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Wednesday, 29 June 2011

THE ASSOCIATION OF EDUCATIONAL PSYCHOLOGISTS (AEP) CHALLENGES WIDESPREAD USE OF PSYCHOTROPIC DRUGS FOR CHILDREN WITH BEHAVIOURAL DIFFICULTIES + FULL AEP STATEMENT

http:www.channel4.com/news/adhd-drugs-prescribed-to-under-6s-against-guidelines


CLICK ON LINK ABOVE TO WATCH CHANNEL 4 "SPECIAL REPORT" WHERE THE AEP STATEMENT IS RELEASED

Coutesy of: Psychminded.co.uk By Angela Hussain June 15, 2011

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.

Thursday, 23 June 2011

BBC RADIO 4 - WOMANS' HOUR PROGRAMMES - 17TH JUNE 2011 - DIAGNOSIS AND MISDIAGNOSIS OF ADHD- EMINENT PSYCHIATRISTS,PROF SAMI TIMIMI AND DR TIM KENDALL(RCP) DEBATE THIS KEY ISSUE AND THE 11TH FEBRUARY 2011 - THE RAPID RISE IN PRESCRIPTIONS FOR ADHD IN THE LAST TEN YEARS.




The Diagnosis of ADHD- JUNE 17TH 2011

TO LISTEN TO PROGRAMME CLICK ON TITLE AND GO TO "WOMANS' HOUR"OR LINK :


http://www.bbc.co.uk/iplayer/console/b011vhsj 

OR 'GOOGLE' BBC RADIO 4 WOMANS' HOUR PODCASTS -17TH JUNE 2011

The use of Ritalin to treat children with ADHD (Attention Deficit Hyperactivity Disorder) has been the subject of intense debate recently. Prescriptions for Ritalin have increased from 389,000 in 2005 to 661,000 in 2010. According to NICE Guidelines medication should only be prescribed in cases of ‘severe’ ADHD. We discuss what behaviours children have to show to give them a diagnosis of ADHD. Is it time to review the NICE Guidelines? 


To discuss the issues Jenni is joined by Dr Sami Timimi, Consultant Child and Adolescent Psychiatrist in the Lincolnshire NHS and Dr Tim Kendall, Adult Psychiatrist and spokesperson from the Royal College of Psychiatrists.

EXPONENTIAL GROWTH OF ADHD DIAGNOSIS + PRESCRIPTIONS RATE.

DAVE TRAXSON DEBATING WITH DR TIM KENDALL REPRESENTING THE ROYAL COLLEGE OF PSYCHIATRISTS on 11th February 2011 click below:
http://www.bbc.co.uk/iplayer/console/b00y8vb2



Tuesday, 21 June 2011

THE SCOTTISH SUN +THE SUNDAY MERCURY - WEST MIDLANDS CHILDREN THREE TO SIX ON PSYCHOTROPIC DRUGS BREACHING NICE GUIDELINES


West Midlands kids aged three and upwards put on mind-bending drugs that could cause long term harm.

Jun 21 2011 by Ben Goldby, Sunday Mercury




EXPERTS have warned that kids as young as three years of age are being given mind-altering drugs to tackle behavioural problems.

Toddlers are being prescribed drugs to tackle conditions like Attention Deficit Hyperactivity Disorder (ADHD), and academics fear naughtiness is being misdiagnosed as a serious medical condition due to socioetal pressures.

Child psychologist David Traxson, who has more than 30 years’ experience in the field, claims at least 100 children aged three, four and five-year-old in the West Midlands are on drugs like Ritalin.




“These young children are taking powerful, potentially addictive drugs and no-one knows what will happen to their brains in the future,” he warned.




“Doctors seem to be trying to shift more and more children into clinical treatment and this is very dangerous.DSM5 will broaden these criteria even further in 2013.”

Educational psychology expert Sue Morris, from the University of Birmingham, says huge advances have been made in diagnosing mental health issues among kids, but she fears drugs are being given to children who are too young and being used as the first response rather than the last port of call as NICE recommends.




“It’s not uncommon for the diagnosis of ADHD to be made based on parental reports – without observation of the child in a home and school environment,” she said.

“The prescription of drugs certainly shouldn’t be the first step in treating the disorder.


DANGER - BLACK BOX WARNING ISSUED AT HIGHEST LEVEL IN U.S. DUE TO SUDDEN CHILD DEATHS.


“Sometimes drugs are being used in the absence of talking, of therapy and psychological assistance, and that is wrong.

“The prescription of drugs like Ritalin to the under-fives is against the guidelines set down by the National Institute of Clinical Excellence (NICE).




“I’ve encountered cases were under-fives have been prescribed medication to deal with ADHD. That shouldn’t be happening.

“It’s a difficult disease to diagnose in young children.

“Any medication that affects developing brains carries inherent risks, and handing out drugs to children who are below the age of six, as set out in the guidelines, is dangerous.”



Around 660,000 prescriptions for Ritalin are dished out annually in Britain to treat childhood ADHD.




Ritalin is banned for recreational use in the UK and side-effects can include stunted growth, heart problems, depression and insomnia.

According to NHS figures, the number of children aged eight to 13 on drugs such as Ritalin has undergone a sevenfold increase from the 92,700 kids put on similar drugs in 1997. One family in the West Midlands has two children on medication for ADHD.

They receive £600 a month in disability allowances for each of the two children diagnosed.




Ms Morris believes cash can be a factor in a family seeking an ADHD diagnosis.

“Sometimes, financial factors play a part,” she said. “The disabled living allowance gives an incentive to some famies who want a diagnosis so they can receive increased benefits.”




Last week the father of 10-year-old Harry Hucknall, from Cumbria, who hung himself last September, revealed he had made a formal complaint to the NHS.

He blames Harry’s death on drugs prescribed for his boisterous behaviour. An inquest in April ruled out a deliberate suicide, but said the influence of Ritalin and Prozac could not be excluded as a factor

THE SCOTTISH SUN - CHILDREN AS YOUNG AS THREE ON PSYCHOTROPIC MEDICATION

Kids of three in ‘danger’ drug alert



Published: 20 Jun 2011: SCOTTISH SUN

PROBLEM children as young as THREE are being prescribed mind-altering drugs, experts have warned.

Some of the youngsters are simply naughty and don't even need medical treatment.




Child psychologist David Traxson said at least 100 children aged three to five in the West Midlands are on drugs like Ritalin - used to treat attention deficit hyperactivity disorder.

He said: "They are taking potentially addictive drugs and no one knows what will happen to their brains in future."

University of Birmingham expert Sue Morris said: "Sometimes drugs are used rather than therapy and that is wrong."

About 660,000 Ritalin prescriptions are dished out annually for childhood ADHD - a sevenfold rise since 1997.

The drug can stunt growth and cause heart problems and depression.

Read more: http://www.thescottishsun.co.uk/scotsol/homepage/news/3647032/Problem-children-as-young-as-THREE-are-being-prescribed-mind-altering-drugs-experts-have-warned.html#ixzz1PtZnTlvd

Saturday, 18 June 2011

ORGANOPHOSPHATES - POSSIBLE LINK TO RAISED OCCURENCE OF ADHD - NEW HARVARD UNIVERSITY STUDY



Pesticides tied to ADHD in children in U.S. study


PLANE DISPERSING ORGANOPHOSPHATES OVER NEW ORLEANS 2005


  

NEW YORK | Mon May 17, 2010 7:35pm EDT

(Reuters) - Children exposed to pesticides known as organophosphates could have a higher risk of attention-deficit/hyperactivity disorder (ADHD), according to a U.S. study that urges parents to always wash produce thoroughly.

Researchers tracked the pesticides' breakdown products in children' urine and found those with high levels were almost twice as likely to develop ADHD as those with undetectable levels.

The findings are based on data from the general U.S. population, meaning that exposure to the pesticides could be harmful even at levels commonly found in children's environment.

"There is growing concern that these pesticides may be related to ADHD," said researcher Marc Weisskopf of the Harvard School of Public Health, who worked on the study.

"What this paper specifically highlights is that this may be true even at low concentrations."

Organophosphates were originally developed for chemical warfare, and they are known to be toxic to the nervous system.

There are about 40 organophosphate pesticides such as malathion registered in the United States, the researchers wrote in the journal Pediatrics.

Weisskopf said the compounds have been linked to behavioral symptoms common to ADHD -- for instance, impulsivity and attention problems -- but exactly how is not fully understood.

Although the researchers had no way to determine the source of the breakdown products they found, Weisskopf said the most likely culprits were pesticides and insecticides used on produce and indoors.

Garry Hamlin of Dow AgroSciences, which manufactures an organophosphate known as chlorpyrifos, said he had not had time to read the report closely.

But, he added" "the results reported in the paper don't establish any association specific to our product chlorpyrifos."

Weisskopf and colleagues' sample included 1,139 children between 8 and 15 years. They interviewed the children's mothers, or another caretaker, and found that about one in 10 met the criteria for ADHD, which jibes with estimates for the general population.

After accounting for factors such as gender, age and race, they found the odds of having ADHD rose with the level of pesticide breakdown products.

For a 10-fold increase in one class of those compounds, the odds of ADHD increased by more than half. And for the most common breakdown product, called dimethyl triophosphate, the odds of ADHD almost doubled in kids with above-average levels compared to those without detectable levels.

"That's a very strong association that, if true, is of very serious concern," said Weisskopf. "These are widely used pesticides."

He emphasized that more studies are needed, especially following exposure levels over time, before contemplating a ban on the pesticides. Still, he urged parents to be aware of what insecticides they were using around the house and to wash produce.

"A good washing of fruits and vegetables before one eats them would definitely help a lot," he said.

(Reporting by Reuters Health, Editing by Belinda Goldsmith)

Friday, 17 June 2011

NEW SCIENTIST -JUNE 8TH 2011 - BIPOLAR KIDS - "VICTIMS OF THE MADNESS INDUSTRY."

Bipolar kids: Victims of the 'madness industry'?


    08 June 2011 by Jon Ronson
   The New Scientist  Magazine


There's a children's picture book in the US called Brandon and the Bipolar Bear. Brandon and his bear sometimes fly into unprovoked rages. Sometimes they're silly and overexcited. A nice doctor tells them they are ill, and gives them medicine that makes them feel much better.

The thing is, if Brandon were a real child, he would have just been misdiagnosed with bipolar disorder.

Also known as manic depression, this serious condition, involving dramatic mood swings, is increasingly being recorded in American children. And a vast number of them are being medicated for it.

The problem is, this apparent epidemic isn't real. "Bipolar emerges from late adolescence," says Ian Goodyer, a professor in the department of psychiatry at the University of Cambridge who studies child and adolescent depression. "It is very, very unlikely indeed that you'll find it in children under 7 years."

How did this strange, sweeping misdiagnosis come to pass? How did it all start? These were some of the questions I explored when researching The Psychopath Test, my new book about the odder corners of the "madness industry".
Freudian slip

The answer to the second question turned out to be strikingly simple. It was really all because of one man: Robert Spitzer.

I met Spitzer in his large, airy house in Princeton, New Jersey. In his eighties now, he remembered his childhood camping trips to upstate New York. "I'd sit in the tent, looking out, writing notes about the lady campers," he said. "Their attributes." He smiled. "I've always liked to classify people."

The trips were respite from Spitzer's "very unhappy mother". In the 1940s, the only help on offer was psychoanalysis, the Freudian-based approach of exploring the patient's unconscious. "She went from one psychoanalyst to another," said Spitzer. He watched the psychoanalysts flailing uselessly. She never got better.

Spitzer grew up to be a psychiatrist at Columbia University, New York, his dislike of psychoanalysis remaining undimmed. And then, in 1973, an opportunity to change everything presented itself. There was a job going editing the next edition of a little-known spiral-bound booklet called DSM - the Diagnostic and Statistical Manual of Mental Disorders.




DSM is simply a list of all the officially recognised mental illnesses and their symptoms. Back then it was a tiny book that reflected the Freudian thinking predominant in the 1960s. It had very few pages, and very few readers.

What nobody knew when they offered Spitzer the job was that he had a plan: to try to remove human judgement from psychiatry. He would create a whole new DSM that would eradicate all that crass sleuthing around the unconscious; it hadn't helped his mother. Instead it would be all about checklists. Any psychiatrist could pick up the manual, and if the patient's symptoms tallied with the checklist for a particular disorder, that would be the diagnosis.

For six years Spitzer held editorial meetings at Columbia. They were chaos. The psychiatrists would yell out the names of potential new mental disorders and the checklists of their symptoms. There would be a cacophony of voices in assent or dissent - the loudest voices getting listened to the most. If Spitzer agreed with those proposing a new diagnosis, which he almost always did, he'd hammer it out instantly on an old typewriter. And there it would be, set in stone.

That's how practically every disorder you've ever heard of or been diagnosed with came to be defined. "Post-traumatic stress disorder," said Spitzer, "attention-deficit disorder, autism, anorexia nervosa, bulimia, panic disorder..." each with its own checklist of symptoms. Bipolar disorder was another of the newcomers. The previous edition of the DSM had been 134 pages, but when Spitzer's DSM-III appeared in 1980 it ran to 494 pages.

"Were there any proposals for mental disorders you rejected?" I asked Spitzer. "Yes," he said, "atypical child syndrome. The problem came when we tried to find out how to characterise it. I said, 'What are the symptoms?' The man proposing it replied: 'That's hard to say because the children are very atypical'."

He paused. "And we were going to include masochistic personality disorder." He meant battered wives who stayed with their husbands. "But there were some violently opposed feminists who thought it was labelling the victim. We changed the name to self-defeating personality disorder and put it into the appendix."

DSM-III was a sensation. It sold over a million copies - many more copies than there were psychiatrists. Millions of people began using the checklists to diagnose themselves. For many it was a godsend. Something was categorically wrong with them and finally their suffering had a name. It was truly a revolution in psychiatry.

It was also a gold rush for drug companies, which suddenly had 83 new disorders they could invent medications for. "The pharmaceuticals were delighted with DSM," Spitzer told me, and this in turn delighted him: "I love to hear parents who say, 'It was impossible to live with him until we gave him medication and then it was night and day'."

Spitzer's successor, a psychiatrist named Allen Frances, continued the tradition of welcoming new mental disorders, with their corresponding checklists, into the fold. His DSM-IV came in at a mammoth 886 pages, with an extra 32 mental disorders.



Now Frances told me over the phone he felt he had made some terrible mistakes. "Psychiatric diagnoses are getting closer and closer to the boundary of normal," he said.

"Why?" I asked. "There's a societal push for conformity in all ways," he said. "There's less tolerance of difference. Maybe for some people having a label confers a sense of hope - previously I was laughed at but now I can talk to fellow sufferers on the internet."

Part of the problem is the pharmaceutical industry. "It's very easy to set off a false epidemic in psychiatry," said Frances. "The drug companies have tremendous influence."

One condition that Frances considers a mistake is childhood bipolar disorder. "Kids with extreme temper tantrums are being called bipolar," he said. "Childhood bipolar takes the edge of guilt away from parents that maybe they created an oppositional child."

"So maybe the diagnosis is good?"

"No," Frances said. "And there are very good reasons why not." His main concern is that children whose behaviour only superficially matches the bipolar checklist get treated with antipsychotic drugs, which can succeed in calming them down, even if the diagnosis is wrong. These drugs can have unpleasant and sometimes dangerous side effects.
Knife edge

The drug companies aren't the only ones responsible for propagating this false epidemic. Patient advocacy groups can be very fiery too. The author of Brandon and the Bipolar Bear, Tracy Anglada, is head of a childhood bipolar advocacy group called BP Children. She emailed me that she wished me all the best with my project but she didn't want to be interviewed. If, however, I wanted to submit a completed manuscript to her, she added, she'd be happy to consider it for review.

Anglada's friend Bryna Hebert has also written a children's book: My Bipolar, Roller Coaster, Feelings Book. "Matt! Will you take your medicines please?" she called across the kitchen when I visited her at home in Barrington, Rhode Island. The medicines were lined up on the kitchen table. Her son Matt, 14 years old, took them straight away.

The family's nickname for baby Matt had been Mister Manic Depressive. "Because his mood would change so fast. He'd be sitting in his high chair, happy as a clam; 2 seconds later he'd be throwing things across the room. When he was 3 he'd hit and not be sorry that he hit. He was obsessed with vampires. He'd cut out bits of paper and put them into his teeth like vampire teeth and go up to strangers. Hiss hiss hiss. It was a little weird."

"Were you getting nervous?" I asked. "Yeah," said Hebert. "One day he wanted some pretzels before lunch, and I told him no. He grabbed a butcher knife and threatened me."
"How old was he?"

"Four. That was the only time he's ever done anything that extreme," she said. "Oh, he's hit his sister Jessica in the head and kicked her in the stomach."

"She's the one who punched me in the head," called Matt from across the room.

It was after the knife incident, Hebert said, they took him to be tested. As it happened, the paediatric unit at what was then their local hospital, Massachusetts General, was run by Joseph Biederman, the doyen of childhood bipolar disorder. According to a 2008 article in the San Francisco Chronicle, "Biederman's influence is so great that when he merely mentions a drug during a presentation, tens of thousands of children will end up taking it." Biederman has said bipolar disorder can start, "from the moment the child opens his eyes".

"When they were testing Matt he was under the table, he was on top of the table," said Hebert. "We went through all these checklists. One of Dr Biederman's colleagues said, "We really think Matt meets the criteria in the DSM for bipolar disorder."

That was 10 years ago and Matt has been medicated ever since. So has his sister Jessica, who was also diagnosed by Biederman's people as bipolar. "We've been through a million medications," said Hebert. "There's weight gain. Tics. Irritability. Sedation. They work for a couple of years then they stop working."

Hebert was convinced her children were bipolar, and I wasn't going to swoop into a stranger's home for an afternoon and tell her they were normal. That would have been incredibly patronising and offensive. Plus, as the venerable child psychiatrist David Shaffer told me when I met him in New York later that evening, "These kids can be very oppositional, powerful kids who can take years off your happy life. But they aren't bipolar."
"So what are they?"

"Attention-deficit disorder?" he said. "Often with an ADD kid you think: 'My God, they're just like a manic adult.' But they don't grow up manic. And manic adults weren't ADD when they were children. But they're being labelled bipolar.

"That's an enormous label that's going to stay with you for the rest of your life. You're being told you have a condition which is going to make you unreliable, prone to terrible depressions and suicide."



The debate around childhood bipolar is not going away. In 2008, The New York Times published excerpts from an internal hospital document in which Biederman promised to "move forward the commercial goals of Johnson & Johnson", the firm that funds his hospital unit and sells the antipsychotic drug Risperdal. Biederman has denied the allegations of conflict of interest.

Frances has called for the diagnosis of childhood bipolar to be thrown out of the next edition of DSM, which is now being drawn up by the American Psychiatric Association.

This article shouldn't be read as a polemic against psychiatry. There are a lot of unhappy and damaged people out there whose symptoms manifest themselves in odd ways. I get irritated by critics who seem to think that because psychiatry has elements of irrationality, there is essentially no such thing as mental illness. There is. Childhood bipolar, however, seems to me an example of things having gone palpably wrong.

On the night of 13 December 2006, in Boston, Massachusetts, 4-year-old Rebecca Riley had a cold and couldn't sleep. Her mother, Carolyn Riley, gave her some cold medicine, and some of her bipolar medication, and told her she could sleep on the floor next to the bed. When she tried to wake Rebecca the next morning, she discovered her daughter was dead.

The autopsy revealed that Rebecca's parents had given her an overdose of the antipsychotic drugs she had been prescribed for her bipolar disorder. They had got into the habit of feeding her the medicines to shut her up when she was being annoying. They were both convicted of Rebecca's murder.

Rebecca had been diagnosed as bipolar at 2-and-a-half, and given medication by an upstanding psychiatrist who was a fan of Biederman's research into childhood bipolar. Rebecca had scored high on the DSM checklist, even though like most toddlers she could barely string a sentence together.

Shortly before her trial, Carolyn Riley was interviewed on CBS's 60 Minutes show by Katie Couric:

KC: Do you think Rebecca really had bipolar disorder?

CR: Probably not.           

KC: What do you think was wrong with her now?

CR: I don't know. Maybe she was just hyper for her age.

Jon Ronson is a writer and documentary maker living in London. He is the author of five books, including The Men Who Stare at Goats. His latest book, The Psychopath Test, is about the psychiatry industry

Monday, 13 June 2011

THE DAILY MAIL - CHILD DEATH IN CUMBRIA ATTRIBUTED BY FATHER TO PSYCHOTROPIC MEDICATION




Child victims of the chemical cosh: Boy who killed himself after taking Ritalin.


By Sue Reid

Last updated at 11:18 PM on 12th June 2011

 

Captured in a family video, Harry Hucknall gives a cheeky grin before whizzing off down the street on his new bike. His father, Darren, will never forget the moment — when Harry was seven — and often watches the scene again and again.

It is a precious memory of Harry who, one Sunday evening in September last year, kissed his mother Jane and older brother, David, goodnight before going upstairs to his bedroom and locking the door. He then hanged himself with a belt from his bunk bed.

He was ten years old.
Boisterous: Harry Hucknell was, says his father, a 'normal kid' whose problems were overstated

Boisterous: Harry Hucknall was, says his father, a 'normal kid' whose problems were overstated

His father blames Harry’s death on two ‘mind-altering’ drugs that his son had been prescribed by a psychiatrist to cure his boisterous behaviour and low spirits.

An inquest was told in April that the boy had more drugs in his body than the normal level for adults suffering from the same problems.

Now, a distraught Mr Hucknall is to make a formal complaint to the NHS for prescribing his son Ritalin, a cocaine-like stimulant which, paradoxically, is said to calm down a child, and Prozac, a powerful antidepressant.

‘When I was growing up there were lots of kids like Harry — a bit over-active, a bit naughty, who didn’t always do as they were told. Now they are branded with a complaint called attention deficit hyperactivity disorder,’ says the computer engineer at his semi-detached house on the outskirts of Barrow-in-Furness, Cumbria.


  ‘What is it? What has changed? Is there some weird disease in the air? Harry was just a normal little boy. But because we live in 2011 he, and many other kids, are on tablets.

‘It seems nearly every child has suddenly developed this ADHD. What a load of nonsense. It’s an easy get-out for parents and schools who can’t control children.’

Mr Hucknall is obviously grieving for Harry, and his words are spoken with anger. But they are close to the truth. Earlier this year, this paper revealed that 661,000 prescriptions are dished out annually in Britain to treat childhood ADHD — double the figure of five years ago.


Coroner: An inquest was told in April that the boy had more drugs in his body than the normal level for adults suffering from the same problems

Coroner: An inquest was told in April that the boy had more drugs in his body than the normal level for adults suffering from the same problems

These medicines are being given to very young children — one aged just 15 months, according to our investigations — despite official guidelines from the manufacturer and the fact that the UK’s National Institute for Health and Clinical Excellence (NICE) prohibits their use for those under six.

Last week, educational psychologist David Traxson told me he suspects that in the West Midlands at least 100 three, four and five-year-olds in total who are on Ritalin or similar drugs. If this is replicated around the country — as is likely to be the case — the number will run into thousands U.K. wide.




‘These young children are taking powerful, potentially addictive drugs and no one knows what will happen to the effects of toxicity in their brains in the medium and longer term future,’ he warned.

The Association of Educational Psychologists last week demanded a national review into the use of Ritalin and similar drugs on children.

General Secretary Kate Fallon said: ‘The danger is that we rely on this “quick fix” for children with conditions such as ADHD, which frequently means a prescription for Ritalin.
‘No one’s certain what it will do to children’s brains’




‘We have significant concerns that the neurological impact of these drugs on the developing brains of children has not been fully researched. The potential damage they could cause needs further investigation.’

The psychologists’ call was backed by the National Union of Teachers, whose members have to cope with the huge rise in pupils being dosed with ADHD drugs — which act on the central nervous system to change a child’s behaviour.




In some state primary classrooms, one in ten pupils is on Ritalin pills, which have to be handed out by teachers at lunch or break times. In one junior school of 389 children in the South-East, no fewer than 80 pupils — more than 20 per cent — are on the medication.

It is a phenomenon across Britain, affecting families in every income bracket. The area with the highest proportion of children receiving the drug is the Wirral, a wealthy part of Cheshire which is home to millionaire footballers and business executives.

Meanwhile, sceptics question the very existence of ADHD as an illness. There is no recognised test for it. A diagnosis is made by a psychiatrist or paediatrician merely by watching a child’s behaviour.
'Enough is enough': Home Secretary Theresa May said before the last election, she warned of the dangers of the ADHD drugs




'Enough is enough': Home Secretary Theresa May has warned of the dangers of the ADHD drugs

Some of the doubters argue the condition is really a politically correct creation, conjured up by the medical world for a child who finds it difficult to sit still or concentrate thanks to a combination of a fast-food diet, late nights and lack of exercise.

It’s easier for the medical world and its political masters, of course, to diagnose a syndrome rather than deal with the real causes.

Another worrying factor is that the parents of children receiving drugs for ADHD immediately become eligible for an array of generous state benefits, including a carer’s allowance and child-disability allowance, which can total thousands a year.

For instance, one family in the West Midlands has two children receiving medication for ADHD. They get £600 a month in disability allowances for each of the two children who have been diagnosed with the ailment.

A third child is being examined by psychologists to see if he is also a sufferer. If he is diagnosed, the family’s annual haul from the state will be £21,600 tax free.

No wonder thousands of families happily agree with child psychiatrists when they are told their son or daughter needs medicine to ‘cure’ their hyperactive behaviour.

Gwynedd Lloyd, an education researcher at Edinburgh University, has explained her doubts. ‘You can’t do a blood test to see if a child has ADHD. It is diagnosed by ticking a behaviour checklist — getting out of your seat and running about is an example. Half the kids in a school would qualify under these sorts of criteria.’

And, it appears, a lot of them do. In the four years to 2010, there was a  65 per cent increase in NHS spending on drugs to treat childhood ADHD, with a cost to the taxpayer of £31million annually. This does not take into account thousands of prescriptions paid for by parents who take their children to private doctors.

In America (where the term ADHD was first created 50 years ago), one in five children is diagnosed as having a hyperactivity disorder and is on Ritalin or a similar drug.

It is predicted that unless the craze for drugging children is not stopped in the UK, one in seven pupils will soon be diagnosed with the condition in many parts of the country, as is already the case in places such as the Wirral.
'Doubters say it’s an illness conjured up by medics'

Meanwhile, the side-effects of the ADHD treatments are legion. Ritalin is a Class B drug, which is banned for recreational use. It was invented in the Fifties in the U.S. to combat the effects of illegal drug overdoses.

Alarmingly, it can stunt growth (doctors are asked to regularly monitor a young patient’s height and weight), while making children prone to heart problems, depression and insomnia.

At least 11 deaths of children while taking Ritalin have been reported to the UK’s Medicines and Healthcare Products’ Regulatory Agency since the drug became available 20 years ago. The official causes of nine of the deaths included heart conditions, respiratory problems and brain diseases. Significantly, two of the children ended their own lives just like Harry Hucknall.

Home Secretary Theresa May has said that enough is enough. As the Shadow Leader of the House of  Commons before the last election, she warned of the dangers of the ADHD drugs. ‘They are powerful prescription drugs and we don’t know what their long-term effects on a child will be.’

She related to Parliament the story of a six-year-old on Ritalin. ‘He experienced low moods and marked depression and tried to throw himself out of a window within two months of starting treatment. He only recovered once the drug had been withdrawn.’

Sadly, Harry Hucknall never had the chance to stop taking Ritalin, or the antidepressant Prozac. Now his father is asking difficult questions about why his son died. On the fateful weekend last September, Harry was staying at the home in Dalton-in-Furness of his mother, Jane White, 33, his brother David, and his two step-siblings.
In America (where the term ADHD was first created 50 years ago), one in five children is diagnosed as having a hyperactivity disorder and is on Ritalin or a similar drug

In America (where the term ADHD was first created 50 years ago), one in five children is diagnosed as having a hyperactivity disorder and is on Ritalin or a similar drug

He would spend every other weekend and one day during the week with his father, who parted amicably from Jane when Harry was three.

Early last year, child psychiatrist Mr Sumitra Srivastava had prescribed Harry with Prozac for depression, and Ritalin for hyperactivity. He was having difficulty concentrating at school, was being bullied by classmates, and had told his parents he was feeling unhappy.

At an inquest in April, the coroner Ian Smith declared that Mr Srivastava had acted appropriately, but warned that doctors should be extremely careful what they prescribed to ten-year-old boys.

The coroner ruled out a deliberate suicide, but said that the influence of Ritalin and Prozac could not be excluded as a factor in Harry’s death. ‘What a child with ADHD is prescribed by his doctor is mind-altering drugs of a powerful nature,’ he added.

But Harry’s father believes drugs had a huge part to play in the tragedy. ‘Harry was put on Prozac first, and without my knowledge,’ he told me. ‘I only found out about it when he came to stay for the weekend and his mother told me what dose to give him: one in the morning and one at night. “Are you crazy?” I asked her. “That’s an antidepressant.”

‘I can go to work every day and pay for my child’s keep, but it seems I have little say when it comes to things like the authorities deciding to give my son drugs.’ At first, Mr Hucknall refused to give Harry the pills. But Harry’s mother said that if he didn’t dose his son, the child would not be allowed to visit him. She said the doctors had told her Prozac would stop Harry being depressed.
‘I think ADHD is a disease invented by drug companies' - Darren Hucknell

‘I reluctantly agreed. I wanted to see Harry,’ remembers 37-year-old Mr Hucknall. ‘Later, I went with Harry’s mother to see the psychiatrist. I insisted on going along to tell him that I did not want Harry on any drugs whatsoever.

‘While I was there, he said Harry was going to be put on Ritalin as well. I said I did not want him on more drugs. I didn’t want him  on any at all.

‘I had never heard of Ritalin. I was told it was to help his concentration. I was never told a side-effect of Ritalin is depression. But the doctor said that if Harry took the Ritalin he would be off everything and drug free within a month.’

Mr Hucknall believed him, although this scenario was very unlikely. Most children remain on ADHD drugs for years. ‘In the end I agreed, because I thought I was doing the right thing. The next thing I know, a month or two later, there was a knock on my door and two police officers were telling me my son had  hanged himself,’ he says.

‘He was just a kid. There was nothing wrong with him. He may have had some problems, but they were overstated.

‘A lot of things that Harry’s mum complained about in terms of his behaviour, he did not do here. How can you have ADHD in one place and not in another?

‘I think Harry might have been playing up a bit by attention- seeking because there were three other children in the family.

‘I admit there were a couple of times I forgot to give him his  tablets. To me, he seemed quiet and subdued when he was on them.

‘I would have happily thrown them in the bin. Harry just took them, of course. He was a kid and he did as he was told.’

An emotional Mr Hucknall continues: ‘I think ADHD is a disease invented by drug companies. Nobody ever died of ADHD and it didn’t existed once upon a time. It’s too easy to hand out tablets. They are being over-prescribed to children.

‘A perfectly normal kid isn’t allowed to grow up without interference these days. I’m angry about what has happened because I have lost my son.

‘At the school meetings about Harry, his teachers said he was quiet. My son had just recently moved house and been put into a new school, where he didn’t know anybody. What did they expect?

‘Another teacher said Harry didn’t laugh at his jokes. I asked Harry about that. He told me they weren’t very funny.’

Mr Hucknall believes his son was ‘inappropriately medicated’ and has asked Independent Complaints’ Advocacy Service (ICAS) — which supports those wishing to complain about the NHS — to take on the case. 

At the inquest, Mr Hucknall also took the chance to challenge Mr Srivastava again about why he had put Harry on drugs. ‘This doctor said at the inquest my son had a chemical inbalance in his brain. I asked him: “How do you know? Did you take chemicals from his brain?”

‘He told me it was a theory. So based on a theory — and seeing my son five times at the most — he decided to put him on this drug, Ritalin, which is as powerful as cocaine.

‘Harry ended up taking two drugs that work against each other — the Prozac that fights depression and the Ritalin that can cause it. How can that be right?’

Read more: http://www.dailymail.co.uk/news/article-2002856/Child-victims-chemical-cosh-Boy-killed-taking-Ritalin.html#ixzz1P8LY2UnZ


A 10-year-old Cumbrian boy who hanged himself did not understand what he was doing, a coroner had said.

The inquest into the death of Harry Hucknall, from Ullswater Close, Dalton-in-Furness heard that the youngster was "troubled" and had been bullied.

The coroner ruled that it was not suicide, but he "died as a consequence of his own actions without understanding their true consequences".

The schoolboy was discovered hanged at his home last September.

He had been diagnosed with clinical depression and attention-deficit hyperactivity disorder (ADHD) and was prescribed an anti-depressant and Ritalin.
 

'Double tragedy'

West Cumbria Coroner Ian Smith, said that Harry had been given "two powerful, mind altering drugs".

He urged doctors to be "extremely careful in prescribing such medication".

At the end of the hearing in Barrow Town Hall Mr Smith said: "This was not suicide for one minute.

"I record that Harry died as a consequence of his own actions without understanding their true consequences.

"Nobody expected this to happen, or foresee it, or even fear it may happen."

He added: "The loss of a child when self-inflicted is a double tragedy for everyone, for both the family and society.

"I do believe it reflects upon society on how we expect children to behave. We expect them to be little adults.

"I think it is very sad. He was clearly a troubled boy."



    Boy's sudden death investigated 20 SEPTEMBER 2010, CUMBRIA



Sunday, 12 June 2011

Up to one million children in the U.S. risk being diagnosed with ADHD just because they are the youngest in their year groups.



One million children misdiagnosed with ADHD making them 'pill poppers,' simply because they are the youngest in their year group.

Wednesday, December 01, 2010 by: Monica G. Young
See all articles by this author
Email this author

(NaturalNews.com)


Nearly 1 million U.S. children are potentially misdiagnosed with ADHD simply because they are the youngest in their class, according to a recent study by a Michigan State University economist, Todd Elder.

'YOUNGEST IN CLASS' DRUGGED FOR IMMATURE BEHAVIOUR. WHY?


Using a sampling of about 12,000 children, he compared ADHD diagnosis and medication rates between the youngest and oldest in each grade. Elder found the youngest kindergartners (typically less mature) were 60 percent more likely to be diagnosed with ADHD than the oldest in that grade. And by the time students reached the fifth to eighth grades, the youngest were more than twice as likely to be prescribed stimulants.

"If a child is behaving poorly, if he's inattentive, if he can't sit still, it may simply be because he's 5 and the other kids are 6," said Elder, assistant professor of economics. "Many ADHD diagnoses may be driven by teachers' perceptions of poor behavior among the youngest children in a kindergarten classroom."

He pointed out that although teachers cannot diagnose ADHD, their opinions are instrumental in decisions to send a child for a mental health evaluation.

This study suggests that 20 percent - or 900,000 - of the 4.5 million children currently labeled with ADHD have been misdiagnosed based on their age relative to classmates.



No blood tests or other medical analyses are used in diagnosing ADHD (Attention Deficit Hyperactivity Disorder). Children so labeled are routinely prescribed high-risk psychostimulants, despite documented adverse effects that can range from loss of appetite, anxiety and insomnia to stunted growth, high blood pressure and heart failure.

In 1987, the American Psychiatric Association voted ADHD into the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders 4th edition - the psychiatric bible used in prescribing medication) as an authorized "mental disorder". There was no scientific evidence to support this as a brain malfunction, disease, chemical imbalance or neuro-biological condition. Yet psychostimulants widely prescribed for ADHD alter the natural chemistry of the brain and body and can have long term impact on children's health.

 The Pharmaceutical Industry spends billions in convincing the public, schools, legislators and the press that ADHD, ADD and other so-called mental disorders are diseases on par with verifiable medical conditions such as diabetes and heart disease.

How could all this come to be? The ADHD myth and its costly medications bring the pharmaceutical and psychiatric industries billions of dollars a year in revenue.

This marketing deception is not isolated to the U.S. A recent Canadian study suggests that many boys are prescribed ADHD drugs for being, well, boys. (Core symptoms used in diagnoses are inability to focus and hyper and impulsive behavior.) On Oct 18, 2010 Canada's Globe and Mail published an article entitled "Are we medicating a disorder or treating boyhood as a disease?"

"Last year, more than two million prescriptions for Ritalin and other ADHD drugs were written specifically for children under 17, and at least 75 per cent of them were for young males", wrote the author. The Globe's investigation shows that prescriptions for ADHD drugs in Canada shot up to 2.9 million in 2009, a jump of more than 55 per cent in four years. And ADHD prescriptions for males increased 50 per cent since 2005.

Sources for this story include:

http://news.msu.edu/story/8160/
http://www.cchrint.org/2010/10/30/1...
http://www.theglobeandmail.com/news...
http://www.adhdtesting.org/


Learn more: http://www.naturalnews.com/030580_ADHD_children.html#ixzz1P51knDXb

"BRITSH DOCTORS BREACH NICE GUIDELINES AND PRESCRIBE STIMULANTS TO CHILDREN AS YOUNG AS FOUR "-COURTESY OF Natural News.com website

CHILDREN AS YOUNG AS FOUR TAKING PRESCRIBED STIMULANTS AGAINST N.I.C.E. GUIDELINES.

"British doctors illegally prescribe ADHD drugs to children as young as four."(Courtesy of NaturalNews.com)

FOR MORE ON THIS WATCH CHANNEL 4 'SPECIAL REPORT' ON STIMULANTS FOR THE UNDER SIXES:


Friday, April 01, 2011 by: Jonathan Benson, staff writer
    
  
  
(NaturalNews) The overall rise in the number of attention deficit hyperactivity disorder (ADHD) drugs being dispensed to children has been a major cause of concern among some medical groups, particularly as such drugs are now being prescribed to children under the age of six. In the UK, National Health Service (NHS) guidelines restrict the prescription of ADHD drugs to children under age six, but a recent report in the UK Guardian says that some doctors are unlawfully prescribing the drugs to children as young as four years old.




Researchers from the Centre for Paediatric and Pharmacy Research compiled data showing that prescription rates for ADHD drugs like Ritalin are highest among the age six to 12 category, which is the youngest age category for which they can legally be prescribed. And between 2004 and 2008, prescription rates doubled in this category, jumping to eight out of every 1,000 children.


But according to Professor Tim Kendall, joint director of the National Collaborating Centre for Mental Health and former chair of the National Institute for Health and Clinical Excellence (NICE) guideline committee, confirmed reports indicate that doctors often illegally prescribe ADHD drugs for children even younger than six, and they do so without a comprehensive diagnosis. And in many cases, he says parents actually push doctors to prescribe the drugs as a quick-fix solution to perceived behavioral problems that may not even exist.




"There are two reasons why parents go shopping for a diagnosis," he said to the Guardian. "The first is to improve their child's performance at school, and the second is to get access to benefits. There are always GPs (general practitioners) that will do it, but it's wrong to give a child a diagnosis without also consulting schools and teachers."




Previous research has highlighted the dangerous side effects caused by taking many popular ADHD drugs, including serious hallucinations and psychosis (http://www.naturalnews.com/025433_d...). ADHD drugs can also lead to an increased risk of heart problems, according to a 2008 study published in the journal Pediatrics,AND IN CERTAIN CASES SUDDEN HEART FAILURE.


Sources for this story include:


http://www.guardian.co.uk/society/2...


Learn more: http://www.naturalnews.com/031921_ADHD_drugs_children.html#ixzz1P2aTg2DK

Saturday, 11 June 2011

KEY AMBIGUITIES IN STIMULANT MEDICATION TREATMENT FOR CHILDREN WITH CONTROLLED DRUGS - EVIDENCE B(I)ASED PRACTICE REVIEW.

SENIOR LECTURER, LIONEL BAILLY

Stimulant medication for the treatment of attention-deficit hyperactivity disorder: evidence-b(i)ased practice?
Lionel Bailly, Senior Lecturer in Child and Adolescent Psychiatry and Honorary Consultant


NEMHP NHS Trust, Royal Free and UCL Medical School, Wolfson Building, 48 Riding House Street, London W1N 8AA, e-mail: rejulba@ucl.ac.uk


Attention-deficit hyperactivity disorder (ADHD) and its pharmacological treatment remain the objects of intense controversy. 

The conflict reaches far beyond the area of scientific debate. An article on ‘behavioural syndromes’, published in The Times on 28 July 2003, was headlined: ‘Hyperactive? Just go to a park and climb a tree’. An internet search will produce equal numbers of sites warning either that the prescription of stimulant medication is a denial of children’s human rights, or that not prescribing stimulant to an ADHD child denies their right to treatment.

In this age of evidence-based medicine, what is the evidence guiding professionals?

 
Serious scrutiny shows that numerous ambiguities regarding this condition and its treatment remain.

Is ADHD an illness?

Attention deficit hyperactivity disorder is an operationally defined concept which is built on a series of behaviours, none of which is specific (contrary to phobias, obsessions, post-traumatic stress disorder, panic attacks, depression, autism, Tourette syndrome, etc.). There is therefore much room for interpretation of these behaviours, and clinicians with opposing views would probably agree only on the most serious cases. In addition, the diagnostic process depends heavily upon information from third parties (parents and teachers), which gives rise to questions about the neutrality of these informants in the face of a clearly difficult child (but one who does not necessarily have ADHD). The diagnostic process is sufficiently controversial for the pharmaceutical industry to post the following warnings to customers on their websites:

    ‘Specific etiology of this syndrome [ADHD] is unknown and there is no single diagnostic test... The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of the required number of DSM-IV characteristics’ (Adderall website; Shire US, 2004: p.1).

    ‘Specific etiology of this syndrome is unknown, and there is no single diagnostic test...Characteristicscommonly reported include: chronic history of short attention span, distractibility, emotional lability, impulsivity, and moderate-to-severe hyperactivity.. .The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of one or more of these characteristics’ (Ritalin website; Novartis Pharmaceuticals, 2004: p. 2).

Attention-deficit hyperactivity disorder without attention deficit?

The name ADHD suggests an impairment of attention in at least two of its subtypes (predominantly inattentive and combined), but in clinical practice attention as such is rarely formally assessed in children with ADHD. In a recent study, Koschack et al (2003) assessed the attentional functions of control children and those with ADHD on a computer-driven battery of neuropsychological tests. Their findings show that according to normative data, ‘most ADHD subjects performed on all attentional measures within the normal range’ (Koschack et al, 2003). Comparisons with the control group revealed that ‘ADHD subjects reacted faster on all attentional tests and performed with significantly fewer errors on the Divided Attention test’ (Koschack et al, 2003). These findings would question the appropriateness of the ‘attention deficit’ in ADHD.

Non-ADHD causes of hyperkinetic behaviour

Not all children with hyperkinetic behaviour have ADHD. Many other conditions and situations may lead to ADHD-like symptoms.

Sleep disturbances
 

In a study on sleep and neurobehavioural characteristics of 5- to 7-year-old children with symptoms of ADHD reported by a parent, O’Brien et al (2003) reported that sleep-disordered breathing can lead to mild ADHD-like behaviour ‘that can be readily misperceived and potentially delay the diagnosis and appropriate treatment’. Not sleeping enough is also a well-known non-medical cause of agitation in children, and if the clinician is unaware of the lack of sleep a child can be wrongly diagnosed with ADHD on the basis of school reports and parental statements.

Side-effects of ß-stimulants
 

Bronchodilator medication prescribed for asthma has numerous behavioural side effects. In a 12-week double-blind trial of Ventolin in 104 children between the ages of 4 and 11 years, the drug manufacturer, GloxoSmithKline, reported that nervousness was present in 1% of the children, agitation in 1%, hyperactivity in 1% and aggressive behaviour in 1% (http://us.gsk.com/products/assets/us_ventolin.pdf). A child with one or more of these side-effects might be wrongly diagnosed with ADHD. In addition, if these side-effects occur during the child’s formative first years, the symptoms can become habitual behaviours that are difficult to change even after medication has been discontinued.

Hearing impairment
 

Data from a large multipurpose birth cohort study show that hyperactive and inattentive behavioural problems were evident in children with otitis media (Bennett & Haggard, 1999; Bennett et al, 2001). They can persist into late childhood and the early teens (as late as 15 years) (Bennett et al, 2001).

Behavioural difficulties and bereavement
 

Some ADHD-like symptoms can be encountered as a consequence of complicated bereavement and could wrongly lead to the diagnosis of ADHD if the professional assessing the child is not aware of the loss. In a review of childhood bereavement following parental death, Dowdney (2000) reported that non-specific emotional and behavioural difficulties among children are often reported by the surviving parents and the bereaved children themselves. Among other behavioural difficulties, such children can display hyperactivity and temper tantrums. Hutton and Bradley (1994), in their study of the effects of sudden infant death on bereaved siblings, found that children between the ages of 4 and 11 years who had lost a sibling to cot death showed significantly more behavioural problems (as reported by their mother) than a matched comparison group. Fifteen individual items of the Child Behavior Checklist were more frequent in the bereaved group. Among these 15 items the following 8 are commonly encountered in children with ADHD: ‘is nervous, highstrung; easily jealous; destroys own things; restless, hyperactive: unusually loud; demands a lot of attention; gets teased a lot; can’t concentrate’ (Hutton & Bradley, 1994).

Manic symptoms
 

Significant debate exists on whether early-onset bipolar disorder is mistakenly diagnosed as ADHD or conduct disorder (CD). In a review of the literature Kim and Miklowitz (2002) found that ‘Reliable and accurate diagnoses can be made despite the symptom overlap of bipolar disorder with ADHD and CD’. However, this symptom overlap may lead to the erroneous diagnosis of ADHD in manic children.

Child abuse
 

Among the symptoms and signs of physical abuse listed in the Royal College of Psychiatrists’ factsheet Child Abuse and Neglect: the Emotional Effects, are: ‘aggressive or abusive, unable to concentrate, underachieving at school, having temper tantrums and behaving thoughtlessly, truanting from school’ (Royal College of Psychiatrists, 2004a). An unsuspecting professional can wrongly attribute these behavioural symptoms to ADHD. It is therefore important that physicians ‘keep their eyes open to behaviours that signal distress’ (Gushurst, 2003) and do not systematically attribute behavioural difficulties to neurodevelopmental causes.

Inadequate parenting
 

In an article on the diagnosis of ADHD in pre-school children, Blackman (1999) points out that ‘environmental stressors, inadequate parenting skills can mimic ADHD’. In its factsheet for parents and teachers, The Restless and Excitable Child, the Royal College of Psychiatrists lists among the factors which can make children hyperactive: troubled parents who pay little attention to their children or set no clear rules. The message to the parents is pragmatic: ‘if you have never said what is allowed and what is not, children may simply learn they can get away with being noisy and boisterous’ (Royal College of Psychiatrists, 2004b).

The mode of therapeutic action of stimulant medication in ADHD is unknown

As the makers of two of the most prescribed stimulants for the treatment of ADHD point out, amphetamines are non-catecholamine sympathomimetic amines with central nervous system stimulant activity whose

    ‘mode of therapeutic action in Attention Deficit Hyperactivity Disorder (ADHD) is not known’ (Adderall website; Shire US, 2004: p.1).

    ‘The mode of action in man is not completely understood’

but Ritalin

    ‘presumably activates the brain stem arousal system and cortex to produce its stimulant effect. There is neither specific evidence which clearly establishes the mechanism whereby Ritalin produces its mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system’ (Ritalin website; Novartis Pharmaceuticals, 2004: p.1).

Little is known of the long-term effectiveness of stimulant treatment of ADHD

Again the pharmaceutical industry warns us:

    ‘The effectiveness of ADDERALL XR for long-term use, i.e., for more than 3 weeks... has not been systematically evaluated in controlled trials.Therefore, the physician who elects to use ADDERALL XR for extended periods should periodically reevaluate the long-term usefulness of the drug’ (Shire US, 2004: p.1)

    ‘Sufficient data on safety and efficacy of long-term use of Ritalin in children are not yet available... Long-term effects of Ritalin in children have not been well established’ (Novartis Pharmaceuticals, 2004, pp. 3-4)

Stimulant medication is not a specific treatment for ADHD

Rapoport et al (1980) studied the cognitive and behavioural effects of dextroamphetamine in boys with hyperactive behaviour and control boys and men. In a superb piece of research using a double-blind drug versus placebo with crossover methodology, they examined the effects of a single dose of dextroamphetamine sulphate on motor activity, vigilance, learning, and mood in three groups: prepubertal boys with hyperactive behaviour, control prepubertal boys and control men of college age. After taking the stimulant drug ‘both groups of hyperactive and non-hyperactive boys and men showed decreased motor activity, increased vigilance and improvement on a learning task’. ‘While there were some quantitative differences in drug effects on motor activity and vigilance between these different groups, stimulants appear to act similarly on normal and hyperactive children and adults’. Stimulant medication appears to decrease motor activity and increase vigilance of any child and therefore cannot be used as a form of diagnostic test: clinicians cannot say the child has ADHD because stimulant medication calms them down.

After taking the stimulant the men reported euphoria. The boys reported only feeling ‘tired’ or ‘different’. It is not clear whether this difference in effect on mood between adults and children was due to ‘differing experience with drugs, ability to report affect or pharmacologic age-related effect’ (Rapoport et al, 1980). Considering the drug’s potential for addiction, the possibility of an age-related effect is worrying, because it would mean that in their teens, youngsters treated with stimulant would start to experience euphoria.

Risk of addiction and misuse

Members of the Community Epidemiology Work Group of the National Institute for Drug Abuse (NIDA) in the USA made the following information public at their June 2000 meeting:

    ‘The abuse of methylphenidate has been reported in Baltimore, mostly among middle and high school students; Boston, especially among middle and upper-middle class communities: Detroit; Minneapolis/St Paul; Phoenix; and Texas.When abused, methylphenidate tablets are often used orally or crushed and used intranasally. Some users inject methylphenidate (this is referred to as "west coast"). Also, some mix it with heroin (a "speedball") or in combination with both cocaine and heroin for a more potent effect’ (National Institute for Drug Abuse Community Epidemiology Work Group, 2000: p. 97).

In County Durham, police officers investigating the use of Ritalin found that 30 out of 300 pupils in a comprehensive school were using the drug illicitly. The school price of a tablet was 50p to £1.50 (The Times, 28 July 2003: p. 3).

Influence of advertising

The prescription market for the treatment of ADHD is evaluated at nearly $2 billion in yearly sales, according to IMS Health, a pharmaceutical research and consultancy firm. The competition for a slice of this market is intense, with pharmaceutical companies struggling to keep the lead.

These companies use aggressive marketing techniques to promote their drugs and their reasons are not always purely altruistic. The example of atomoxetine (Strattera) marketed as a non-stimulant drug is particularly interesting. Strattera was introduced in the USA in January 2003 and by June had grabbed 12% of the nearly $2-billion-a-year prescription market. In the first 6 months after Strattera’s introduction, market leader Concerta XL’s prescription share fell from 26% to 22.7%, and Adderall XR from 22.6% to 20.9%, according to IMS Health. Bert Hazlett, an industry analyst with SunTrust Robinson Humphrey (http://www.miami.com/mld/miamiherald/business/6709174.htm) attributes some of Strattera’s rapid growth in sales to ‘Lilly’s expertise in marketing drugs for the central nervous system, gleaned by years of promoting Prozac, its blockbuster antidepressant’. He adds that ‘Strattera is a key pillar in strengthening Lilly’s sales and earnings, which plummeted when it lost the Prozac patent in August 2001’.

Advertising campaigns promote not only drugs but also sometimes the disorder itself: ‘We have to raise awareness of the disease before promoting a brand’, said Lilly spokesman David Shaffer (http://www.miami.com/mld/miamiherald/business/6709174.htm). How much doctors and parents are influenced by the sheer pressure of advertising rather than by medical information remains a crucial but unanswered question.

Conclusion

Depending on a clinician’s interpretation of the available scientific evidence one may conclude that: ADHD is a commonly diagnosed behavioural disorder of childhood for which studies, including randomised clinical trials, have established the efficacy of stimulant drugs in alleviating ADHD symptoms, or that, ADHD is an operationally defined disorder built on a series of non-specific behaviours of which specific aetiology is unknown and for which there is no single diagnostic test.

Contrary to what the name of the disorder suggests, attention processes are rarely impaired. Numerous environmental and emotional stressors can lead to ADHD-like symptoms in children. The mode of therapeutic action of stimulant medication in ADHD is unknown and little is known about its long-term effectiveness. Stimulant medication is not a specific treatment of ADHD and appears to act similarly on children and adults with and without hyperactive behaviour by decreasing motor activity, increasing vigilance and improving performance at a learning task. The clinical response to stimulant medication cannot be used as a form of diagnostic test. The risk of addiction and misuse is not negligible and illicit use of methylphenidate has been reported in UK schools. It is possible that prescription practices in the treatment of ADHD are influenced by the sheer pressure of advertising.

References

    BENNETT, K. & HAGGARD, M. (1999) Behaviour and cognitive outcomes from middle ear disease. Archives of Disease in Childhood, 80, 28 -35.[Abstract/Free Full Text] 


BENNETT, K., HAGGARD, M., SILVA, P., et al (2001) Behaviour and developmental effects of otitis media with effusioninto the teens.Archives of Disease in Childhood, 85, 91 -95.[Abstract/Free Full Text]

BLACKMAN, J. (1999) Attention-deficit/hyperactivity disorder in preschoolers. Does it exist and should we treat it? Pediatric Clinics of North America, 46, 1011 -1025.[CrossRef][Medline] 

DOWDNEY, L. (2000) Childhood bereavement following parental death. Journal of Child Psychology and Psychiatry, 41, 819 -830.[CrossRef][Medline] GUSHURST, C. (2003) Child abuse: Behavioral aspects and other associated problems. Pediatric Clinics of North America, 50, 919 -938.[CrossRef][Medline] 

HUTTON, C. & BRADLEY, B. (1994) Effects of sudden infant death on bereaved siblings: a comparative study. Journal of Child Psychology and Psychiatry, 35, 723 -732.[CrossRef] 

KIM, E. & MIKLOWITZ, D. (2002) Childhood mania, attention deficit hyperactivity disorder and conduct disorder: a critical review of diagnostic dilemmas. Bipolar Disorders, 4, 215-225.[CrossRef][Medline]

KOSCHACK, J., KUNERT, H., DERICHS, G., et al (2003) Impaired and enhanced attentional function in children with attention deficit/hyperactivity disorder. Psychological Medicine, 33, 481 -489.[CrossRef][Medline] 

NATIONAL INSTITUTE FOR DRUG ABUSE COMMUNITY EPIDEMIOLOGY WORK GROUP (2000) Epidemiologic Trends in Drug Abuse, Volume 1. Highlights and Executive Summary. June 2000. Bethesda, MD: National Institutes of Health (available at http://www.drugabuse.gov/pdf/cewg/cewg600.pdf). 

NOVARTIS PHARMACEUTICALS (2004) Ritalin. East Hanover, NJ: Novartis Pharmaceuticals (available at http://www.pharma.us.novartis.com/product/pi/pdf/ritalin_ritalin-sr.pdf).

O’BRIEN, L., HOLBROOK, C., MERVIS, C., et al (2003) Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics, 111, 554 -563.[Abstract/Free Full Text]

RAPOPORT, J., BUCHSBAUM, M., WEINGARTNER, H., et al (1980) Dextroamphetamine. 
Its cognitive and behavioral effects in normal and hyperactive boys and normal men. Archives of General Psychiatry, 37, 933 -941.[Abstract/Free Full Text]

ROYAL COLLEGE OF PSYCHIATRISTS (2004a) Child and abuse and neglect: the emotional effects. In Mental Health and Growing Up (3rd edn) (eds G. Rose & A.York), p.19. London: Royal College of Psychiatrists (available at http://www.rcpsych.ac.uk/info/mhgu/newmhgu19.htm). 

ROYAL COLLEGE OF PSYCHIATRISTS (2004b) The restless and excitable child. In Mental Health and Growing Up (3rd edn) (eds G. Rose & A.York), p.1. London: Royal College of Psychiatrists (available at http://www.rcpsych.ac.uk/info/mhgu/newmhgu1.htm). 

SHIRE US (2004) Adderall XR. Prescribing Information. Newport, KY: Shire US (available at http://www.adderallxr.com/pdf/prescribing_information.pdf).


Related Articles



MTA Study Conclusion
“We had thought that children medicated longer would have
better outcomes. That didn’t happen to be the case. There
were no beneficial effects, none. In the short term,
[medication] will help the child behave better, in the long run
it won’t. And that information should be made very clear to
parents.”
--MTA Investigator William Pelham, University at Buffalo
Daily Telegraph, “ADHD drugs could stunt growth, “ Nov. 12, 2007.


Long-Term Risks With Stimulants(Power Point Slide)
 

• Desensitized brain-reward system?
• Increased risk of addiction?
• Conversion to bipolar diagnosis: 10%
to 25% now convert
 

Source: “Bolla,” The neuropsychiatry of chronic cocaine abuse,” J of Neuropsychiatry and Clinical Neurosciences 10 (1998):280-9.
 

Castner, “Long-lasting psychotomimetic consequences of repeated low-dose amphetamine exposure in rhesus monkeys,”
Neuropsychopharmacology 20 (1999):10-28. Carlezon, “Enduring behavioral effects of early exposure to methylphenidate in rats,”
Biological Psychiatry 54 (2003):1330-37. Biederman, “Attention-deficit hyperactivity disorder and juvenile mania,” J of the American
Academy of Child & Adolescent Psychiatry 35 (1996):997-1008.