Desparate Parents, Dangerous Drugs.

April 23, 2006

DESPERATE PARENTS,DANGEROUS DRUGS Apr 20th 2006 Parents of hyperactive children face a dreadful dilemmaLIFE has just become even harder for parents of children withattention-deficit hyperactivity disorder (ADHD), a complaint that issaid to account for many children's irritable unruliness and inabilityto concentrate. Many have had their doubts about the general wisdom ofputting young children on drugs to help them focus. Now, it seems,there are specific side-effects that they should worry about.Two committees of the body that regulates drugs in America, the Foodand Drugs Administration (FDA), have recently reported adversereactions to medicines that are often used to control ADHD. The mostcommon of these drugs is Ritalin, an amphetamine-like stimulant (which,curiously, calms hyperactive people), but two others are also widelyprescribed. They sometimes have unscripted

side-effects. Up to 5% of children may suffer hallucinations from the drugs, onecommittee warned. One child reported insects crawling under her skin,while another was surrounded by imaginary cockroaches. A second FDAcommittee looked at 25 reports of sudden death from heart problems andrecommended that the drugs carry a black box warning about heart risk.The FDA is considering what other warnings should accompany the sale ofsuch drugs.Britain's Medicines and Healthcare Products Regulatory Agency (MHRA) isnow reviewing the safety of drugs prescribed in England and Wales, inpart because of the FDA reports. One of the three drugs used inBritain, Straterra, already carries a warning that it may provokesuicidal thoughts. ADHD is a hard condition to diagnose. There is no medical test for it.A list of symptoms--including inattention, impulsivity and"overactivity"--is used to define the condition. In Britain,

aspecialist must diagnose the condition and the child must show that heis unable to function properly in two different settings.Yet more and more children in developed countries are being diagnosedas having ADHD, and more are taking drugs for it. Rates are highest inthe United States, where doctors themselves seem hyperactive with theirprescription pads. Some 2.5m children and 1.5m adults there are ondrugs for the condition, compared with 750,000 in 1987. Those figuresinclude over 9% of 12-year-old boys, according to FDA data, and astaggering 17% of all white boys in the state of Virginia. In otherrich countries, between 1% and 5% of the population is reckoned tosuffer from ADHD.In Britain, too, the number of those who take drugs for ADHD is goingup. The National Institute for Clinical Excellence (NICE), whichdecides what drugs are used in England and Wales, said last month that418,300 such prescriptions

had been issued in 2004, most of themapparently to children under 16 years old. The figure had almostdoubled since 1998. Yet the chances of being prescribed drugs for ADHDdiffer widely from place to place, says Eric Taylor, of the Instituteof Psychiatry. QIS Scotland, the health watchdog north of the Tweed,has launched an inquiry into the varying rates of Ritalin prescription. Some psychiatrists argue that ADHD does not exist. They claim that drugcompanies and even doctors are pathologising normally-naughty childhoodbehaviour in order to create a market for drugs or to deal painlesslywith a potentially time-consuming condition. The main ADHD charity inBritain, ADDISS, and the leading one in America, CHADD, have bothreceived money from drug companies. This may seem fanciful. But taking drugs is not always the route tosuccess. Short-term studies find that children do concentrate better ifthey take drugs to calm

them. Yet there is no convincing evidence thatthey have better grades as they leave secondary school than ADHDchildren who do not take drugs. Many parents argue that medicine helps their child to function atschool and enjoy a more normal life. Others dislike the weight-loss andinsomnia that are commonly associated with the drugs, and would preferto find a way to manage their child's behaviour or control his diet.But mental-health services for children are overstretched. Peter Hill,a consultant child psychiatrist, says that some patients wait 18 monthsfor therapeutic help despite studies in America which show thatbehavioural therapy can work, on its own or combined with low doses ofdrugs. NICE has only just agreed to compare the benefits of behaviouraltherapy with the effects of drugs. The report is expected in 2008.Until then children have little choice but to keep popping those pills. See this

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