Health: Give them understanding, not just drugs

Despite research suggesting Ritalin can calm children with ADHD, some experts question the wisdom of relying on an amphetamine.

IT HAD, admits Michele Riley, been a bad morning. Her eight-year- old son Aaron had smashed his wardrobe then broken through a locked door into the kitchen before anyone else was awake, leaving a trail of devastation.

"He had got pounds 5-worth of meat out of the fridge and fed it to the cats, then drunk a litre of juice without diluting it and left the fridge door open. He'd got sweets and crisps out, mixed them all on the floor and in the cat litter tray. And then we found he had broken his wardrobe door", she says.

But 20 minutes or so later after the hyperactive Aaron had taken his pill, all is quiet and peaceful in the Riley household in Essex.

"I leave it for 20 to 30 minutes after I have given him the tablet and then I ask him to get ready for school and he says, `Yes mummy' and then he'll say something like, `Is there anything I can do for you mummy?' Once he has had his tablet he is a totally different boy," explains Mrs Riley.

Aaron, like his five-year-old brother Martin, has been diagnosed as having attention deficit hyperactivity disorder, or ADHD, and the tablets he takes up to three times a day are Ritalin. New research published this week at a British Psychological Society conference says that the classroom behaviour of school children on Ritalin improves to the level of children who do not have ADHD. The work, by Rebecca Shaw at Dundee University, found that medication worked better than increased supervision.

But many critics attack the very idea of giving an amphetamine-family drug to children. They also fear that Britain is following the trend in America, where several million children are on Ritalin and some schools report having one-in-four pupils on the medication.

Few conditions and treatment therapies involving children are as controversial as ADHD and Ritalin. At one extreme, it is claimed that five per cent of all children have ADHD and need treatment, while at the other, critics deny the very existence of the disorder and say that drugs dampen what is merely youthful exuberance.

In Britain the number of children being given Ritalin has rocketed over the last six years, according to new figures. In 1992, only 2,000 prescriptions were issued, but in the last 12 months that annual figure had shot up to nearly 100,000 and appears to be more than doubling every year. This does not include drugs given by hospitals to children or those prescribed by private practitioners. One of the problems with ADHD is the difficulty of diagnosis because the symptoms are non-specific and in many cases similar to those seen in a dysfunctional family.

But according to Dr Christopher Green, child care specialist and the co-author of Understanding ADHD, it is a real disorder that has been known about for the best part of a century.

"When we talk about ADHD we refer to a slight but demonstrable difference in normal brain function that causes a clever child to underachieve academically and to behave poorly, despite receiving the highest standard of parenting," he explains.

He says that ADHD is caused by a minor difference in the fine tuning of the brain due to an imbalance in the neurotransmitter chemicals, noradrenaline and dopamine. This imbalance is mostly found in those parts of the brain responsible for putting the brakes on unwise behaviour.

The result is that affected children act before they think, do not consider the implications of a sequence of events and are less satisfied with rewards.

In the USA, ADHD is treated almost universally as an organic disease, with the use of medication, mostly the stimulant Ritalin. In the UK, drug therapy has traditionally been used far less frequently and the symptoms have often been diagnosed and treated with behaviour therapy or counselling.

Dr Alyson Hall, consultant child psychiatrist at the Royal London Hospital says that in Britain psychiatrists have been careful not to view drug therapy as a panacea for all child behavioural problems.

"There is a small core of children that require medication, but it is a difficult diagnosis to make. Ritalin is an amphetamine derivative and improves concentration. It works by allowing children to stop and think", she says. "Use here varies and some psychiatrists are reluctant to use it, or are philosophically opposed to it."

In the USA there is a backlash against the huge amounts of Ritalin being used. The international pressure group Parents Against Ritalin (PAR) has been active in campaigning and a number of teachers and psychiatrists are also opposing its use with the slogan, "Education not medication".

One of the most vocal of the opponents is Maryland psychiatrist Dr Peter Breggin, who says that the stimulants work by suppressing and controlling children and not by treating any biological problem.

He says the drugs work by making many children robotic, lethargic, depressed and withdrawn: "In the short term, Ritalin suppresses creative, spontaneous and autonomous activity in children, making them more docile and obedient", he says. He also warns, "In the long run we are giving our children a very bad lesson, that drugs are the answer to emotional problems."

But parents like Mrs Riley, who runs the Essex ADHD Family Support Group reject those views.

"Aaron is my oldest child and we knew from day one that there was something different. He was alert all day, he couldn't be put down, he was crying all the time, and he wanted to be involved with everything.

"On one occasion I went to the doctor and told him I felt like either walking out or throwing my son across the room. He turned round and said, `Why not throw him across the room, I would if he was my son'.

"But I told him I couldn't do that and eventually we went to an assessment centre where they tried him on a quarter of the tablet and it worked such wonders on him, we couldn't believe it. His brother Martin also has ADHD. He has tried Ritalin but it didn't seem to work with him."

Mrs RIley says she is tired of the critics of the ADHD diagnosis and the drug treatment: "I try to explain that the children can't help themselves when they are in one of their tantrums, but there are a lot of ignorant people out there who assume it is a naughty child.

"Because of that, you tend to stick with the people you know. We have walked away from many people we have been friends with for years. It's hard, but you have to just carry on."

The ADHD Family Support Group, 1a High Street, Dilton Marsh, Westbury, Wiltshire, BA13 4DL, has a helpline on 01373 826045

Essex ADHD Family Support Group 01702 30545