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Friday 23 November 2012

Shut up and take your pills The easy way to help hyperactive children is to give them medication - but it is often unnecessary. "Why do affluent parents use it to get 'designer children?'By Libby Purves - September 2005 - Courtesy of Timesonline


Yet sometimes I wonder whether future generations may not look back at our habits and shudder in their turn. One of them in particular grates on me: it is reported that prescriptions of the drug Methylphenidate — commonly sold as Ritalin — have risen sharply in a decade. Last year in England there were 359,000, the vast majority to children under 16. This is a mind-altering drug, described by its most bitter opponents as “ prescription crack”; in the United States 6 per cent of all children take it. Here it is less than 1 per cent, but rising fast: for this is the cure-all for the fairly newly defined condition of “ADHD” — attention deficit hyperactivity disorder.
The amphetamine-based drug is claimed by its many adherents to improve concentration and calm children’s behaviour. Parents who use it are violently defensive of their decision. The ADHD lobby has claimed, controversially, that one in twenty children today suffers such a behavioural “disorder”. Yet it is routinely prescribed to children whose age or circumstances might just as easily explain their erratic behaviour.
In the US babies have been given the drug: here, it is more likely to be administered to a nursery or school-age child who is not interested in what his teacher says and disrupts both class and home with destructive boisterousness.
I say “his” for good reason. Most children diagnosed with ADHD are boys. There is no hard clinical diagnosis or medical test for the condition; neurological theories contradict one another or fade under close examination. So it is generally diagnosed on the basis of mere behaviour — restlessness, fidgeting, outbursts of temper, unwillingness to take instructions or concentrate (which means failure to concentrate on what adults and the national curriculum want you to concentrate on). Indeed, the more descriptions of the symptoms you read the more images swim into your head: Alastair Campbell, Piers Morgan, Sir Alan Sugar, Mark Twain, Horatio Nelson, Thomas Edison . . . It is hard not to feel an uneasy suspicion that this is a conspiracy against boyish boys. In the heavily feminised, mimsy tick-box culture and educational system that now runs children’s lives, with fathers often working for long hours or absent altogether, the very nature of boyhood attracts disapproval. Or the very nature of childhood, indeed: one woman interviewed about the marvels of Ritalin complained that before it her three-year-old was always asking questions, and going on to another as soon as one was answered, which drove her mad. Well, it drives us all mad: “Why is the moon? Can sheep fly?” But if we are wise, we rejoice in it.
There are strong lobbies against Ritalin too, some of which describe it as pharmacologically similar to cocaine and brand psychiatrists as dupes of “irresponsible pseudo-science”. But calmer voices express unease, too. Professor Sir Alan Craft, president of the Royal College of Paediatrics, admits that it is “concerning”; Professor Peter Hill, a specialist in ADHD at Great Ormond Street, is quoted as admitting: “While Methylphenidate undoubtedly works for some children, clinicians are under increasing pressure from vast waiting lists to see people as quickly as possible, resulting in some medicating where it is perhaps not necessary . . .”
Incidentally, our propensity to drug children rather than meet their awkward emotional needs is also underlined by the fact that Britain has one of the world’s highest rates of prescribing antidepressants to under-16s. Thoughtful doctors go so far as to say that pharmacological solutions are popular because they offer parents an alternative explanation for bad behaviour, removing any suggestion that inadequate parenting, family breakdown or bad food are involved (an experiment in Co Durham found that if you give a daily dose of fish oil to poor children who eat junk food, it has almost as much effect as Ritalin in improving concentration and behaviour).
Without being Luddite or hysterical, we should certainly be worried. In the US there is a strident middle-class lobby for the use of the drug, with websites encouraging children to “feel good about themselves” when they take it. In Britain it is less explicit, for I have a hunch that if you took a social profile of ADHD prescriptions, a disproportionate number would go to boys from poor and ill-supported homes, without attentive fathers. Note also that when a child is diagnosed (and doctors’ definition of severe ADHD is subjective), the parents are eligible for disability benefits. So the family gets a bit more money, the child is outwardly calm, the school can function better despite its huge classes, lack of outdoor space and prescriptive learning targets. The doctor has the family off his back. The drug company doesn’t do badly, either.
Again, let us have no hysteria. There is such a thing as destructive hyperkinetic disorder. Sometimes it does go beyond normal boyish high spirits into an area of real mental illness. Sometimes, after exhaustive and responsible experiment, it is clear that the cause is not emotional neglect, bad diet or too much screen time. Sometimes Ritalin is a boon. But are there really so very many British children intrinsically disordered in their brains? So ill that they must take a psychoactive drug for 10 or 15 years of their young lives, with unknown long-term side-effects?
You would think that a country that obsesses for days about a rich adult supermodel snorting a bit of cocaine would be more worried about this.

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