Ritalin nation

Andrea Bilbow says her son’s life changed dramatically at six
years old when he began taking Ritalin. Joe suffers from attention
deficit hyperactivity disorder (ADHD), but within half an hour of
taking the drug he could sit still and watch television – something
that had been impossible beforehand, writes Katie
Leason.

His behaviour at school improved dramatically too. Whereas before
he was unable to sit still and would wander around the class
touching things, the medication enabled him to focus on what he was
doing.

“His reading age jumped three years in a year,” says Bilbow, who
describes the change as “a total transformation”.

Now 16, Joe still takes the medication, aware that without it he
acts differently. “When he’s off it he can’t focus, is impulsive
and upsets the people around him, and that has a negative effect on
him,” his mother says.

But Bilbow, who founded the Attention Deficit Disorder Information
and Support Service (Addiss) is aware that not everyone thinks that
giving young children powerful drugs is the right thing to do. Yet
she says anything that helps treat ADHD must be explored, as the
disorder can lead to a lack of educational achievements,
psychiatric problems and offending.

“It’s no good saying we should have considered medication when the
child is in the criminal justice system,” she says. “It’s like
saying I’ve got an infection but I’m not going to treat it, let’s
see how it works out and then it gets worse and worse. ADHD doesn’t
go away, it’s there for life.”

She believes a variety of treatments is required and that
medication can help the effectiveness of other approaches, such as
behavioural therapies.

Like many parents of children with ADHD, Bilbow is fed up with how
society, and even statutory services, regard the disorder. Parents
are often blamed for their child’s behaviour, and professionals,
including doctors and teachers, can be dismissive.

Similarly, social services are not always helpful. They tend not to
recognise ADHD as a disability and, as a result, carers are not
entitled to respite care. Social services do not want any
involvement, says Bilbow, until a parent is pushed to their limits
by the child’s behaviour and lashes out, which results in child
protection concerns.

Although medication has helped Bilbow’s family, some feel that too
many children are prescribed medication for mental health problems.
Last year, according to the Department of Health, as many as
230,000 children were prescribed Ritalin in England.

Peter Wilson, director of mental health charity YoungMinds, says
that although Ritalin helps in 70 per cent of cases nearly
one-third of children do not respond. He believes proper diagnosis
is essential and that problems may need to be examined more
imaginatively.

“Just to go off to the pill bottle and make people feel temporarily
well when it’s not necessary is disturbing,” he says.

He worries that too many hyperactive children are put into a
medical category unnecessarily.

He is not alone. Ruth Stark, professional officer for the British
Association of Social Workers in Scotland, says medication may be
used to cut corners as there are too few trained workers and not
enough time. Although drugs can be useful in calming a situation in
order to look at the issues, they can also cloud an individual’s
ability to focus.

“There are troubled young people around but not all troubles are to
do with a chemical imbalance,” she says. “A lot may be to do with
their families and the environment in which they live. You need to
have time to explore some of these issues and you can’t do that in
a 10-minute or half-hour interview.”

But, given the stress on human resources, can drug therapy work on
its own? Judy Hutchings, a consultant clinical psychologist for
North West Wales NHS Trust says there is little evidence to support
the effectiveness of medication alone for children with ADHD. Even
with the medication, parents will still need to be trained in how
to manage their children.

Hutchings runs two programmes, one for parents and one for
children, to manage ADHD and other disorders. The first teaches
parents how to manage their children and how to build positive
relationships and encourage good behaviour. The other teaches
children how to do their best in school, make friends and manage
their anger. Some of the children on the programme will be taking
medication, others will not.

Doctors are the ones doing the prescribing and they deny that
medication is the easy option, saying that it is time-consuming and
requires regular reviews.

James Kennedy, the prescribing spokesperson for the Royal College
of General Practitioners, insists that family doctors are
reluctant, indeed very conservative, in their prescribing of drugs
to children and adolescents with mental health difficulties. He
says it has always been thus and that prescribing rates are lower
in the UK than elsewhere. In addition, the recent warnings around
the prescribing of some antidepressants to children and adolescents
have made doctors even more aware of the problems.

“There is recognition that these issues are often multi-factorial
and that a simple prescription is not going to solve the problem,”
Kennedy says.

And those children who need specialist help often encounter
problems accessing child and adolescent mental health services,
which in his area have an 18-month waiting list.

He would like health and education to work more closely together.
“There should be good relationships with local schools so that, if
someone does need to see us, there’s a referral by the teacher.
This will help us hear about some of the background rather than
secondhand via a parent,” he says. “I’ve been working in general
practice for 14 years and I recently got my first referral letter
from a teacher about a child.”

He would also like to see health’s interaction with social services
improved “so that, when we get a child in, instead of talking to a
duty social worker you can speak to someone with specialist
knowledge of child and adolescent issues”.

He hopes that the national service frameworks for mental health and
children will provide a “turbo boost” to build local alliances and
secure resources.

But how far can teachers become involved? John Bangs, head of
education at the National Union of Teachers, says teachers do not
receive enough training on children’s mental health problems. And
he does not think that they should be expected to take on the
responsibilities of health and social workers.

“They need to have the ability to recognise a problem and know who
to go to,” he says, adding that teachers are responsible for
children’s education, not their health.

It is hoped that the green paper Every Child Matters will improve
integrated working between the different agencies, which will help
in the identification and treatment of children with ADHD and other
mental health problems.

For many children, medication improves the quality of their lives.
But as the debate over the prescribing of medication to children
continues, the pharmaceuticals industry emerges as the only clear
winner.

Signs of disorder 

There are several indicators that a child may have attention
deficit hyperactivity disorder (ADHD), according to mental health
charity YoungMinds.  They may be:

• Restless and unable to sit still. 
• Easily distracted.  lUnable to pay attention. 
• Struggling at school. 
• Appearing not to listen. 
• Disruptive in their play. 
• Behaving impulsively. 

Symptoms usually start when a child is a toddler and always
before age seven. About 1-2 per cent of children have ADHD, which
is more common in boys. 

What causes ADHD? 

Many experts believe the condition is caused by a problem in the
part of the brain which controls impulses and the ability to
concentrate, although a combination of factors, including
environmental ones, are likely to contribute. 

What help is available? 

Medication, behavioural therapy, counselling, family meetings
and special educational provision.  Most commonly prescribed drugs
are methylphenidate (Ritalin) and dexamphetamine (Dexedrine). These
work by stimulating the part of the brain that regulates
activity.

‘Your mother has given you cocaine’   

Sharon O’Dell’s daughter, Yasmin, was diagnosed with attention
deficit hyperactivity disorder (ADHD) when she was five. As a baby,
Yasmin seemed different and had to be watched constantly. 

“If we were shopping I had to bribe her to keep her in the
pushchair otherwise she’d run away,” says O’Dell.  

Once she started school the difference between her and other
children became more apparent. She got into trouble and would
wander around the classroom finding it difficult to sit still. At
home O’Dell needed subtitles to watch television as Yasmin would
always be making so much noise. At night Yasmin would have night
terrors and wake up screaming. 

After seeing a programme about ADHD on television O’Dell decided
to take Yasmin to the doctor. But her GP was sceptical. “He laughed
at me and said ADHD was for boys not for girls.” 

But eventually he agreed to refer her to a specialist. After
eight visits to mental health professionals, Yasmin was given a
diagnosis – 11 months after her mother first went to the doctor.
And with the diagnosis came a prescription for Ritalin. 

O’Dell says the effects of the medication were immediate.
Although other techniques, including changing Yasmin’s diet and
rewarding good behaviour, had not helped, Yasmin could watch
television within 20 minutes of taking her medication. 

The dosage was increased gradually and the psychiatrist rang
every other day. The medication would wear off after about four
hours, and needed to be taken three times a day. Yasmin is now on a
slow release version so she does not have to take the medication to
school. 

O’Dell feels that some of the media reports on ADHD can be
misleading and upsetting. She says: “I don’t let my daughter read
them but other children have and said to her ‘your mother has given
you cocaine’.” 

But she maintains that the medication has made a big difference
to her daughter and the rest of the family and wonders whether the
press would be so negative if her daughter was being given insulin
for diabetes. 

O’Dell advises parents who suspect that their child may have
ADHD to ask their GP for a referral to a psychiatrist. But she
warns that they may have to fight on their child’s behalf and may
need help from a support group.