Ritalin calms hyperactive children and prescriptions are soaring – but experts warn of serious side-effects and it's even being linked to suicide
08:09 GMT, 9 May 2012
When the school holidays arrive, Andrea Antunes makes sure her son Ruben, ten, has a break — not just from classwork, but from the Ritalin pills he takes each day.
Four years ago, Ruben was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), a syndrome which causes hyperactivity, restlessness and inattention. His school told Andrea Ruben faced exclusion unless he took drugs to control his behaviour.
The drugs dull his hyperactive tendencies, but Andrea, 37, a mother of two from Norwich, dislikes them — in fact, she avoids them whenever possible.
Concern: Andrea Antunes and her son, Ruben
‘When he is off Ritalin, he will run around, ride his bike, not sit still,’ she says. ‘But he sleeps and eats better. The drugs keep him wakeful and reduce his appetite.’
Andrea’s reluctance to medicate her son’s behaviour unnecessarily seems very wise.
Figures released last week showed prescriptions of Ritalin have quadrupled in the last decade — from 158,000 in 1999 to 661,463 in 2010 — with children as young as three taking the powerful medication.
This massive growth comes despite warnings from experts that the more children take ADHD drugs, the more ‘rare’ but lethal side-effects, such as suicidal thoughts and psychosis, become common.
This human toll was starkly revealed at the inquest last year of ten-year-old Harry Hucknall, who killed himself while on a high dose of Ritalin.
The youngster, a cousin twice-removed of the singer Mick Hucknall, had ADHD. The level of Ritalin found in his system was above the normal therapeutic level and he was also on drugs for depression when he was found at his home in Dalton-in-Furness, Cumbria, in September 2010.
The West Cumbria coroner, Ian Smith, said doctors must be ‘extremely careful’ in prescribing drugs to ten-year-olds.
‘We as a society try to stop children dabbling in street drugs and yet a child with this label of ADHD is prescribed mind-altering drugs of a very powerful nature — the full consequences of which I do not believe are fully understood,’ he said.
The case echoes an earlier tragedy, in 2008, when 15-year-old Anthony Cole hanged himself in his bedroom after his Ritalin prescription was increased. The Milton Keynes schoolboy had been on the drug for six years, having been diagnosed with ADHD at the age of nine.
This week, the Association of Educational Psychologists (AEP) said that in a worrying new trend its members are seeing Ritalin dosages being increased over time.
Ritalin – also known as methylphenidate – is being increasingly prescribed to young children to tackle hyperactivity
‘The benefits of psychostimulant medication are not sustainable over the long term, necessitating stronger and stronger dosages,’ it said, adding that it was becoming, ‘common practice for children to be prescribed stronger dosages than recommended in the morning as a “kick-start” so medication lasts the school day’.
The AEP also found a substantial increase in children under six on Ritalin even though the National Institute for Health and Clinical Excellence (Nice) watchdog recommends it 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.
'Children who are anxious may misbehave and be fidgety, but those symptoms must not be mistaken for ADHD'
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 says. ‘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, says 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’
These are not the words of a lone maverick. Traxson has won the backing of the British Psychological Society (BPS) and the AEP. The AEP is now drafting a call for a nationwide government review on the issue before still more children are put on the drugs.
Peter Kinderman, a chair of the BPS, says: ‘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.’
Indeed, recent research proves that drug-free approaches can dispel the symptoms of ADHD.
A Colorado University study in 2010 showed that when 150 adolescents diagnosed with the disorder were given sessions of cognitive-behavioural therapy plus an inactive sugar pill (which they were told was a Ritalin-type drug), their symptoms disappeared just as effectively as in 150 adolescents who were given both the therapy and a chemically active Ritalin-type drug.
A similar placebo effect was seen in a study of children whose parents and teachers were told they had been put on another kind of ADHD drug, called Adderall, which in fact was a placebo pill.
So what had happened Dr Daniel Waschbusch of Florida International University, who led the research, says: ‘Thinking a child has received medication may induce positive expectations in parents and teachers.
‘In turn, this may influence how parents and teachers evaluate and behave towards the children.’
Such research indicates that a significant number of ADHD cases may be in the mind — both of young people and of their parents and teachers. The more we believe in ADHD, the more we see of it, and the more we dose children with potentially dangerous drugs without monitoring them for dangerous responses.
This latter concern is shared by Professor Peter Helms, a professor of child health at Aberdeen University, who recently published a study in the journal Drug Safety on ADHD drugs. ‘The effects on people who have been on the drugs for years is a potential problem.
‘Clinical trials give us only short-term answers, as the trials last a year at the most. We should introduce monitoring systems to check what is happening with patients.’
Indeed, one important study in 2007 found there are no benefits to giving children medication after they have been taking the drug for three years.
British GPs agree that many are left on Ritalin for more than three years, and often as many as six.
Furthermore, there is also disturbing evidence from studies on laboratory rats that giving Ritalin-type drugs to adolescents may cause them mental problems when they are adults. These may include memory damage and depression. In humans, there have been no studies to explore this, because it is illegal to test drugs on children.
Instead, something else is happening: we are effectively witnessing an uncontrolled chemical trial that involves the mass-medication of thousands of youngsters across Britain. What is even more tragic is that we are not even trying to monitor these children for early evidence of the serious problems this may cause.