According to latest figures prescriptions for Ritalin for attention deficit hyperactivity disorder (ADHD) have quadrupled in a decade. This has raised concerns that it is being given to children at the expense of alternative treatments and without appreciation of long-term effects.
The NHS business services authority released the statistics to the Liberal Democrat MP Tessa Munt. The figures show that the number of prescriptions of methylphenidate hydrochloride, the generic name for Ritalin, rose in England from 158,000 in 1999 to 661,463 in 2010. Ritalin is a psychostimulant drug most commonly approved for treatment of ADHD in children. It is also used to treat conditions such as narcolepsy and in certain cases may also be prescribed for lethargy, depression and obesity.
The Association of Educational Psychologists said its members were reporting an increase in children with behavioural difficulties being prescribed the drug in conjunction with antidepressants, despite the fact there was, “little to no evidence about the effect which these cocktails of drugs are having on the development of children's brains”.
According to the association, clinical studies show the “beneficial effects of psychostimulant medication are not sustained over the long term, necessitating stronger and stronger dosages to be prescribed over time”. They also said that it is “becoming a common practice for children to be prescribed stronger dosages than recommended in the morning as a 'top-up' or 'kickstart' dose so that medication lasts the full school day”.
The Association of Educational Psychologists said it believed guidelines were not being followed. The guidelines recommend that ADHD medication should not be prescribed to pre-school children for the long term, or in isolation from other therapeutic interventions, without consultation.
Munt said there were natural alternatives that could help combat ADHD. She highlighted a report commissioned by the Royal Society for the Protection of Birds (RSPB) that suggested activities in a natural environment appear to improve children's symptoms by 30% compared with urban outdoor activities, and threefold compared to playing indoors. But Munt added that many young people were prevented from enjoying the outdoors because of reasons such as lack of school playing fields and the distractions posed by video games, smartphones and social networking.
“It is extremely alarming that in the decade up to 2010, prescriptions for Ritalin quadrupled,” she said. “Statistics show that 90% of prescriptions for this powerful drug in 2004 were used to combat behavioural problems in school-age children. I am shocked that there has been such a huge explosion in use.”
ADHD is believed to affect between 5% and 10% of schoolchildren in the UK. Symptoms include overactive and impulsive behaviour and difficulty paying attention. The increase in Ritalin prescriptions appears to mirror the US where there was an 83% increase in sales of the drug between 2006 and 2010.
Munt said, “Unless the Department of Health collects vital statistical data about prescribing habits, no one will know what is happening. We hear teachers tell of their students' lack of ability to concentrate, from police about increasingly disruptive and antisocial behaviour, and from parents unable to control the actions of young family members. We need to show young people how to deal with the normal stresses and strains of growing up. Resorting to powerful drugs only stores up trouble for the future.”
The AEP said an informal survey of educational psychology practitioners across the West Midlands had revealed there were more than 100 children under six on the medication in the area. “This is reaffirmed across the country by our members,” the association said. This is even though the National Institute for Health and Clinical Excellence (NICE) recommends Ritalin is not prescribed to pre-school children.
Children on ADHD medication can be exposed to serious risks. Suicidal thoughts are among a battery of known side-effects of Ritalin-type drugs. Others include stress and anxiety, cardiovascular complaints, decreased appetite, stomach problems, dizziness, tics, skin problems and bruising.
In 2009, the EU regulator, the European Medicines Agency, said all patients should be monitored for psychiatric symptoms during treatment. The agency added that, given the lack of information on the long-term effects of Ritalin, children should have treatment stopped once yearly to see if it is still needed. But experts say the rules are being widely ignored, often because healthcare professionals’ workloads are already too heavy to take on the job of monitoring children regularly.
Dave Traxson, an educational psychologist who works across schools in the West Midlands, adds that psychiatrists are also flouting NICE guidelines, which stress that children who show evidence of anxiety should not be put on Ritalin-type stimulant drugs. “Children who are anxious may misbehave and be fidgety, but those symptoms must not be mistaken for ADHD,” he said. “The last thing you want if you are feeling anxious is to take a stimulant drug.”
The guidelines also advise that children on these drugs be weighed every six months, as the medication can severely shrink their appetites. But, said Traxson, “This rule is being breached all over the country. One group of psychiatrists told me point-blank that they do not have the staff to do this. If they haven’t the resources to do the thing safely, should they be doing it at all?”
Peter Kinderman, a chair of the British Psychological Society (BPS) said, “Children are being prescribed medication as a quick-fix rather than being given full assessments and psychological therapies, which may take longer and cost more but ultimately are better in the long run.”