pressure, tachycardia and stunted growth.

The NICE guidelines also rule out omega 3 fish oils and say that while children need a good nutritious diet, adding special foods or avoiding others makes no difference.

Dr. Kendall says training would enable parents to understand what was ADHD and what was not, and how to "focus the child and manage the child's behaviour without getting locked into big battles".

Ritalin is a stimulant that acts on the brain in the same way as amphetamines and cocaine.