The numbers of children in the UK being prescribed the ADHD drug Ritalin should be stepped up, rather than reduced, according to a major new study.
Approximately 5% of the child population (or one child in every classroom) have Attention Deficit Hyperactivity Disorder, but only 10% of those 300,000 children are receiving medical treatment, while others fall below the diagnostic radar.
“ADHD is under recognised and under diagnosed,” says David Coghill, professor of child and adolescent psychiatry at the Royal Children’s Hospital in Melbourne. “And if you don’t recognise and diagnose someone you don’t have the option of what treatment they receive.”
ADHD is a brain disorder, which affects both children and adults, and is characterised by hyperactivity, impulsivity, and an inability to maintain attention.
Children with the disorder are far more likely than average to suffer accidents, and adults are at greater risk from traffic accidents either as pedestrians or motorists. Crime rates are also unusually high among those with ADHD.
Contrary to popular belief, the cause of the condition is under-activity in the brain, rather than excess activity, and drugs (such as Ritalin) used to treat the condition, are stimulants, not sedatives.
The research team were keen to dispel the common belief that ADHD drugs such as Ritalin, or methylphenidate, are a form of “chemical cosh” and children are better off with less treatment.
Although Ritalin is already recommended as a first line treatment for children with ADHD by the National Institute for Health and Care Excellence, which vets the cost effectiveness of treatments in England and Wales, it is underused, they said.
“Clinicians are very cautious about using medication in this country,” said Professor Emily Sminoff, co-author of the paper from King’s College London. “The problem in the UK is predominantly about under-recognition and diagnosis across a range of conditions. As a result there are a number of children suffering with a range of mental health disorders who could benefit from treatment.”
The trial looked at the data of 24,000 patients, including 14,000 children, across four years, studying the treatment they were receiving for their ADHD and the outcomes. The authors concluded Ritalin remained the best medical option for children with ADHD. And in adults, amphetamines were most effective.
Professor Coghill also wanted to emphasise that children with ADHD aren’t simply displaying ‘bad’ behaviour: “We now have very clear evidence that the brains of children with ADHD both structurally and functionally are very different.
“The medication treatments are very effective at improving those functional deficits as well as reducing the core symptoms.”
What are the signs my child may have ADHD?
“Children who display signs of ADHD will have a number of indicators as they are growing up,” explained Dr Tony Lloyd, CEO of the ADHD Foundation.
“Frustration at not being able to remember what they are learning in school and in life; they can be quick to anger and display an overly impulsive behaviour.
“There are also children who retreat into day dreaming and have poor concentration - homework can be a major cause for distress at home.
“Sometimes but not always a hyperactivity and poor sleep patterns can add to stress.”
The diagnosis process can be slow and complicated - a report organised by ADHD charities and experts found that nearly a third of children with the disorder had waited for two or more years to receive a diagnosis.
Dr Lloyd, who worked on the report, said: “Ignoring ADHD is a potential time bomb for these children, placing them at risk of severe problems that may well burden them for their entire lives.
“Early diagnosis and treatment is proven to reduce anxiety and the risk of depression and other mental health problems later in childhood.
“Treatment will also improve your child’s experience of school and they will more likely achieve their potential.”