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Friday 25 March 2011

Sydney Morning Herald - 17-02-11 - Sedation the cost of taking the boisterous out of boys.

Elizabeth Farrelly journalist.


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I have an acquaintance who, apart from being a practising professional, successful academic and author of several important books, is a pianist capable of rendering entire Bach cantatas as casually as you or I might plunk out Chopsticks. He also has seven equally accomplished children, an undisclosed number of complex relationships, a flourishing side-career as a magician and a personal presence so intensively entertaining that catching up once every few years is enough.

These days, I imagine, he would be diagnosed with ADHD and medicated into normalcy. And it's this that makes me wonder. Assuredly there are those who benefit from Ritalin, but a fourfold increase in seven years? And five times as many boys as girls, almost all of them pubescent? Surely this should give us pause for thought.

The Ritalin wars are usually treated as just another tussle between the pharmaceutical companies and the rest, but is there something else going on here as well? Is it part of a more generalised, covert war on boyhood?
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Thirty years ago Australian primary schools employed five male teachers for every four females. By 2006 there was one male teacher for every four females. This overwhelming feminisation of primary education, and of culture generally, has made boy-type behaviour stuff to frown upon. Are we in danger of seeing boyhood itself as a disorder?

When Christopher Lane, author of Shyness: How Normal Behaviour Became a Sickness, quoted a psychoanalyst saying "We used to have a word for sufferers of ADHD; we called them boys", he probably did not expect it to become the most famous line of his book.

Lane's point was more general, about how personality traits that were once tolerated and even celebrated are now treated as disorders.

What was once introversion is now "avoidant personality disorder", nervousness is "social anxiety disorder" (SAD) or dating anxiety disorder (DAD) and so on. It's not that these disorders don't exist, says Lane, a Guggenheim fellow studying the ethics of psychopharmacology, but that our definitions are so broad that the entire mysterious subconscious is reduced to chemical balance, and any deviation looks like disease.

Why, he asks, is ADHD so commonly diagnosed in boys? Is it new behaviour? Or just a new attitude to that behaviour?

A report last year by Dr James Scott and others in the Australian and New Zealand Journal of Psychiatry suggests the latter. Ritalin prescriptions have quadrupled in seven years, which might be explained by the drug being covered by a government subsidy were not the same thing happening overseas.

There's also this: although, in Australia as elsewhere, the male-to-female ADHD ratio is 2.45:1, Ritalin rates are 5:1. Diagnosis is more than twice as likely in boys, and medication more than twice as likely again.

So the argument is not just about medication or even deviation. It's also about gender. And as the hetero heart-throb morphs from John Wayne into Justin Bieber, it is worth wondering whether our behavioural expectations show a similar shift.

Consider the following story. There is an opportunity class in a public school that prides itself on nurturing the gifted, and displays the usual oestrogen-heavy teacher ranks. In the class is a boy - not mine - who is 10 years old. Let's call him Jack. Opportunity classes are known to collect excitable kids, and Jack, even by opportunity class standards, is unusually clever; bright, funny, literary, sporty and artistic but also intensely emotional.

The school is so highly regarded that its roll swells and swells. With the extra classrooms and then, to top it off, one of Julia Gillard's enormous new school halls, the playground becomes so reduced that lunchtime ball games are banned. Instead, crowded in, the kids play tip.

So when the fight comes it should be no surprise. The only surprise is no one is hurt. Sure, one boy is kicked and another kneeled on, but there is no real damage, no blood. Yet a complaint is made and all hell breaks loose. Violence? In our school? OMG.

There is no physical punishment, heaven forbid. But the substitute, from boy-perspective, is far worse. It's talk. Regulation department-issue talk, certainly, but it spreads what might have been an afternoon's pain (and pride) into half a dozen sessions across a week or more.

With various combinations of parents, teachers and child witnesses, Jack endures a heaping-on of emotional pressure, with dark mutterings about Matthew Newton, the actor accused of assaulting his partner, and recommendations of psychological therapy.

Now, I have nothing against talk, or talk therapy. In fact, being female, I like it. But talk is girl stuff. Not only are Jack's parents made to feel they have a psychopath in their bosom, when it is really just a boy thing and small beer by Tom Sawyer standards, they also come away feeling primary schools in general "expect boys to act like girls".

Jack has now moved on to an all-boy high school where his tutors say he is a pleasure to teach and they wish there were more like him.

Although there is no suggestion that Jack has ADHD, the attitudes are similar, and disturbing. ADHD, Dr Scott says, is characterised by "immaturity of the frontal lobes" the brain site for planning and organisation. This is why Ritalin, a stimulant, is prescribed for hyperactivity; it stimulates the control centres. It's also why most ADHD sufferers eventually grow out of it.

But why the gender imbalance, and why now? We know that boys tend to be late maturers anyway, but Scott concedes there are also social and perceptual factors at play. Teachers with "less structured" teaching style and "more distracting" classroom environments, he says, yield many more of his clients than their more disciplined (my word) colleagues.

Whereas ADHD girls "sit quietly in a corner", the boys are more disruptive and more noticed, more referred, more medicated. And although much the same is true of ''normal'' boys and girls, the upshot is that ''girl'' is a norm to which boys are expected to strive. Scott sees it as "an unintended consequence of how society operates".

But consequences this important should be either clearly intentional, if girlifying boys is really what we want, or remedied. Personally, I reckon the crazily creative are types we'll need more of, rather than fewer of, in the future, even if they are male.

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Guardian article: 30 -10 - 09 :'Tories slam doctors for drugging children.' October 2009.

Tories slam doctors for drugging children


Press link or title for more information and BBC Radio programmes on topic.

• Conservatives used FoI act to obtain data from NHS
• Prescriptions issued to 16-18 year olds up by 51% since 2005
    * guardian.co.uk, Friday 30 October 2009   

The number of prescriptions issued to children for anti-depressants, anti-psychotic drugs and attention deficit disorder medication has rocketed, according to figures released today.

The increasing use of drugs to treat mental health problems in youngsters is condemned by the Conservative Party which obtained the statistics from the NHS Prescription Pricing Authority.

Following a series of Freedom of Information requests, the authority revealed that more than 420,000 prescriptions of ADHD (Attention Deficit Hyperactivity Disorder) drugs were issued to children under 16 in 2007 – a rise of 33 per cent over the previous two years.

For those aged between 16 and 18, more than 40,000 prescriptions were issued – an increase of 51% compared to 2005. The NHS spent over £17m on ADHD drugs in 2007.

The number of prescriptions is not the same as the number of patients since some children may receive repeat or multiple prescriptions. The increase nonetheless suggests doctors are frequently resorting to pharmaceutical remedies rather than talking therapies.

Around 113,000 prescriptions for antidepressants were issued to children under 16 in 2007 and almost 108,000 to 16 to 18 year-olds, according to the same series of FoI requests. For children under 16, that respresented a 6% increase over two years. The NHS spent around £1.5m on anti-depressant drugs for children in 2007.

For anti-psychotics, in excess of 86,000 prescriptions were issued to children under 18 in 2007. The number given to 16 to 18 year-olds was up 7% since 2005 and the number handed out to under 16s rose by 11%. The NHS spent almost £3.5m on anti-psychotic drugs for children in 2007.

The Conservative health spokeswoman, Anne Milton, said: "We already know that our children suffer the lowest levels of well-being in Europe. This data shows that increasingly health professionals are prescribing drugs to treat child mental health problems, when evidence suggests that talking therapies can have an equal, if not better effect.

"These drugs have significant risks when given to children and young people, making this rise extremely concerning." Some drugs prescribed for mental health conditions have been associated with potentially dangerous side-effects in children, the Conservatives said. In one US study children reported experiencing hallucinations after taking ADHD drugs.

The Prescription Pricing Authority, which has itself since been subsumed into the NHS Business Services Authority, stopped collecting the data in late 2007 and said that it could no longer provide reliable estimates.

Earlier this year the British Medical Journal estimated that up to 5% of school age children in England and Wales have ADHD - as many as 367,000 children.

Responding to the figures a department of health spokesperson said: "NICE guidance is clear that antidepressants should rarely be prescribed to children and young people and only as part of a treatment regime, stressing that other treatment options should be considered first."

In terms of ADHD medication, the spokesperson added: "Treatment with prescribed drugs should only be started after a specialist in ADHD has thoroughly assessed the child or adolescent and confirmed the diagnosis. Once treatment has been started it should be monitored by a GP. Drug therapy should be one part of a comprehensive treatment programme that includes advice and support to parents and teachers."

Thursday 24 March 2011

Guardian Article 18-03-11,"Inquiry urged over 'Quick Fix' behaviour drugs at four.

Some young people claim medication affects their personality but it helps to "get their parents off their case."


For more information and BBC radio programmes e.g. Womans' Hour discussion, press the link or title.
Behaviour drugs given to four-year-olds prompt calls for inquiry

ADHD medication given in breach of NHS guidelines as professor says parents putting pressure on GP

    * Rowenna Davis
    * guardian.co.uk, Friday 18 March 2011 21.08 GMT


Children as young as four are being given Ritalin-style medication for behavioural problems in breach of NHS guidelines, the Guardian has discovered, prompting the leading psychological society to call for a national review.

Family-based therapy is recommended for treating children with ADHD (attention deficit hyperactivity disorder), with prescription drugs used only for children over six years old and as a last resort.

The figures, based on data from 479 GPs, show prescription rates were highest for children aged six to 12, doubling to just over eight per 1,000 in the five years up to 2008. Children aged 13 to 17 had the second highest rate at six per 1,000, while those aged 25 and over had less than one per 1,000.

Concern is greatest over children under six who should not be receiving drugs at all, says the National Institute for Health and Clinical Excellence (NICE).

There are no reliable figures for how many children under six have been given Ritalin. But Professor Tim Kendall, joint director of the National Collaborating Centre for Mental Health, who chaired the NICE guideline committee, confirmed that he had heard reliable reports of children in nursery and pre-school being prescribed medication unnecessarily, and that it was often parents who were putting pressure on GPs.

He said: "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. There are always GPs that will do it, but it's wrong to give a child a diagnosis without also consulting schools and teachers."

In one case seen by the Guardian, a five-year-old from the West Midlands was found to be receiving a double dose of methylphenidate, commonly known by the brand name Ritalin, the drug used to treat ADHD, despite his school insisting that he is "among the best-behaved children in his class".

In notes seen by the leading educational psychologist in the case, the boy's headteacher reports that the school does not believe he has ADHD, but that the medication is being prescribed "to help mum at home".

In another case in the West Midlands a five-year-old was put on the drugs for three years at the request of his parents without any consultation with teachers or psychologists.

Kendall said prescriptions could continue to rise due to impending health cuts. "It's a false economy … all the evidence says that parent training courses combined with partnership working with schools is what works, but these programmes are being cut by local councils."

Speaking on behalf of the British Psychological Society, Peter Kinderman, chair of the division of clinical psychology, said he supported calls for a review, saying he would be concerned if children were being prescribed medication as a quick fix.

He added that mental health services were already "grossly under-resourced" and that cuts were likely to put services to children at risk.

Kinderman expressed particular worries about the cases uncovered by the Guardian. "Many psychologists are very concerned at the use of psychiatric and medical diagnoses in cases such as mild social anxiety or shyness, not only because of doubts about the validity of many of the diagnostic approaches, but because of the possible adverse effects."

But Dinah Jayson, consultant child and adolescent psychiatrist at Trafford general hospital and a spokesperson for the Royal College of Psychiatrists, insisted that in some cases it could be "cruel" not to treat children of any age if all other options had been exhausted.

She said: "With every child there is a risk of doing something but there is also a risk of doing nothing. We know early [medical] intervention can help children who would otherwise be losing out."

Professor Ian Wong, director at the Centre for Paediatric and Pharmacy Research, who led the prescriptions research, pointed out that prescription rates were still below the expected number of diagnoses for hyper-kinetic disorders.

"GPs and psychiatrists are much more aware of mental illness, and the drugs are so effective and have such a big effect that it's tipped the balance. They [drugs] can make a real difference not just to the child but to households and classrooms where children may be causing real disruption."

According to NICE guidelines, between 1% and 9% of young people in the UK now have some form of ADHD, depending on the criteria used. NHS figures show a rise in all methylphenidate prescriptions across all age groups by almost 60% in five years, rising from 389,200 in 2005 to 610,200 in 2009.

Side-effects include sleeplessness, appetite loss and reduced growth rates. Wong, who says the long-term effects are inconclusive, recently received a €3m (£2.6m) grant from the European commission to investigate side-effects further.

Professor Paul Cooper, a psychologist and professor of education based at Leicester University, who has completed qualitative research with adolescents on psychostimulant medication, expressed concerns about the possible effects of the drugs on personality development.

"Some young people say that it affects their personality but accept it because it gets mum and dad off their case or stops them getting into trouble," he said. "They don't like it, but take it for the benefit of other people."

Medical experts in the West Midlands say over-prescription continues to be a problem. "This whole area needs public scrutiny – there has to be some kind of review," said the educational psychologist who oversaw the cases but did not want to be named. "Handing out strong psychotropic drugs to children should be a last resort, but they're being handed out like sweets."

Monday 14 March 2011


Yoga is a proven alternative to medication for kids.

Click on link or title to see video with alternatives menu +BBC Radio 5 'Investigates' programme as commentary,
over 100 slides on alternative strategies to avoid reliance on medication.