Ritalin drug should only be used in severe cases, says doctor

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THE Sheffield psychiatrist who drew up national guidelines on the use of Ritalin said the powerful drug should only be given to children with severe hyperactivity problems - and even then alongside other treatments.

Dr Tim Kendall is director of the National Collaborating Centre for Mental Health, set up by NICE, the body which approves medications offered for treatment through the NHS.

“Ritalin should not be used for mild or moderate ADHD, and it should not be prescribed by GPs unless they’ve been seen by a specialist,” he said.

“Their first treatment should be a training and education programme. Their parents should get training to deal with their difficult behaviour and on top of that their school teachers should be contacted to co-ordinate the key adults in the child’s life.

“If you do that, particularly when they’re young, you can halve the number of kids diagnosed with ADHD. It’s very effective.”

He said individual cognitive behavioural therapy is also an option for children with persistent behavioural problems.

“If a child has severe ADHD you may also want to try all of that with Ritalin, but monitor it very carefully for all the side effects.”

According to Dr Kendall, exercise and a good, balanced diet can also help, but he warned parents to be wary of nutritional supplements.

“We found there’s no general benefit but you do get stories where it has worked,” he added.

Dr Kendall said methylphenidate - sold as Ritalin and Equasym, among other brands - works in the brain by releasing dopamine, a mood-setting chemical.

“It helps maintain concentration and focus - it’s abused by students for swotting because it does the same for them,” Dr Kendall said.

“A common side-effect is that it raises children’s anxiety levels, makes them lose their appetite and they don’t sleep well. It calms them down and does tend to make them slightly different.”

He said the outcome for hyperactive children treated only with Ritalin is ‘really quite poor’.

“If they don’t get the right help a lot of them will end up with psychiatric disorders as adults and quite a lot will end up in the prison system.”

Meanwhile, Rick Hughes, consultant child and adolescent psychiatrist for Sheffield Children’s NHS Foundation Trust, said: “Ritalin has a very good safety record so long as it is prescribed by an appropriately trained specialist.

“However, like many drug treatments, it does not help in every case. While methylphenidate does not cause drowsiness it can produce changes in emotional state and some parents report that their child seems rather distant or in a world of their own.

“A reduction in dose, in discussion with the prescriber, can often eliminate this particular problem.”