of ADHD drugs is soaring, while concerns are escalating about damaging
side effects. Is it time that the social and family lives of ADHD-diagnosed
children are examined as much as their brains, asks Adam James
February 14, 2006
you're sceptical about the wisdom of the soaring prescription rate
of drugs for ADHD-diagnosed children, you can place some of the
blame for zealous prescribing at the hands of the National Institute
for Health And Clinical Excellence (Nice).
in 2000 the treatment advisory body gave psychiatrists and pediatricians
the green light to prescribe methylphenidate drugs such as Ritalin
and Concerta to ADHD-diagnosed children without any obligation to
reflect on how that child’s family or social environment may
underpin the child's behaviour
one hand Nice's guidelines on methylphenidate did recognise that
“a comprehensive treatment programme [for ADHD] should involve
advice and support to parents and teachers". But, on the other,
the guidelines added: "While this wider service is desirable,
any shortfall in its provision should not be used as a reason for
delaying the appropriate use of medication.”
message is clear. It's acceptable to prescribe a nine-year-old with
psychostimulant medication without needing to insist on any meaningful
support or education for the child’s family or teachers.
So, if that nine-year-old’s disadvantaged, unemployed, fraught
parents are forever at each other’s throats or the child is
getting routinely beaten up by bullies behind the school bike shed
then fear not - no intervention can, or need be, enforced in combination
with medication. Nice’s message is to home in on the child’s
brains, not, for example, the child's bullies.
the rush to prescribe ADHD-diagnosed children with methylphenidate
ADHD drugs, such as Ritalin and Concerta, is unrelenting. This month’s
Nice draft scope guidelines on how best to treat ADHD-diagnosed
children reported that the prescribing of ADHD drugs almost doubled
between 1998 and 2004. Around 420,000 prescriptions were made in
much testimony, as well as evidence, purporting to back the effectiveness
of ADHD medication. But what of the effectiveness of other interventions
for ADHD-diagnosed children whose impulsiveness, hyperactivity,
and restlessness could – as many researchers argue - be linked
to family/socio-economic factors (such as abuse or poverty) as much
as, for example, “deficient neuronal inhibition”? What
about exploring family dynamics? What about helping mum or dad control
their aggressive outbursts? What about boosting a youngster’s
self-esteem? What about stopping the youngster from getting beaten
by a drunken uncle? Such “psychosocial” or support interventions
are available. There's the Family Well-Being Project in Birmingham,
or the Parent Adviser Scheme scheme in Tower Hamlets, London, or
the Sutton Hill Families Project in Telford.
they successful? Yes, say the practitioners. But, as GP Raja Bandak
wrote in the book, Making and Breaking Children’s Lives, published
last year, no random controlled studies have evaluated family support
for ADHD children. And without such objective “evidence-base”,
will Nice ever have the justification to give family support the
same weight of importance as medication?
now, it has been families with designed-in-a-bedroom websites, such
as ritalindeath.com, which have been most energetic in trying to
warn professionals about fatal effects of, for example, Ritalin.
But the debate around ADHD drug safety heated up last week after
advisors to the US drug regulator, the Food and Drugs Administration,
recommended that “black box” warnings be issued on ADHD
drugs. Figures show that 52 people have died in the US after taking
methylphenidate or amphetamine ADHD drugs.
the meantime, nine children on methylphenidate drugs have died in
the UK, and it’s likely that the UK’s drug licensing
body, the Medicines and Healthcare Products Regulatory Agency, is
to feel pressure to examine more closely the possible damaging long
term effects of ADHD drugs. It seems puzzling that, while the MHRA
recommends against SSRI antidepressants being prescribed to under
18s, psychostimulants - with chemical properties similar to cocaine
– can be given to a five-year-old
last month began its long deliberations on drawing up clinical guidelines
for doctors and other professionals on how best to treat/support
ADHD-diagnosed children. A first meeting is to be held in March.
Will non-pharmacological interventions have a level playing field
with pharmaceutical firm backed drug treatments? For reasons outlined
above, probably not. Infact, Nice’s draft clinical guidelines
scope has already hinted at a preference to refer to the biology
– as opposed to the experience - of ADHD-diagnosed children.
The scope states that "various genetic and environmental risk
factors for ADHD have been identified” and that “hereditary
aspects, neuroimaging data and responses to pharmacotherapeutic
agents support the suggestion that ADHD has a biological component”.
Here it is again - the green light for psychostimulant prescribing
without the requirement to examine, with resource-backed commitment,
the lives of ADHD children.
Interestingly, however, Nice’s scope also states there “is
a continuing debate over the causes of ADHD”. Exactly. And,
if so, then possible abuse, bullying, or room-for-improvement parenting
underpinning the behaviour of impulsive, hyperactive, disturbed
children should surely be "treated" as much as their brains.
National Institute for Health and Clinical Excellence's draft scope
for clinical guidelines on ADHD (pdf)
National Institute for Health and Clinical Excellence's guidelines
on methylphenidate (pdf)
James is editor of psychminded.co.uk
14, 2006: ADHD drugs should carry heart attack warning, US scientists
recommend - pressure on UK drug regulator to issue similar warning
likely to mount.
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