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Sunday 31 July 2011

BPS -THE PSYCHOLOGIST - British Psychological Society's Recent Scathing Critique of the American Psychiatric Association's Proposed DSM5 Revision for 2013 + PSYCHOLOGY TODAY'S RESPONSE BY DR ALLEN FRANCES - LEAD EDITOR OF DSM4




In 'The Psychologist' -August 2011

Society’s critical response to DSM-5

Work on the latest, fifth version of psychiatry’s diagnostic code (DSM-5: see www.dsm5.org), due for publication by the American Psychiatric Association in 2013, has already suffered from resignations and accusations of vested interest. Now the British Psychological Society has had its say by publishing a highly critical response to the planned revisions (access the full document at tinyurl.com/67wygp7).

The Society says it is ‘concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation’. The statement was made public in June, signed off by Dr Carole Allan, chair of the Professional Practice Board, and prepared by Professor Peter Kinderman, chair of the Division of Clinical Psychology.

The statement criticises the DSM-5 for being based on social norms and subjective judgement, and for locating problems within individuals, rather than recognising the role of social causes, such as poverty. The Society also has concerns with specific conditions found in DSM-5, including the proposed new conditions of ‘attenuated psychosis syndrome’ (the presence of psychotic-like symptoms without a full disconnect from reality) and ‘disruptive mood dysregulation disorder’ (excessive temper tantrums). The former ‘is very worrying’ the Society statement says, ‘it could be seen as an opportunity to stigmatise eccentric people, and to lower the threshold for achieving a diagnosis of psychosis’.



The only aspect of the DSM-5 welcomed by the Society is the plan to rate symptom severity over the preceding month, because to do so focuses on specific problems and ‘introduces the concept of variability into the system’.

The Society concludes by calling for a revision to the way mental distress is thought about, including recognition that mental disorder is on a spectrum with normal experience, and recognition of the role played by social factors. ‘Rather than applying preordained diagnostic categories to clinical populations,’ the Society says, ‘we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or “symptoms” or “complaints”’. The statement ends with the Society offering to help in any exercise to develop an alternative approach to the DSM.

The Vice-Chair of the DSM-5 task force, Dr Darrel Regier is robust in his defence of the DSM (see www.bps.org.uk/dsm5news). In an e-mail to The Psychologist he says that he and his colleagues agree that there is an overlap between normal responses and disease states, but that ‘psychiatry also recognises that there are real and discrete disorders of the brain that cause mental disorders and that can benefit from treatment’.

Regier says that experts working on DSM-5 have attempted to approach this issue by adding more dimensional approaches to describing psychological symptoms and opportunities to assess both disorder severity and associated disability levels. ‘The problem’, he says, ‘is that the psychologists quoted here think we shouldn’t consider any mental disorder, including individuals whose psychosis renders them mentally incompetent, to have a brain-based illness. The group also wishes to emphasize the relational context of mental disorders and wants to exclude the possibility of mental disorders being independently present in the person – the way that cancer or heart disease may be affected by social and psychological realities but nevertheless exist within individuals as discrete states. What seems to be missing is an appreciation of mental disorders as the result of gene–environmental interactions that would trigger abnormal neuronal function in the brain. Why the brain should be exempt from pathology when every other organ system is subject to malfunction is left unaddressed.’

Regier further explains that DSM-5 will recognise that boundaries between conditions like schizophrenia and bipolar disorder are not clear cut and better thought of as ‘central tendencies’, which can be modified by high-level psychological domains, such as anxiety or addictions. ‘However, the complexity of psychiatric disorders in no way abrogates the psychiatrist’s obligation to provide treatments, including talk therapies and medications, that succeed in ameliorating symptoms and reducing suffering,’ he says.

In conclusion Regier reminds us that psychiatric disorders have existed since the beginning of recorded history, but that tremendous progress has been made in recent decades in our ability to treat them. ‘The DSM strives to be a living document that will continue to draw upon research and clinical experience as we endeavour to relieve the suffering of the millions of people worldwide who suffer the devastating effects of mental illness,’ he says.

Looking ahead, Professor Kinderman notes that many psychologists continue to work in healthcare contexts that use diagnoses, including helping people with physical and neurological problems where he considers diagnosis to be valid. ‘So we have to strike a balance and offer pragmatic advice,’ he says. ‘We base our advice on evidence, and will continue to develop our position in the light of research. We are currently developing practical guidelines for psychologists in their day-to-day work. We will also continue to make a constructive contribution to the debate by promoting a positive way forwards in developing alternative paradigms rooted in psychological models.’ Christian Jarrett

- For background on the development of DSM-5, see April 2010 News and August 2009 Forum.

The response was coordinated by the Society’s Consultation Response Team.

To get involved with future responses, see www.bps.org.uk/consult. For other recent activity, see p.608.

The British Psychological Society Condemns DSM 5

Published on July 27, 2011 by Allen J. Frances, M.D. in DSM5 in Distress

"Once the genie was out of the bottle with DSM4 and heavy drug marketing followed, also the internet and ADHD and school services or benefits began being tied to a diagnosis, the manual gets used differently to the way you thought it should and you have no control over it," he says.

The British Psychological Society (BPS) is a highly esteemed organization representing 50,000 members. Recently, it released an open letter to the American Psychiatric Association offering a harshly critical view of DSM 5. Most of the BPS criticisms are right on target, accurately pointing out the dangerous excesses of DSM 5. But some are so overly broad that the cogent points get lost in the shuffle, allowing the DSM 5 leadership to be archly dismissive of the entire letter. This is unfortunate because the BPS warning deserves serious consideration as we approach the endgame of DSM 5 decision making.

The BPS is at its best when exposing those DSM 5 proposals that medicalize normal variability. It vigorously and convincingly opposes the DSM 5 tendency to turn the expectable reactions to life's difficulties (eg grief)into psychiatric illness. The letter rightly expresses particular concern about suggestions to include in DSM 5 the risk syndromes (eg psychosis risk) or the attenuated, milder forms of existing psychiatric disorders (eg mixed anxiety depression, mild neurocognitive, binge eating) .

This portion of the BPS critique is crisply telling and completely true and goes to the heart of what is most wrong and most dangerous in DSM 5. Medicalizing normal experience stigmatizes and cheapens the human condition and promotes overtreatment with unnecessary and potentially harmful drugs. But the BPS critique goes too far and wide in denying the value of all psychiatric diagnosis.

The most striking example is its seemingly blanket disdain applied equally for both schizophrenia and for 'psychotic risk syndrome' (lately in a name changing game aka 'attenuated psychotic symptoms'). The letter implies that these are more or less equally flawed and undeserving constructs. Most decidedly they are not. The BPS willingness to throw the valuable baby of schizophrenia out with the problematic bathwater of 'psychosis risk' reduces the force of its otherwise persuasive argument against the risky bathwater.

Schizophrenia is admittedly a flawed construct with limited descriptive and explanatory power. It is a wildly heterogeneous with dozens of different presentations and probably hundreds of different causes (none of them known). This diverse group of schizophrenias contains within it a wide range of possible onsets, courses, severities, and treatment responses. There is no available biological test available for its diagnosis and none is on the horizon.

All that said, schizophrenia remains a valuable diagnosis that economically captures a great deal of information and serves as a useful (if imperfect) guide to clinical care and research. The literature on schizophrenia accumulated over the past century is extensive and suggests at least the outlines of what we don't yet know. The BPS criticizes schizophrenia as a construct, but offers no viable alternative.

In contrast, 'psychosis risk' is a relatively newcomer whose properties remain quite unknown. We don't know how best to define it, can't diagnose it accurately, don't know how to treat it, don't know if treating it has any lasting value, and don't know the extent of its harmful unintended consequences if it were to be made official.

Most telling of all is the widespread opposition to including psychosis risk syndrome as an official diagnosis in DSM 5 even among those who have devoted their careers to researching it. The tipping point was reached recently when two of the most prominent promoters of psychosis risk (Patrick McGorry and Alison Yung) withdrew their support for its inclusion in DSM 5 and asserted publicly that it will not be included in Australia's ambitious new mental health program that is targeted at treating early presentations of schizophrenia.

It is now only the DSM 5 diehards who are still hanging fast to the "psychosis risk" bandwagon- but unfortunately it is they who hold the final casting vote. The BPS is doing a great service in entering this fray and adding its strong voice to the diverse chorus trying to prevent this travesty. But BPS dilutes its valuable message when it simultaneously attempts a takedown of the venerable concept of schizophrenia (especially when there really is no currently available diagnostic alternative).

Psychiatric diagnosis is admittedly imperfect, but also absolutely necessary; extremely easy to criticize, but so far impossible to replace. It gives comfort to the misguided DSM 5 workers (and protection for their worst ideas) if outside critiques can be dismissed by them as "antipsychiatry" broadsides. DSM 5 deserves and badly needs searching and sustained outside criticism, but this will be most effective if targeted to its numerous, egregious, and specific defects, not to the whole enterprise of psychiatric diagnosis.

Thursday 28 July 2011


A stroll in the park is as good at calming children as Ritalin, study finds

By Pat Hagan(The Daily Mail) October 2008.

A stroll in the park could be just as effective for treating hyperactive children as drugs such as Ritalin, a study has revealed.

Troubled youngsters showed significant improvements in concentration levels after what researchers called 'a dose of nature'.

A 20-minute walk in green surroundings gave improvements on a par with a daily dose of drugs for Attention Deficit Hyperactivity Disorder.

A pleasant stroll in the park could be just as effective as drugs for calming hyperactive children

Record levels of medicines are being dished out to hyperactive children on the NHS.

Latest figures show GPs wrote more than 535,000 prescriptions for anti-hyperactivity drugs last year  -  more than 10,000 a week. The figure has doubled since 2002.

Critics have accused doctors of using such drugs as a 'chemical cosh' to calm thousands of youngsters thought to have ADHD, a condition that makes them inattentive or boisterous and unable to concentrate at school.

Roughly one child in every classroom is thought to be affected by ADHD.

In the latest study, researchers at the University of Illinois took a group of 17 hyperactive children on three walks in a park, town centre and residential area.

The children stayed off their medication that day so researchers could be sure any benefit was from the environment alone.

The youngsters were tested on their powers of concentration after each walk.

After strolling in green areas, their scores were improved by as much, if not more than, when they took prescription drugs.

But the same children did not get any benefit from walking through town centres or residential streets.

Ritalin is one of three drugs recommended by the NHS to treat ADHD - but a 'dose of nature' has been suggested as a chemical-free alternative

Researcher Andrea Faber Taylor said: 'The greenest space was best at improving attention.

'We calculated the size of the effect in our study and compared it with the size of effect in a recent study involving medication.

'We were surprised to see the "dose of nature" had effects the same size or even larger than those of drugs.

'We can't say for sure that two hours of outdoor play will get you this many days of good behaviour. But we can say as little as 20 minutes could potentially buy you an afternoon, or a couple of hours, to get homework done.'

Andrea Bilbow, from the National Attention Deficit Disorder Information and Support Service, said it was a well-known fact that fresh air and exercise could calm down a child.

But she stressed: 'You cannot possibly alter the structure of the brain by going out and looking at trees. There is no good evidence that this is as effective as drug treatment.'
Attention aid or chemical cosh?

Ritalin is one of three drugs recommended by the NHS to treat ADHD. Side effects can include hallucinations, insomnia, headaches, mood swings, decreased appetite, bleeding and suicidal thoughts.

Ritalin and similar medications have been linked to 12 deaths in the UK.

It is a methylphenidate - the same class of drug as cocaine and amphetamines.

Read more: http://www.dailymail.co.uk/health/article-1080447/A-stroll-park-good-calming-children-Ritalin-study-finds.html#ixzz1TOI42NRD


'Chemical cosh' boom: Demand for ADHD drugs soars 70% in five years

By Sophie Borland

    Over 12,000 prescriptions for Ritalin and similar medications written out each week

Troubled: Prescriptions for Ritalin and other drugs for ADHD have soared.

Soaring numbers of hyperactive children are being given controversial drugs to control their behaviour.

Prescriptions for Ritalin and similar medications for ADHD have risen by 70 per cent in the past five years, with more than 12,000 written out each week.

But some doctors fear that parents are simply using the drugs to sedate unruly children without knowing enough about the potential risks.

The drugs, nicknamed ‘chemical coshes’, can cause nausea, fatigue and mood swings and have also been linked to suicides.

Department of Health figures show last year 661,500 prescriptions were written out for Ritalin and similar drugs such as Concerta – up from 382,000 in 2005.

Most will have been handed out to those under the age of 19 diagnosed with attention deficit hyperactive disorder, with symptoms including an inability to concentrate and restless or impulsive behaviour.

Experts say Ritalin and similar drugs contain the same chemicals as speed and cocaine.


In 2008, health watchdog NICE advised doctors to hand the drugs out only in the most severe cases.

Dr Sami Timimi, a consultant child and adolescent psychiatrist at the NHS in Lincolnshire, said: ‘There is no evidence the drugs make a positive impact.


Read more: http://www.dailymail.co.uk/health/article-1388903/Chemical-cosh-Ritalin-demand-soars-70-years.html#ixzz1TO7t62Os

Wednesday 27 July 2011


Proposed DSM-5 Changes for ADHD
Could these be the new changes to ADHD diagnosis?
Published on March 14, 2011 by Dr. Stephanie Sarkis, Ph.D. in "Here, There, and Everywhere."

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, will have a new edition published in 2013. This edition will be called the DSM-5. (This is a departure from previous editions, because a roman numeral will not be used in the title.) The DSM is used by clinicians to determine whether a client or patient meets (or does not meet) the criteria for a particular diagnosis.

As with many of the disorders in the DSM-5, new diagnostic criteria and classifications are being proposed and reviewed. This includes proposed changes to the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD).

The proposed changes to ADHD in the DSM-5 include:

* 1. Changing the diagnostic criteria from "symptoms being present before seven years of age" to "symptoms being present before twelve years of age." This new criteria would read: "B. Several noticeable inattentive or hyperactive-impulsive symptoms were present by age 12."
Related Articles

    The "ADHD Personality": Its Cognitive, Biological, and Evolutionary Foundations
    Anger Disorder: What It Is and What We Can Do About It
    ADD and ADHD: The Same?
    Stewey Griffin: DSM's Enfante Terible
    Get those kids to bed on time!

2. For the Inattentive type and Hyperactive/Impulsive subtypes of ADHD, a minimum of only four symptoms need to be met if a person is 17 years of age or older. The current DSM-IV-TR criteria of meeting a minimum of six symptoms for the Inattentive type or Hyperactive/Impulsive Type would still apply for those 16 years of age or younger.

* 3. Recommending teachers as sources of information. The wording that comes before the list of symptoms may read: "In children and young adolescents, the diagnosis should be based on information obtained from parents and teachers. When direct teacher reports cannot be obtained, weight should be given to information provided to parents by teachers that describe the child's behavior and performance at school. Examination of the patient in the clinician's office may or may not be informative. For older adolescents and adults, confirmatory observations by third parties should be obtained whenever possible."

* 4. The following symptoms are being considered for inclusion into the "Hyperactive/Impulsive type":

(j) Tends to act without thinking, such as starting tasks without adequate preparation or avoiding reading or listening to instructions. May speak out without considering consequences or make important decisions on the spur of the moment, such as impulsively buying items, suddenly quitting a job, or breaking up with a friend.
(k) Is often impatient, as shown by feeling restless when waiting for others and wanting to move faster than others, wanting people to get to the point, speeding while driving, and cutting into traffic to go faster than others.
(l) Is uncomfortable doing things slowly and systematically and often rushes through activities or tasks.
(m) Finds it difficult to resist temptations or opportunities, even if it means taking risks (A child may grab toys off a store shelf or play with dangerous objects; adults may commit to a relationship after only a brief acquaintance or take a job or enter into a business arrangement without doing due diligence).

Over 8,000 comments were submitted to the APA regarding the proposed criteria for the DSM-5. In October 2010, "field trials" were started to test out the proposed criteria. These trials are occurring in both large academic settings and in smaller clinical settings. Keep in mind that all of these changes are only proposed at this time, and not final. For more information on the DSM-5 ADHD criteria, see the following websites:

American Psychological Association - DSM-5 Development (ADHD):

American Psychological Association - DSM-5 Options Being Considered for ADHD:


Copyright 2011 Sarkis Media LLC

Tuesday 26 July 2011

DSM5 - Dangers of subjective and ethically flawed DSM5 scales which will increase the diagnosis of childhood disorders -see the real criteria in this chosen exemplar and decide for yourself- 'Oppositional Defiant Disorder' -some information provided courtesy of the APA website - let's get the National Institute of Clinical Excellence (N.I.C.E..) to block the use of this unscientific manual in the U.K. as we are not an insurance based healthcare model and we do not need the four digit code to pay for the meds- we need to act now!

DANGER : DSM5 Revision in 2013 is due!-
please sign petition:


"After changes DSM5 is still very subjective, lacks rigour, face validity and inter-subject/inter-rater reliability." Dave Traxson 2011(Supported by the BPS critiques of July 2011 and June 2012 - see posts below and use SEARCH window)

DSM5 therefore is found wanting on all these statistical criteria and it is not needed in same way in U.K. as we are not an insurance model of healthcare - in the U.S. they need the four digit code from DSM5 on the claim form in order to pay for the drugs.

Proposed  Revision for 2013 of Oppositional Defiant Disorder is an example of how dangerous DSM5 could be to young people in the U.K. due to widening the categories and allowing many more children to be medicated with potentially toxic psychotropic drugs .


Read and do exercise below

to obtain a diagnosis using DSM5

four or more of the list of symptoms below must be present.




Have a typical YP that you work with or know in your circle of contacts and ask the question would they get a 'false positive' diagnosis' and therefore be diagnosed with O.D.D. whatever that is.

Do they score positive on the next eight subjective criteria? They only need four out of eight to have an O.D.D. label for life!

Only one seems to have relatively rigorous criteria involving a frequency of occurence in a specified time period that is scientific enough.

Why no mention of key behavioural criteria?
   e.g.- Frequency, Intensity, Duration and Occurrence. (FIDO)- basic test design?

Would it be helpful to the young person and their famly and friends to have this diagnostic label at a key transition point in their life?

Would having a mental illness label hung permanently around their neck be helpful to them and society?


BELIEVE IT OR NOT! (See DSM5 website)

A persistent pattern of angry and irritable mood along with defiant and vindictive behavior as evidenced by four (or more) of the following symptoms being displayed with one or more persons other than siblings.

Angry/Irritable Mood

1.   Loses temper

2.   Is touchy or easily annoyed by others.

3.   Is angry and resentful

Defiant/Headstrong Behaviour

4.   Argues with adults

5.   Actively defies or refuses to comply with adults’ request or rules

6.   Deliberately annoys people

HAVE YOU REACHED 4 YET?? = the criteria needed.

7.   Blames others for his or her mistakes or misbehavior


8.   Has been spiteful or vindictive at least twice within the past six months

B. (NOTE:  UNDER CONSIDERATION- why? this is the only vaguely scientific bit!) The persistence and frequency of these behaviours should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic to determine if they should be considered a symptom of the disorder. For children under 5 years of age, the behaviour must occur on most days for a period of at least six months unless otherwise noted (see symptom #8). For individuals 5 years or older, the behaviour must occur at least once per week for at least six months, unless otherwise noted (see symptom #8). While these frequency criteria provide a minimal level of frequency to define symptoms, other factors should also be considered such as whether the frequency and intensity of the behaviours are non-normative given the person’s developmental level, gender, and culture.

C. The disturbance in behaviour causes clinically significant impairment in social, educational, or vocational activities.

D. The behaviors may be confined to only one setting or in more severe cases present in multiple settings.




"Now is the time to challenge this systemic lunacy of negatively labelling hundreds of thousands of young people."

Let's avoid a :

With 'soma'  or 'drug cocktails of psychotropics for many more of our kids and avoid the U.S. business model to social control!

Sunday 24 July 2011


Ritalin: The scandal of 'kiddy coke.'

Last updated  27 November 2007


When he was in the throes of his worst tantrums, Daniel Fletcher would rip wallpaper off the walls at home and hit and kick anyone who came near him.

Once, he put his pet mouse in the microwave. On another occasion he jumped out of a moving car.

He was first diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) at the age of two, and just three years later the little boy was prescribed the amphetamine-like drug Ritalin.

The effect, says his mother Hayley, was a loss of appetite but no difference in his behaviour.

"So the doctor kept upping the doses until he was on six times the normal dose, yet he was still hyperactive."

Eight months ago, Daniel, now 14, was put on Risperdal - an antipsychotic drug usually given to schizophrenics.

"It was as if my son had been replaced by a doped-up zombie,' says Hayley, 35, who took him off it a month later.

"I could hardly wake him in the morning. It was as if all his personality was disappearing, like a patient in a mental institution."

Last week, it emerged that around 8,000 British youngsters are being treated with this powerful tranquilliser and another, similar drug called Zyprexa - despite the fact that their dangerous side-effects range from diabetes to brain tumours.

Hundreds of thousands of others are still being prescribed Ritalin, an amphetamine-like stimulant which has the same effect as "speed" and cocaine, and which, according to new evidence from the U.S., doesn't even work in the long-term.

Ritalin is a methylphenidate which acts in a similar way to cocaine by stimulating the central nervous system, which, paradoxically, can have a calming and focusing effect.

Scientists are unclear why it works in this way, although there is some evidence that the effect is achieved by the slow release of the hormone dopamine, which controls behaviour, attention and learning.

Recent findings also suggest that Ritalin can stunt growth as well as causing heart problems, insomnia and weight problems.

In the U.S., there have been 51 deaths among children and adults taking Ritalin since 1999.

According to the Medicines and Healthcare Products Regulatory Agency, 11 British children on Ritalin have died.

The cause of two deaths was heart-related: one had a heart attack, the other an enlarged heart.

One was recorded as a "sudden death". One died of a brain haemorrhage; another of a swelling in the brain.

Two committed suicide, and the last died of neo-natal respiratory distress syndrome.

Not surprisingly, experts fear that inappropriate drugs are not only being used to control children's behaviour, but are being massively over-prescribed to some children who are simply naughty.

ADHD, they say, is nothing more than a symptom of Britain's time-poor society, where children of parents working long hours are cracking under the strain of family life.

There are criticisms, too, that some doctors dole out pills when therapy would be a safer option.

In the U.S., where one in ten children takes Ritalin and where doctors write two million prescriptions a month, the situation is even worse.

A growing body of experts is even questioning whether ADHD exists at all.

"As a society, we are quick to reach for a pill," says David Healy, one of the world's leading psycho-pharmacology experts, and Professor of Psychiatry at Cardiff University.

"There's much less willingness on the part of the medical profession to say to parents: 'You have an awkward child. You must discipline them.'

"So we prescribe pills instead.

"The drugs used to treat ADHD are the same as speed and cocaine.

"We react with horror to the idea that our kids would use such drugs, but don't react about drugs such as Ritalin being given to them.

"There's a risk that your child won't grow as well.

"There are high risks that children will go on to use street drugs, too, because they will have grown used to their effects."

Professor Healy says anti-psychotic drugs such as Risperdal were used in the Soviet Union to extract information from political prisoners.

"People who took them would tell anything to anyone," he says.

"When you think about giving these drugs to kids, it's a whole new ball game."

Dr Tim Kendall of the Royal College of Psychiatrists, who is heading a team drawing up new NHS guidelines for ADHD, insists there is a place for drugs in treatment, but admits: "We have a situation where GPs prescribe anti-psychotics inappropriately.

Scroll down for more...

Are doctors prescribing Ritalin without just cause?

"There is no real excuse for prescribing drugs which are associated with such severe side-effects."

But even where Ritalin is used, Dr Kendall says guidelines do not make it clear when doctors should diagnose ADHD and when they should prescribe drugs.

"If you diagnose people loosely, you could end up with 16 per cent of the child population with ADHD.

"Under tight criteria, only 1.6 per cent would be diagnosed," he says.

"A generous understanding would be to say that doctors have reached a point where they don't know what else to offer, and they haven't got the right support to help parents."

Of course, the ADHD debate inevitably arouses enormous passions.

While some question the disorder's very existence and say medicating has simply replaced good parenting, for others, the idea that "bad parenting" is behind their child's problems is almost too much to bear.

Linda Shepherd, from Ipswich, whose son Zaque, 15, has been taking Risperdal since he was nine, describes the drug as a "life-saver".

"Without it, he's unmanageable," she says. "It controls his ADHD and gives us both peace of mind.

"I know there are side-effects, but for me it's a calculated risk.

"He's put on a lot of weight and is now obese because the drug makes him hungry all the time, but I think that's the lesser of two evils."

A spokeswoman for ADDISS, the Attention Deficit Disorder Information & Support Service, which believes medication has a valuable role to play, says: "Every child needs a proper evaluation and a treatment programme tailored to their problem.

"It's not one issue. It's a collection of factors. The problem is that people don't have access to comprehensive evaluation and treatment.

"But not giving them medication is worse."

Although there is no consensus on what ADHD is and, if it exists, what causes it, there is no doubt it has become a fashionable diagnosis for a host of behavioural issues.

In 1993, just 3,500 prescriptions were written for Ritalin in Britain. By 1998, there were 26,500. Last year, around 250,000 prescriptions were handed out on the NHS alone.

Such figures are underpinned by a study in 1999, which appeared to confirm Ritalin's benefits.

But eight years on, the original researchers have re-examined the children involved in the study and there is evidence the initial effects of Ritalin wore off after three years.

Ritalin was also found to stunt the growth of some of the children.

Professor William Pelham, of the University of Buffalo, New York, who was involved in the first study, says: "They had a substantial decrease in their rate of growth in terms of both height and weight.

"In the short-term, medication will help the child behave better.

"But in the long run it won't. And that information should be made very clear to parents."

Perhaps most disturbing, however, is the suggestion that ADHD is nothing more than the invention of pharmaceutical companies who have used clinical trials to create a disease that can be treated with their drugs.

Last year, the NHS spent £28 million on Ritalin alone.

Professor Healy says: "There is an active campaign by pharmaceutical companies to convince people that there's adult ADHD.

"Adults having problems are being told they have adult ADHD and are being offered drugs for it.

"Pharmaceutical companies market these drugs aggressively. How can GPs refuse to prescribe a drug 'clinically proven' to work?"

It is hardly surprising, then, that parents encouraged to give drugs to their children, rather than face up to the causes of their behaviour, usually take the easy way out.

Hayley Fletcher, who lives with her husband Andrew and their son Daniel in King's Lynn, Norfolk, remembers the moment her son's psychiatrist handed her a prescription for Risperdal.

"You assume the experts know best," she says. "But within a month, I knew something was terribly wrong.

"I couldn't wake him in the mornings. It was as if my son was disappearing before my eyes.

"I did some research and found they give this brain-altering drug to adults in mental institutions.

"Why did they give it to my son?

"He has severe problems, there is no doubt about that, but I cannot agree with the philosophy that these children should be drugged up to the eyeballs so they cannot be a threat to society.

"That isn't what I want for my son."

Instead, Hayley persuaded Daniel's doctor to change his medication to the weaker drug Concerta, a slow-release version of Ritalin, and improved his diet with natural produce and fish oils. She also removed him from his special school and teaches him at home.

"It's been a very long, hard path," she says, "but Daniel is a different boy. The difference is amazing.

"Initially, I trusted the doctors. But really all they are doing is turning these children into zombies.

"Now that Daniel is virtually drug free he is taking the supplement Eye Q Fish Oils as part of a trial, and it has made such a difference to his concentration levels."

Her son's story echoes that of Craig Buxton, 14, who featured on last week's Panorama, which exposed the use of anti-psychotic drugs on children with behavioural problems.

Craig, who lives with his parents, Alan and Sharon, in Stoke-on-Trent, was given both Risperdal and Zyprexa.

"The effects were dramatic and awful," says Sharon. "Within a month, he had started self-harming, cutting himself.

"Then he attempted suicide by cutting his wrist.

"He's taking Concerta now, and is much more stable and happy."

John Tyson, 39, a businessman from Yarm, Teesside, didn't question the paediatrician who put his ' restless, bouncy, fidgety' son John, now 15, on Ritalin two years ago.

"When it's a doctor you just smile and nod," he says.

"I knew nothing about the drug or how toxic it was. But things rapidly went downhill once John started taking it.

"He became aggressive and he couldn't cope with the word 'no'.

He became a horrible person. The doctors increased the dose and he turned into a monster.

He was headbutting walls and throwing things out of the window. The doctors said: 'You need more Ritalin.'"

Eventually, Mr Tyson turned for help to the Cactus Clinic at the University of Teesside's school of social sciences.

The groundbreaking centre uses a drug-free approach, and helps children learn appropriate behaviour.

The clinic also refuses to use the term ADHD.

"Attention disorders are not diseases, but patterns of inappropriate behaviour," says clinic manager Amanda Clarkson.

According to Mr Tyson, who cut gluten, wheat and dairy out of his son's diet and gave him mineral supplements: "After six weeks, the benefits were noticeable.

"After three months, I knew I was getting my boy back. I think it's wicked how children are being doped when there are alternatives."

The treatment, however, is not free. Parents can pay up to £600.

Money well spent, according to Mr Tyson, but he says it should be available to all on the NHS.

For the time being, however, it seems the medical consensus is that drugs do have a place in controlling children's behaviour, although next year could see dramatic changes.

NHS guidelines on ADHD and its treatment are being revised after concerns were raised that current treatment is not consistent.

The National Institute for Health and Clinical Excellence has spent two years investigating the disorder and its treatment and will deliver its preliminary findings in January.

Experts led by Dr Tim Kendall are looking at the criteria under which ADHD should be diagnosed and, if it exists, the best treatment.

Most likely, the guidelines will be aimed at reducing the over-prescription of drugs, while recognising their usefulness in extreme cases.

"We are looking at dietary interventions," says Dr Kendall.

"There is some evidence that coal tar derivatives found in things such as diet colas increase hyperactivity.

"There is some evidence that fish oils improve things.

"There is evidence that education can help teachers deal better with hyperactive children, and that parent training programmes are helpful."

The final NICE guidelines are not likely to be released until next summer.

Until then, the only winners are the pharmaceutical companies.

According to a spokesman for Janssen-Cilag, maker of Risperdal: "We don't recommend the use of Risperdal for children.

"Doctors are free to prescribe the drugs they feel are most appropriate."

Eli Lilly, U.S.-based maker of Zyprexa, says it has never promoted its use for ADHD.

And Novartis, which makes Ritalin, says: "Ritalin has a long record as a safe and effective medication.

"It is important that medication is only one part of a total treatment programme that should include psychological, social and educational measures."

For parents and children still baffled by the ADHD debate, such words bring little comfort.

"I'm not sure my son ever had anything called ADHD," says John Tyson.

"He just needed a bit of help. He didn't need to be doped.

Wednesday 20 July 2011


NHS spending on 'chemical cosh' child-calming drugs soars by 60% to £31m

By Laura Clark

Last updated at 6:01 PM on 11th May 2010


NHS spending on 'chemical cosh' drugs to treat hyperactivity has soared by two-thirds to £31million in just four years, new figures revealed yesterday.

Nearly 750,000 prescriptions are now being doled out every year for Ritalin and similar drugs - most of them to children.

The surge triggered concerns that children are being unnecessarily drugged as poor discipline is increasingly seen as a medical issue.

Teachers warned today that prescribing calming drugs was often cheaper and easier than 'talking cures' and parenting support.

Over-use: experts claim that prescribing drugs such as Ritalin to children is an 'easier' option than discipline at schools or parental support

Three drugs are now routinely used to treat Attention Deficit Hyperactivity Disorder (ADHD), which is characterised by disruptive behaviour, impulsiveness and difficulties focusing on specific tasks.

These are drugs based on methylphenidate (Ritalin), atomoxetine (Strattera) and dexamfetamine (Dexedrine).

Figures released under the Freedom of Information Act show that NHS spending on the three drugs in England alone rose from £18.97million in 2005 to £31.14million in 2009.

An increase in the cost of the drugs partly accounts for increase. But statistics also show that, over the same period, the number of prescriptions issued by doctors surged, from 486,536 to 744,078.


    Ritalin is from the same drug family as cocaine and amphetamines and increases levels of the brain chemical dopamine, reducing restlessness and promoting concentration.
    Children who take ADHD drugs for 36 months are about an inch shorter and six pounds lighter than their peers, according to US researchers, and may need a 'drug holiday' to catch up.
    ADHD could be a mark of genius, according to academics in Ireland. Oscar Wilde, Che Guevara, Walter Raleigh, Picasso, Kurt Cobain and Lord Byron - all thought to have been ADHD sufferers - may owe their success to 'risk-taking' genes that play a role in the condition.
    Ritalin is a Class B controlled drug and illegal possession is punishable with a five-year jail sentence or fine.
    Hyperactive children given Ritalin do better in exams than ADHD youngsters who do not take drugs, according to US research, which studied 600 primary pupils and found they were three months ahead in reading and two months in maths.
    Ritalin has been described as 'Viagra for the brain' and a 'smart drug' that can boost brainpower in healthy people by boosting concentration; critics say there are too many risks in taking it unless for serious cases of ADHD.
    Doctors have warned that Ritalin tablets are being sold in school playgrounds for just a few pence a time to pupils in search of an illicit 'high'.
    Growing numbers of Oxford University students are taking Ritalin and other so-called smart pills to boost performance in exams, according to an investigation last year. They are buying the tablets online and trading them in college libraries.
    Doctors have warned that competitive parents are increasingly giving healthy children Ritalin pills in a bid to boost their exam grades and university chances.

The figures may underestimate the true scale of spending since private prescriptions and those handed out by in-house hospital pharmacies are excluded from the data, which was issued to The Guardian by the NHS Business Services Authority.

Official NHS guidelines recommend drug treatment for the most severely affected but some doctors take this more literally than others.

Figures published in 2008 showed that doctors in the Wirral dispensed one Ritalin prescription for every seven children under 16, although this did not equate to one in seven children taking Ritalin - since one child could have repeat prescriptions.

Across England, the average was one for every 23 children, while Stoke-on-Trent doled out just one prescription for every 159 children.

Experts warned that some doctors and teachers are too keen to pin medical labels on what would previously have been branded poor discipline.

Dr Gwynedd Lloyd, an education researcher at the University of Edinburgh, said: 'You can't do a blood test to check whether you've got ADHD - it's diagnosed through a behavioural checklist.

'Getting out of your seat and running about is an example - half the kids in a school could qualify under that criterion.

'I know a lot of children have genuine difficulties, and some of these are biological, but most are social and cultural.'

Meanwhile teachers warned that funding pressures on schools could lead to an increase in prescribing in future.

Mental health programmes to help children through counselling and parental support were labour-intensive, they said.

Tim Bown, assistant head of Queen's Park Community School, North London, said: 'Ideally, schools would prefer to offer intensive one-to-one support, but if the resources are limited - which they usually are - then we're pushed into a choice between medication or exclusion.

'Hearing a student say that a drug "takes away his soul" doesn't sit comfortably with us as a school, but permanent exclusion doesn't either.'

He warned that therapists, counsellors and mentors could be sacrificed as schools fought to keep teachers.

Professor Frank Furedi, a sociology expert from Kent University and author of Therapy Culture, said: 'Parents are ambitious for their children and teachers are at a loss about how to manage classroom behaviour, so they medicalise it.'

Since ADHD was first recognised as a medical condition in the mid-1980s, debate has raged over the use of drugs to treat it.

Side-effects can include stunted growth and cardiovascular problems, as well as insomnia, lethargy and headaches.

But research also shows that youngsters treated with Ritalin and similar drugs do better in tests.

Thursday 14 July 2011

New Approach to Revise Australian Guidelines for ADHD for Children-July 2011

Australia Revises ADHD Guidelines - Open book approach - a good start for the new National ADHD Guidelines Committee

Today (Wednesday 13 July 2011) Mental Health Minister Mark Butler announced the membership of the committee responsible for developing new Australian guidelines on ADHD. Of the ten members invited to participate, two have significant conflicts of interest that should preclude their involvement. However, this compares very favorably to previous ADHD guideline development processes which have been dominated by pharmaceutical company allies who have relied on commercially compromised research.

It is also, for the first time, an open process. We know from the start who is developing the guidelines and the details of their conflict of interest declaration. (see http://www.nhmrc.gov.au/guidelines/adhd-conflicts-interest ) Gillard Government Mental Health Minister Mark Butler deserves credit for this. Let us hope this creates a precedent for future commonwealth government medical guidelines and advisory committee processes.

Rescinded 2009 draft Guidelines

The new guidelines, due for release in October, will supersede the flawed draft ADHD guidelines developed by the Royal Australian College of Physicians (RACP) at a cost of $135,000. The RACP process begun in 2007 and was dominated by ADHD prescribing enthusiasts and dogged conflict of interest controversies. In November 2009 the commissioning body, the National Health and Medical Research Council (NHMRC), decided that because of the then uncompleted investigation into undisclosed drug company payments to three prominent US researchers, whose work was heavily relied on in the draft guidelines, the process should be halted. 1  On 2 July 2011 the Boston Globe reported that Harvard Professor’s Biederman, Spencer and Wilens, who were referenced 82, 46 and 32 times respectively in the draft guidelines, had been sanctioned by their employer after investigations into allegations of millions of dollars in hidden pharmaceutical company payments were completed. The most high profile of the three Professor Joseph Biederman is believed to be the worlds’ most frequently quoted researcher supporting the use of psychotropic drugs for ADHD.2

The Biederman (et al) scandal was not the only ‘conflict of interest’ controversy around the Draft National ADHD Guidelines. The guidelines committee was initially chaired by Dr Daryl Efron until his ADHD pharmaceutical company ties were exposed by the Daily Telegraph in April 2007. 3 Freedom of Information processes also revealed the vast majority, at least 70%, but probably 80% ‘of the original (guidelines committee) group members, including doctors, have declared receiving grants and air fares, hotels and overseas trips from companies making drugs to treat the disorder.’ 4 (for more detail see http://speedupsitstill.com/gillard-government-continues-turn-blind-eye-drug-company-money) 

Flawed 1997 National Guidelines

The 2009 draft guidelines were supposed to replace Australian National ADHD guidelines developed for the NHMRC in 1997. The 1997 guidelines were also developed by clinicians, mostly paediatricians, with ties to the pharmaceutical industry. They encouraged the widespread ‘off label’ prescribing of stimulants and other psychotropic drugs for ‘co-morbid disorders’, without any evidence base except for ‘reasonable theory’ derived from ‘clinical experience’. This helped facilitate the explosion of prescribing rates in the late 1990’s and into the new millennium by providing a justification for reckless, hypothesis-based prescribing by a relatively small number of self-appointed ‘ADHD experts’; primarily paediatricians with limited mental health training.5

2011 Committee

In comparison with either the 1997 or 2007 guideline development committees, the 2011 committee is relatively ‘conflict of interest’ free. At last this gives hope for true ‘evidence based – first do no harm’ approach.

The 2011 committee consists of:

Bruce Tonge (Chairperson) – Child and Adolescent Psychiatrist, Head of the Centre for Development Psychiatry at Monash Medical Centre.

Mark Dadds – Professor of Psychology, University of New South Wales.

John Dowden – Director of Therapeutic Guidelines Ltd.

Jon Jureidini - Professor of Psychiatry and Paediatrics, Adelaide University.

Michael Kohn - Paediatrician, Westmead Hospital Sydney.

Nicole Rinehart – Consulting Clinical Psychologist, Associate Professor, School of Psychology & Psychiatry, Monash University.

Margaret Vikingur representing LADS – Volunteer, Learning and Attentional Disorders Society, Perth.

Three others are expected to join the committee:

Vicky Anderson – Paediatric Neuropsychologist, University of Melbourne.

Kim Cornish - Developmental Neuroscientist, School of Psychology and Psychiatry, Monash University.

Professor Helen Milroy – Child and Adolescent Psychiatrist and Professor Aboriginal and Torres Strait Islander Health, University of Western Australia.

While a number of members of the committee have worked with or for pharmaceutical companies, for most these affiliations don’t relate directly to ADHD. However this can’t be said for Sydney’s Westmead Hospital paediatrician, Professor Michael Kohn, and the Perth based pharmaceutical company sponsored Learning and Attentional Disorders Society (LADS) who have a ‘consumer representative’ on the committee. Both Kohn and LADS have significant and direct conflicts of interest and should be excluded from the committee.

Professor Kohn’s quasi-religious faith in Ritalin

Professor Michael Kohn’s 2009 description of an article in Sydney’s Daily Telegraph detailing extreme reactions to ADHD medications reported to the TGA, such as psychotic episodes and suicidal ideation as “BLASPHEMING the use of Ritalin” indicates a near religious fervour for prescribing amphetamines like drugs to children.6 This is not an isolated comment from Professor Kohn. (refer Where is the evidence to support ‘ADHD expert’ Prof Kohn’s claim that amphetamines aid brain development? )

Professor Kohn has significant financial connections to ADHD drug manufacturers Eli Lily and Janssen Cilag7  He was a member of Strattera Advisory Board for Elli Lilly and is currently undertaking publicly funded research on Strattera. He has received other financial support from both Janssen Cilag and Eli Lilly and been paid to prepare and deliver educational materials by Janssen Cilag. He has also received research support for ADHD studies from Brain Resource Ltd which has received funding from at least 13 different pharmaceutical companies.

Learning and Attentional Disorders Society (LADS)

LADS is partially funded by drug companies and has a long history of marketing of ADHD as having a biological cause best treated with ‘safe, effective medication’. 8 In 2003, on a Perth community television program Face the Facts, speaking on behalf of LADS, Michelle Toner and psychiatrist Dr Roger Patterson made some noteworthy statements.

Dr Patterson said: Dexamphetamine has the amphetamine name in it and this is what people are starting to worry about because they are giving them to children – or they are taking them themselves…let me dispel that, they are taking a medicinal form of amphetamine…this is not addictive stuff. In fact, I wish it was a little more addictive so that my younger patients would remember to take it rather than having to be reminded by their long-suffering parents.9

Toner’s statements on the same TV program were even more notable. ‘In order to get a high equivalent to what people are taking [as] street speed, you would have to take close to 200 tablets. Children take 1 or 6 tablets a day and it is not addictive at all.’ 10 Two hundred of the standard 5 milligram dexamphetamine tablets would deliver a dose of 1 gram which would kill most people and a fair proportion of elephants as well. 11

Also obviously ignorant of the effects of 1 gram of dexamphetamine, the interviewer went on to ask Toner: ‘Right, but if you do have ADHD and you take the medication, is it successful?’ Toner replied, ‘Oh yes…a lot of people discovered they had ADHD by accident. For example, truckies who needed uppers to keep them awake while they were driving across the Nullarbor suddenly found that they were driving a whole lot better…when they were taking dexies.’ Both Toner and Patterson remain on the professional advisory board of LADS.  12

LADS have even encouraged the illegal diversion of ADHD amphetamines. In 1998 LADS was warned twice not to recommend the illegal use of a child’s ADHD stimulants by parents if they thought they had adult ADHD.13 LADS have also publicly endorsed ADHD drugs in press releases prepared by public relations business in order to promote ADHD drugs. 14

LADS’ representative Margaret Vikingur is probably a very well intentioned individual, however, LADS acceptance of drug company money and its history should preclude it from membership of the committee. Failing LADS exclusion a counter-balancing voice from a ‘conflict of interest’ free support group should be included on the committee.

Minister Butler a vast improvement on ‘Roxon’s hypocrisy’ and ‘Do Nothing Abbott’

The above concerns aside, in comparison to the two previous ministers with responsibility for the development of national ADHD guidelines, Nicola Roxon and Tony Abbott, Mental Health Minister Mark Butler has made a good start.

When opposition health spokesperson Roxon called for the public release of conflict of interest declarations but refused to even release the names of guidelines committee members when she became the Health Minister. Her predecessor, Howard Government Health Minister Tony Abbott, was just as bad. He had the opportunity to prevent the problem when the original panel was appointed. He then had an opportunity to fix his original mistake when the conflict of interest issues were first revealed in 2007. Abbott expressed concern and then did next to nothing. (for more detail see http://speedupsitstill.com/gillard-government-continues-turn-blind-eye-drug-company-money )

Minister Butler has delivered an open process and ensured there is a range of views and expertise on the committee. It is hoped that the committee will produce cautious, evidence based, child friendly, rather than drug-company friendly, hypothesis based, guidelines. However it is just the start of the process and only time will tell. I will keep you posted.

Related Media; The Australian – Sue Dunleevy 13 July 2011 Attention deficit disorder guru’s in conflict of interest http://www.theaustralian.com.au/national-affairs/health/attention-deficit-disorder-gurus-in-conflict-of-interest/story-fn59nokw-1226093390142

    NHMRC, ‘Draft Australian Guidelines on ADHD – NHMRC consideration deferred pending outcome of USA investigation’, NHMRC Noticeboard 2009. Available at http://www.nhmrc.gov.au/media/noticeboard/notice09/091130-adhd.htm (accessed 5 January 2010). ↩
    http://www.esi-topics.com/add/interviews/JosephBiederman.html ↩
    ADHD guru quits over Ritalin link, Janet Fife-Yeomans, The Daily Telegraph 5 May 2007 http://www.dailytelegraph.com.au/news/sydney-nsw/adhd-guru-quits-over-ritalin-link/story-e6freuzi-1111113472188 ↩
    Janet Fife-Yeomans, ‘Guidelines panel linked to drug firms’, The Advertiser, 17 November 2008, Available at http://www.news.com.au/adelaidenow/story/0,22606,24660999-5006301,00.html (accessed 4 October 2009). ↩
    National Health and Medical Research Council, Attention Deficit Hyperactivity Disorder (ADHD), Canberra, 1997, pp. 32-38. ↩
    Medicating our children, Reportage Online, 22 December 2009 http://www.reportageonline.com/2009/12/medicating-our-children/ Kohn’s comment was in response to We’re turning our children psychotic with ADHD medication, Kate Sikora, The Daily Telegraph October 13, 2009. http://www.dailytelegraph.com.au/lifestyle/body-soul/were-turning-our-children-psychotic/story-e6frf01r-1225786025127 ↩
    M. Williams (et al), 2010. An ‘integrative neuroscience’ perspective on ADHD: linking cognition, emotion, brain and genetic measures with implications for clinical support. ↩
    ‘LADS has accepted limited unrestricted grants from pharmaceutical companies.’ (Including Eli Lilly and Novartis.) See http://www.ladswa.com.au/page.php?id=6 (accessed 26 June 2009). ↩
    Dr Roger Patterson interviewed on Face the Facts, video recording taken from Channel 31 Perth, 27 January 2003. 25 ↩
    Michelle Toner interviewed on, Face the Facts, video recording taken from Channel 31 Perth, 27 January 2003. This information is also referred to in Ferguson and Rushworth, ‘ADHD – The Quick Fix’. ↩
    ‘Individual patient response to amphetamines varies widely. While toxic symptoms occasionally occur as an idiosyncrasy at doses as low as 2mg, they are rare with doses of less than 15mg; 30mg can produce severe reactions, yet doses of 400 to 500mg are not necessarily fatal.’ GlaxoSmithKline’s Prescribing Information for Dexedrine (dextroamphetamine sulphate). Available at http://us.gsk.com/products/assets/us_dexedrine.pdf (accessed 26 June 2009). ↩
    http://www.ladswa.com.au/page.php?id=9 ↩
    WA Stimulant Committee, Minutes of Meeting held on 4 August, 1998, obtained under Freedom of Information Act 1992 ↩

Wednesday 13 July 2011


Mr Pat McFadden MP:

The Secretary of State will be aware that there has been a tripling of prescriptions for drugs such as Ritalin, or to give it its generic name methylphenidate hydrochloride, in the past decade. He will also know that NICE guidelines state that those drugs should not be prescribed to children under the age of six. Why cannot his Department give a breakdown showing how many of those prescriptions are going to children under the age of six? Will he heed the call from the Association of Educational Psychologists for a review of the growth of the prescription of those powerful psycho-stimulants to very young children?

Paul Burstow(Lib-Dem)-Secretary of State for Care:

The Right Hon. Gentleman raises a very important point. We need to ensure that we have the right data to properly understand prescribing practice, so that we can both challenge bad practice and ensure that the NICE guidance is properly followed. I would like to look more closely at his points and then write to him in detail.


(1) if he will estimate the number of children who have been prescribed Ritalin or a similar drug;

(2) if he will estimate the number of children under the age of six who have been prescribed Ritalin or a similar drug; and if he will assess trends in the number of such prescriptions in the last five years;

(3) if he will estimate the number of children under the age of six in Wolverhampton who have been prescribed Ritalin or a similar drug;

(4) what guidance (a) his Department and (b) the National Institute for Health and Clinical Excellence issues to practitioners on the prescription of Ritalin and similar drugs to young children.

Anne Milton: I refer the right hon. Member to the answer I gave the right hon. Member for Birkenhead (Mr Field) on 4 April 2011, Official Report, column 684W.

The Information Centre Prescribing Team has advised that this information is not available for children's prescriptions. They have however provided information on the numbers of all Ritalin prescriptions dispensed in the community as follows:

Ritalin is a branded version of the drug Methylphenidate Hydrochloride. The following table shows the total number of items dispensed for Methylphenidate Hydrochloride overall (including Ritalin) and for Ritalin separately for individuals of all ages.

Methylphenidate Hydrochloride prescriptions dispensed in the community in England



Prescription items


Methylphenidate Hydrochloride


Of which : Ritalin