ADHD drugs Prescribed Too Frequently to Kids - A Call for a Review of Prescribing in Wales from The Association of Educational Psychologists - Kate Fallon General Secretary - By Nelli Bird BBC News - April 2014 - There was a steep rise in drugs prescribed for ADHD in Wales - LISTEN TO CLIPS ON WAKE UP WALES PROGRAMME

Kate Fallon General secretary of AEP makes call for a review of practice.

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ADHD drugs review call in Wales from psychologists

By Nelli Bird BBC News

There was a steep rise in drugs prescribed for ADHD in Wales

The way drugs to treat a common childhood disorder affecting behaviour are prescribed in Wales should be reviewed, said psychologists.

There was a 57% rise in prescriptions for the most common drug to treat attention deficit hyperactivity disorder (ADHD) between 2007 and 2013.

Experts say the long-term effects of methylphenidate are unknown.

The Welsh government said drug treatment should only be by professionals with ADHD expertise.

Concerns about how ADHD is diagnosed have also been raised by the Association of Education Psychologists.

It is estimated that ADHD affects between 2 to 5% of children and young people.

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What is Ritalin

• Brand name for methylphenidate
• A stimulant that affects certain chemicals in the brain which may help to reduce some of the symptoms of attention-deficit hyperactivity disorder
• First used to treat ADHD in 1960s
• Possible side effects include loss of appetite, nausea, headaches, blurred vision

Source: BBC/NHS

Common symptoms of the disorder, which is normally diagnosed between the ages of three and seven, include inattentiveness, hyperactivity and impulsiveness.

It can be treated with therapy or medication and the most common prescribed drug is methylphenidate, also known as Ritalin.

Figures seen by BBC Wales show there are big variations in the number of prescriptions being given out across Wales.

In the Abertawe Bro Morgannwg University Health Board area - which covers Swansea, Neath Port Talbot and Bridgend - there was an 88% rise to 12,446 from 2007 to 2013.

CASE STUDY: DYLAN PIPER

Zoe Piper from Bridgend, has a 10-year-old son, Dylan, who was diagnosed at the age of six.

Before he was diagnosed he was expelled from one school after three weeks.

"He was going under the tables, apparently hitting children, he was wetting himself - he actually painted himself green one day," said his mother.

"That was five years ago and everybody still knows him as the naughty child.

"It was a really hard decision for us to put Dylan on medication but weighing it up, it was a case of we had to try the medication or he couldn't continue in the school.

"Once we put him on medication we thought it would completely change him.

"But it didn't change him, the only thing it did was dampen down the extremes of the excitability.

"He still had his little wicked sense of humour, he still had all that going for him.

"The problem was that he was getting used to a dosage so we were going up and up but obviously the higher you go, the more weight you could lose.

"Dylan did get to the point where it was quite dangerous - he lost half a stone - he's under four stone now.

"I made the decision to take him off the methylphenidate and now I've put him onto another drug."

Betsi Cadwaladr Health Board, covering north Wales, produced the most prescriptions - 21,111 in 2013 - with the number rising by 78% since 2007.

Over the last seven years, the Welsh NHS spent over £13m on prescriptions.

Kate Fallon, general secretary of the Association of Education Psychologists,

said: "We don't actually have enough research to know what are the long-term effects, particularly of the long-term usage of the drugs, and what effect that might have on these very vulnerable brains of these children if they are being given the drugs at such a young age."

Data on exactly who the prescriptions are going to and how long they have been prescribed the drug are not available.

Ms Fallon added: "You've got some very bald figures here and without knowing the ages of the children or the length of time that the children are on them, then you can't really get a proper picture to say if we tried to implement some of the sorts of programmes might we be able to bring down the use of these drugs.

"I'd be very keen to talk to the Welsh government about suggesting to them that they do look at those figures, and the Welsh government could lead the field in this, in tackling this whole issue of the diagnosis of ADHD and the prescription of drugs and perhaps show to England how it might be done."

A Welsh government spokesperson said: "Drug treatment should only be initiated by an appropriately-qualified healthcare professional with expertise in ADHD and should be based on a comprehensive assessment and diagnosis.

"Child and adolescent mental health services in Wales have strong working relationships with schools and others agencies to enable any problems to be highlighted and addressed at an early stage."

Health Board	2007	2008	2009	2010	2011	2012	2013
Figures from NHS Wales Shared Services Partnership
Abertawe Bro Morgannwg	6660	7456	8200	9201	10890	11941	12446
Aneurin Bevan	3869	4193	4422	4545	4952	5282	5157
Betsi Cadwaladr	11854	13357	14814	16162	18245	19662	21111
Cardiff and Vale	4106	3606	3947	4053	4121	4868	5673
Cwm Taf	5786	6978	7337	7773	7972	7604	7543
Hywel Dda	4701	5341	5796	6362	6402	6693	6821
Powys	1679	1670	1850	2006	2026	2077	1928
							60679 TOTAL 38655 42601 46366 50002 54608 58127 Ritalin and other psychotropic medication for children are a “quick fix” and the government should urgently review their use, psychologists have urged. The Association of Educational Psychologists (AEP) fears there is insufficient data on the effects such drugs have on child development and the functioning of the developing childrens' brain. Further research is urgently needed, it says to establish the risks. The AEP’s demand is despite the fact that a European Medicines Agency (EMA) investigation into methylphenidate drugs, which include psychotropics Ritalin, Concerta, Equasym, Medikinet and Rubifen – had previously stated that the benefits of such drugs usually outweigh any negative effects for children diagnosed with ADHD and other conduct disorders.. Plus, UK doctors have been advised by the National Institute for Health and Clinical Excellence not to prescribe methylphenidate as a first-line treatment for children diagnosed with ADHD. But the AEP – which represents UK educational psychologists – fears there will be an increase of methylphenidate prescribing because the number of official psychological disorders for children is set to increase. The American Psychiatric Association is working on its 2013 review of the Diagnostic and Statistical Manual of Mental Disorders ( i.e. DSMV) in which additional psychological disorders for children are due to be added. These include Post-traumatic Stress Disorder in Preschool Children, Temper Dysregulation Disorder with Dysphoria, Callous and Unemotional Specifier for Conduct Disorder, Non-Suicidal Self Injury, and Non-Suicidal Self Injury,Shyness and Sadness all not previously specified. “These could lead to more young people being referred for treatment with these psychotropic medications,” said Kate Fallon, AEP’s general secretary. She said: “There is a danger that we rely on the ‘quick fix’ for children with conditions such as ADHD, which frequently means the prescription of medication such as Ritalin instead of a number of other possible interventions.” Medicine regulators in European member states had in 2007 requested EMA’s mediation because of concerns over cardiovascular and cerebrovascular effects of methylphenidate – such as heart rate and blood pressure increases and sudden heart attack. A review was carried out by the EMA’s committee for medicinal products for human use. It was based on reported side effects and all studies on methylphenidate since the fifties. The committee also investigated any link between methylphenidate and psychiatric problems, reduced growth and sexual maturation. An urgent restriction to methylphenidate prescribing was not needed, the committee concluded but there were issues needing to be addressed such as more rigorously applying the NICE guidelines in the U.K. especially for stopping the prescribing to the under sixes. http://psychminded.co.uk/news/news2011/june11/Ritalin-for-children-is-quick-fix-and-should-be-reviewed-demand-educational-psychologists001.ht Association of Educational Psychologists: Support for a national review of the use of psychotropic drugs for school aged children in the UK - FULL STATEMENT: The Association of Educational Psychologists (AEP) considers that a national review into the use of psychotropic drugs, such as Ritalin, on school aged children in the UK is urgently needed. This is in agreement with the views publicly expressed by individual educational psychologists and the British Psychological Society (BPS). The AEP has significant concerns that the neurological impact of psychotropic drugs on the developing brains of children has not been fully researched. The potential damage that such drugs could cause needs further investigation. The AEP is also concerned about child treatment with psychotropics ahead of the introduction of new diagnostic criteria, DSM5, in 2013.  These criteria will result in more inclusive definitions of mental health, and could consequently lead to more young people being referred for treatment with these medications Therefore, prior to the introduction of DSM5, the AEP calls on the Government to urgently establish a national review into the standard intervention practices for children and young people considered to have issues of mental health – and further calls for this review to consider seriously the potential damage caused by psychotropics when contrasted with other available therapies.