March 21 2011
"Naughtiness is not a disease. Drugging thousands of nursery and school aged children is barbaric."WELL SAID LIBBY!
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Where children are concerned, every era has its shame: we look back in horror at beatings, enslavement, Dickens in the bottle factory, infanticide, abandonment, gin in the milk, opium in the soothing-draught, threats of hellfire. We shudder at tight-swaddled medieval babies hung up on hooks, at the tawse and the cane, at racks and devices mistakenly thought to straighten or strengthen.
Sometimes the motive was sadistic, sometimes utilitarian — children up chimneys or at looms. But as often as not, the intention was just a wrong- headed theory about promoting their welfare — a straight back and virtuous habits. Parents and guardians preened themselves about it: one 18th-century mother wrote in her diary how her arm “did ache” from beating little Susan (and, of course, there is that legendary headmasterly inaccuracy “this is going to hurt me more than it hurts you”).
So it befits every society to wonder which of our own foibles will make future generations shudder. It is easy to look at the obvious problems: sexual exploitation, bad adoption policies, unsatisfactory schools, poverty. It is less easy to blow the whistle on well-meaning fashionable abuses. But we should blow one, loudly, at the shocking rise in the long-term drugging of children who don’t fit the system. The latest revelation is that, despite the (feeble) NHS guidelines, psycho-active drugs are being fed to children under 6.
The background is familiar. Diagnoses of ADHD — “Attention Deficit Hyperactivity Disorder” — in schoolchildren have rocketed, and with them use of the stimulant drug Ritalin, methylphenidate. It began in the US in the 1960s, and as aggressive marketing moved eastwards, prescriptions here rose from 3,500 in 1993 to 126,500 in 1998; two years ago they went over 610,000. A freedom of information request revealed that spending on ADHD drugs rose 65 per cent in the four years to 2010: more than £31 million.
It is not difficult to get a diagnosis of the “disorder” and of its sibling “ODD — Oppositional Defiant Disorder” (aka, disobedience). There is no blood test or brain scan, merely a checklist of symptoms not unfamiliar to parents: short attention span, carelessness, forgetfulness, “being unable to stick at tasks that are tedious or time consuming”, ignoring rules and instructions, unwillingness to sit still, fidgeting, impulsiveness, “interrupting conversations”, and having too little sense of danger. Boys are diagnosed most, but the NHS website suggests they’re closing in on girls too, with “the mainly inattentive form of the condition, which may make them quiet and dreamy”. Don’t look out of the window or doodle hearts, Suzie, or they’ll get you with the chemical cosh.
Unease is expressed repeatedly — without much result — about the way we have become complacent and complicit in keeping tens of thousands of children on psychotropic drugs for more than a decade of delicate brain development. The long-term risks are unknown, yet medication is sometimes made a condition of continued education by schools unable to cope with a child’s behaviour. You need not listen for long before getting bat-squeaks of evidence that adult convenience is as much involved as the alleviation of childhood suffering.
One academic at the Centre for Paediatric Pharmacy Research, Professor Ian Wong, defending the drug, observed chillingly: “it can make a real difference not just to the child but to households and classrooms where children may be causing real disruption”.
Indeed. The modern classroom is not an ideal environment for active boys in particular. It can be plodding and prescriptive, with little chance to run off steam (my own small son, quiet and concentrated though he was, nonetheless did an immense amount of apparently pointless running up and down; he said it helped him to think).
The modern home is awkward, too: overstretched parents, enslaved to immense mortgages and afraid to let a child run free in open spaces (if any), have an understandably short fuse. One mother, interviewed about her four-year-old’s ADHD, said that he kept jumping up and down and asking questions without waiting for the answer before the next one. Yes, he’s 4. It’s what they do.
While it is known that other measures reduce the symptoms — less television, more exercise, better food, calm bedtime routines, family therapy — they are not always tried first. I once asked a professional advocate of Ritalin how long one should try other things first , and she snapped, “the condition is so distressing that medication should be immediate”.
Now the National Institute for Health and Clinical Excellence (NICE) and a spokesman for the British Psychological Sociey have expressed concern openly. Not at the diagnosis (amazingly, NICE thinks that up to 9 per cent of children have ADHD) or even at the drug . They are worried more that it is creeping down the age scale. Professor Tim Kendall, who chaired the NICE guideline committee, cites “reliable reports of children in nursery being medicated”. He went on to say that: “There are two reasons why parents go shopping for a diagnosis. The first is to improve their child’s performance at school, and the second is to get access to benefits.” It’s a disability, see? One case confirmed is of a five-year-old in the West Midlands on a double dose, though his headteacher reckons he’s fine and the medication is “to help Mum at home”.
OK. There probably is a rare neurological disorder describable as ADHD. There probably is a use for drugs that quieten very extreme children and make them more orderly. But look at the figures, look at the anecdotes, consider the unknown risks of prolonged medication, and reflect how a historical pattern repeats itself: social control, homogenisation enforced by rigid societies impatient at the exuberance of children.
Consider, too, how over-reliant we adults are on mind-meds. I have a friend who, having come off it, “cannot believe” that he spent 17 years on Prozac. As I typed that, into my inbox dropped an American campaign group article saying: “The most influential leaders and academics in psychiatry have been shown to be agents for the drug industry, disregarding psychotropic drugs’ documented, severe, debilitating harmful effects for patients. The American Psychiatric Association itself acknowledged ... that over one third of its funding came from the drug industry.”
I suppose it’s our lookout if, as adults, we take pills because our lives are complicated. But small children, who can’t even read the label yet?
How is that fair?
Libby Purves -
Opinion The Times
March 21st 2011.
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