Doctor with pills

Drugs should not be first-line treatment for ADHD, doctors told

Doctors should stop prescribing drugs such as Ritalin and Concerta as a first-line treatment for children diagnosed with ADHD, new clinical guidelines urge.

Instead parents of ADHD-diagnosed children should be first trained to help manage their child’s behaviour, say new national guidelines by the National Institute for Health and Clinical Excellence (NICE)

And drugs should not prescribed at all to pre-school children diagnosed with ADHD (attention deficit hyperactivity disorder)

ADHD is diagnosed on around 3% of young people in the UK, and about 2% of adults worldwide.

The new advice to doctors follows a surge in recent years of the prescribing of ADHD medication which almost doubled between 1998 and 2004. Around 420,000 prescriptions, mostly of Ritalin and Concerta, were made in 2004.

ADHD is a controversial diagnosis. Some practitioners argue it is not a valid medical concept, and has no established physiological cause.

The new guidelines – compiled by a selected group of psychiatrists, psychologists, carers and service users – recognise that no neurobiological, genetic or environmental measure is “sufficiently predictive” for ADHD

However, the guidelines assert that “there is evidence of genetic associations with specific genes, environmental risks and neurobiological changes”

The guidelines do advise that drugs should be the first-line treatment in children with severe ADHD. But parents should also have training on how to manage and improve their child’s behaviour. And teachers should provide behavioural interventions to help pupils with ADHD.

Drug treatment for young people with ADHD should always form part of a “comprehensive treatment plan” that includes psychological, behavioural and educational advice and interventions, say the guidelines issued last month.

Prof Philip Asherson of King’s College London, who served on the guidelines group, told that the group tried to avoid following the model of ADHD care in the United States, where medication is more widely prescribed.

He said: “We worked very hard to avoid the approach in the US, where one in 10 children are being treated with stimulants.”

Dr Sami Timimi, an NHS child and adolescent psychiatrist in Lincolnshire, does not believe ADHD is a valid diagnosis.

He said NICE had produced no evidence that the condition existed, or that medication worked, despite coming to conclusions supporting its use.

Dr Timimi said draft guidance produced by NICE cited a study that showed Ritalin improved the performance of patients after 14 months but did not consider the longer-term results of the same study, which showed that after three years it made no difference.

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