GUARDIAN ARTICLE "Ritalin - wonder drug or unethical 'monster' creator?" - 31 - 10 - 00

Ritalin - wonder drug or 'monster' creator?

http://www.guardian.co.uk/world/2000/oct/31/qanda?INTCMP=SRCH 
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A government drug watchdog responded today to fears over the use of the drug Ritalin, used to calm hyperactive children. For some, it's a wonder drug whilst others have claimed it has turned children into "monsters" or "zombies". Mark Oliver examines today's move.

• guardian.co.uk, Tuesday 31 October 2000 14.50 GMT

What is Ritalin used to treat?
Attention deficit hyperactive disorder (ADHD), which causes severe impulsive, restless and inattentive behaviour and can make children aggressive and disturbed. Young sufferers often fail at school and are even suspended or expelled because of their uncontrollable actions. Around 3% of the population, mainly children, have ADHD or attention deficit disorder (ADD). The incidence of cases has increased threefold between 1991 and 1995, with the trend still rising.
 
What is Ritalin?
Ritalin is a stimulant, chemically similar to cocaine or amphetamines like speed but, surprisingly, works by actually calming sufferers down. It is a class B drug and its chemical name is methylphenidate hydrochloride.

How widely is Ritalin used?
Last year, 157,000 prescriptions were written for Ritalin, mainly for children. It has been around for 50 years but its use rose dramatically during the nineties with prescriptions doubling every year until 1999. Prescriptions have levelled off but are still rising overall.

Does Ritalin work?
Some parents say their children's lives have been transformed for the better by the drug. However, others claim that Ritalin has turned their youngsters into "monsters" or "zombies", claiming it is used like "a chemical cosh" to make hyperactive children docile, leaving them staring into space and dreamy. Parents in the US are taking legal action against Ritalin manufacturers, Novartis Pharmaceuticals, alleging that the company failed to warn about its possible impact on children's cardiovascular and nervous systems. Here, there have also been allegations of over-prescription of Ritalin, with huge increases in the number of children diagnosed with ADHD and put on psychoactive drugs. Campaigners are concerned that the UK is going the way of the US, where four million children are taking Ritalin. There are claims that some UK doctors are now dishing the pills out "like smarties". The US author, Elizabeth Wurtzel, who wrote Prozac Nation, told earlier this year how she became addicted to Ritalin, chopping up and snorting up to 40 tablets a day.

What are the government doing?
The NHS's "best practice" watchdog is to issue guidelines advising caution on its use for very young children. There are concerns that the use of the medication can mask emotional or other causes of troubled behaviour. Psychiatrists have warned that toddler tantrums, for example, may be confused with more serious disorders. The National Institute for Clinical Excellence (Nice) was setting out advice today on who should be prescribed the drug. Nice is expected to recommend that Ritalin should not be given to under-fives. Although older children may continue to receive it, there will be clearer definitions of the conditions for which it can be beneficial as part of a specialist treatment programme. The move is a bid to end the "postcode lottery" where patients in some parts of the country have access to the drug and others are denied it. The body is also expected to give a clearer definition of exactly who can benefit from it. Ministers, manufacturers and patients have had a few weeks to challenge the findings before today. The guidelines will cover England and Wales.

Will everyone welcome this development?
No. Gill Mead, of ADHD Support for Families, said parents of younger children would be "disappointed" if they were refused medication. She said: "Most parents start coming to us when their children first enter social situations - nursery school. The touch-paper is ignited, the minute you put them into situations that trigger anxiety. "Some parents are very anti-medication. I can recall a sad case of two head teachers with a son diagnosed with ADHD. They said, 'We don't need medication and we don't need to pump our son full of drugs' - they came back to me and said they wished they had tried drug treatment because he is now up for grievous bodily harm." Ms Mead firmly believes that Ritalin works, "not only for the child but for the parents, who are given enough of a breathing space from troubled behaviour to assist the family to maintain the love for that child".

What do supporters of the drug say?
Caroline Hensby, a mother-of-three from Thanet, Kent, has a teenage son with ADHD and last year she was diagnosed with ADD at the age of 37. She believes Ritalin has helped both her and her son Richard. She said: "There have been a lot of scare stories about Ritalin but it has helped thousands and thousands of children and adults. I used to lose my temper and just explode. "Now I can recognise a situation where that might happen, focus and stop myself from exploding. It means children who were failing at school can actually sit and learn and do well."

Are there any alternatives?
There are but these are also controversial. In the US, the family of a man who shot dead his baby daughter and tried to kill himself is suing a British drug company which produced the ADHD drug Adderall. Ryan Ehlis, 26, from North Dakota, in the US, was acquitted of the murder of his five-week-old daughter Tyra. The case was dismissed after psychiatrists for the prosecution and defence agreed that the prescription medicine he was taking for was responsible for the tragedy by inducing in him a temporary psychosis. Adderall is the main rival to Ritalin in the US, where it had captured 28% of the market by the end of last year. A spokeswoman for Shire Pharmaceuticals said: "The safety profile for Adderall is extremely good. Out of 10m prescriptions to date, there have been only 14 incidents of psychosis and they were very mild. This is the only one that was serious." Novartis say its drug is a mild stimulant with no association to violent behaviour. "But some children, and probably some adults, with ADHD suffer from other conditions which may make their management more complex," it said in a statement.

Useful links
Ritalin made my son a demon - Observer
Natural alternative to Ritalin
Ritalin for other problems
Keyplayer - Novartis