One in 20 children suffers attention disorder

By Marie Woolf, Chief Political Correspondent

15 January 2005
http://news.independent.co.uk/uk/health_medical/story.jsp?story=601133

Five per cent of children in England and Wales have been officially
diagnosed with the hyperactivity disorder ADHD ministers said this week,
as new figures showed a dramatic increase in the prescription of the
controversial drug Ritalin.

Health ministers said "it was becoming increasingly common for
paediatricians" to diagnose attention-deficit hyperactivity disorder
(ADHD), which some have warned is simply a symptom of bad behaviour.

Figures released by health ministers showed that at least 345,000
children aged between six and 16 officially suffer from the behavioural
disorder, while the number of prescriptions of Ritalin and other drugs
to treat it has rocketed over the past two years. Last year, 329,000
prescriptions were written for drugs combating childhood hyperactivity,
compared with 271,000 the year before.

Opposition MPs cautioned that many children who had been diagnosed with
ADHD were hyperactive because of poor parenting or because they ate junk
foods full of chemicals.

The Liberal Democrat MP Sandra Gidley, a former pharmacist, warned
against parents regarding Ritalin as "a wonder drug" that could cure
disruptive behaviour in all youngsters.

"Ritalin is regarded as a magic bullet by some parents. It is becoming
so widespread that I have had parents in my surgery who regard it as a
wonder drug, complaining that doctors are refusing to prescribe it to
their children," she said. "In some kids it is because they are eating
so many additives in junk food and often what is needed is some
low-level intervention from social services to help with parenting
skills. In many cases, Ritalin is a cop-out solution to a wider problem."

Although many parents say that Ritalin has helped treat serious
behavioural problems in children who had previously destroyed family
life, others fear that the drug is being too generally prescribed and
given to many children unnecessarily.

Studies by psychiatrists have shown that children with attention deficit
disorder are four times more likely than average to suffer mental
problems later in life. Researchers at Harvard Medical School have also
warned that the misdiagnosis of ADHD in children, followed by the
prescription of Ritalin, could lead to a greater likelihood of
depression in adulthood.

Dr Stephen Ladyman, the health minister, who released the figures this
week to Tory health spokesman Tim Loughton, said that "a treatment
programme" for ADHD should not "rely on medication alone".

"It is recommended that interventions that focus on the behaviour of the
child, family interactions, classroom problems and learning difficulties
should be offered," he said. {And, by the next millennium, healing the
gut, boosting nutritional status, plus chelation will be mentionable in
polite society (ie, by spokespersons quoted in corporate media)}

The Department of Health added that guidelines from the National
Institute for Clinical Excellence said that children on Ritalin should
"receive regular monitoring and be taken off the drug if there was no
improvement of symptoms".

The bill for hyperactivity drugs is believed to exceed 10m a year.

In North America, where Ritalin prescriptions have also gone up, the
drug has been sold illegally to children.

*

Recently announced findings: drugs like Ritalin induce learned
helplessness. Just what America needs, a growing number of voters who
behave, stay in their cubicles, and don't think for themselves. Those
with chemically induced Learned Helplessness will channel surf
peaceably, without making waves. The learned helplessness news item
follows a parent's comment.

A parent had written:
Sadly, I think there's plenty of reason to worry! I worked in public
schools for 33 years, as both a teacher and an administrator. MANY
educators want to medicate those children who aren't easy to teach. They
certainly tried to force me into it with my autistic son, but we were
lucky that I knew as much, or more, about the system as they knew. My
son is 17, and I'm awfully glad that we're nearing the end of our
sojourn with public schools. Isn't it sad that any parent feels they
have to say that?

- - -

A recent news release described Harvard researchers' findings: drugs
like and including Ritalin induce depresssion-like traits and learned
helplessness (A-B).

A. Attention Deficit Drugs May Have Long-Term Effects
http://www.abcnews.go.com/wire/US/reuters20031208_12.html

Dec. 8 - WASHINGTON (Reuters) - Drugs given to children to treat
attention deficit hyperactivity disorder could have long-term effects
on their growing brains, studies on rats suggest.
Several studies published on Monday show that rats given a popular
ADHD drug were less likely to want to use cocaine later in life, but
also often acted clinically depressed and behaved differently from
rats give dummy injections.

While rats are different from humans, the studies suggest that
doctors should watch children for long-term effects, too.

In the United States between 3 percent and 5 percent of children are
diagnosed with attention deficit disorder, marked by reduced ability
to concentrate, difficulty in organizing and impulsive behavior.

Patients are commonly prescribed stimulants but the practice is
sometimes controversial.

William Carlezon of McLean Hospital and Harvard Medical School in
Boston and colleagues raised two groups of rats. One was given
Ritalin, known generically as methylphenidate, during the rat
equivalent of pre-adolescence, while the other was given a salt water
injection.

When they matured, the rats were tested for "learned helplessness" --
how quickly they gave up on behavioral tasks under stress.

"Rats exposed to Ritalin as juveniles showed large increases in
learned-helplessness behavior during adulthood, suggesting a tendency
toward depression," Carlezon said in a statement.

But rats, which generally like cocaine, were less likely to eat it if
they had been give Ritalin.

Carlezon said he did not believe the effects were specific to
Ritalin, made by Swiss drug giant Novartis. It could instead be a
general effect of stimulant drugs, many of which act by increasing
the activity of a key message-carrying chemical called dopamine.

Higher dopamine levels could affect the way brain cells cement their
connections during development, Carlezon wrote in the Dec. 15 issue
of the journal Biological Psychiatry.

A team at the University of Texas Southwestern Medical Center at
Dallas found that adult rats were less responsive to rewarding
stimuli and reacted more to stress if they had been given
methylphenidate as youngsters.

A third study done by a team at Finch University of Health
Sciences/The Chicago Medical School found changes in how dopamine
neurons responded to methylphenidate.

"These three studies remind us how limited our knowledge is of the
neurochemical and functional characteristics of the human brain
during childhood and adolescence and on the effects of psychotropic
drugs on brain development," Dr. Thomas Insel, Director of the
National Institute of Mental Health, wrote in a commentary.

B. Biol Psychiatry. 2003 Dec 15;54(12):1330-7.
Enduring behavioral effects of early exposure to methylphenidate in rats.
Carlezon WA Jr, Mague SD, Andersen SL.
Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont,
Massachusetts 02478, USA.

BACKGROUND: Methylphenidate (MPH) is a stimulant prescribed for the
treatment of
attention-deficit/hyperactivity disorder (ADHD). Stimulant drugs can cause
enduring behavioral adaptations, including altered drug sensitivity, in
laboratory animals. We examined how early developmental exposure to
stimulants
affects behavior in several rodent models. METHODS: Rats received MPH or
cocaine
during preadolescence (P20-35). Behavioral studies began during
adulthood (P60).
We compared how early exposure to MPH and cocaine affects sensitivity to
the
rewarding and aversive properties of cocaine using place conditioning.
We also
examined the effects of early exposure to MPH on depressive-like signs
using the
forced swim test, and habituation of spontaneous locomotion, within
activity
chambers. RESULTS: In place-conditioning tests, early exposure to MPH or
cocaine
each made moderate doses of cocaine aversive and high doses less rewarding.
Early MPH exposure also caused depressive-like effects in the forced
swim test,
and it attenuated habituation to the activity chambers.CONCLUSIONS: Early
exposure to MPH causes behavioral changes in rats that endure into
adulthood.
Some changes (reduced sensitivity to cocaine reward) may be beneficial,
whereas
others (increases in depressive-like signs, reduced habituation) may be
detrimental...