Drugs pouring into misbehaving children

Record numbers of children are being medicated because of behavioural problems despite lingering concerns about the safety and effectiveness of the drugs they are taking.

Figures from the government's drug-buying agency Pharmac show that last year more than 106,000 prescriptions were issued for methylphenidate – commonly sold under the brand names Ritalin and Rubifen – which is typically used to treat children and young people with attention deficit hyperactivity disorder (ADHD). Just over 660 of those prescriptions were for preschoolers.

Overall prescription rates have jumped 13 percent in the past five years and the government is now spending more than $3 million annually on subsidising the drugs, despite studies showing they have no lasting benefit and there are potentially dangerous side-effects, including long-term heart problems.

Most patients are on a combination of both short and long-acting methylphenidate so it is difficult to estimate actual patient numbers, but it is believed that between 3 percent and 5 percent of New Zealand children have ADHD, which can make them extremely hyperactive and unable to focus on tasks.

They are typically treated with either a psycho-stimulant such as methylphenidate or given behaviour-management training. Methylphenidate can be prescribed to children by only a specialist paediatrician or a psychiatrist, not by GPs.

Family First director Bob McCroskrie, who worked in schools in South Auckland for 10 years, said some doctors were too quick to diagnose "naughty kids" with ADHD and prescribe them drugs when what they actually needed was "some counselling, therapy and firm discipline".

"Maybe all we're doing is drugging up naughty kids rather than dealing with the reasons why they're naughty in the first place," McCroskrie said.

He believes medication should be a last resort and that at least two doctors should be consulted before any child is prescribed stimulant drugs, particularly as studies showed methylphenidate was not a long-term solution to the problems associated with ADHD.

A study published in the American Academy of Child and Adolescent Psychiatry journal in 2009 found that children treated with the drug Ritalin for 14 months were still seriously affected by ADHD eight years later.

University of Canterbury psychologist Dr Julia Rucklidge, an ADHD expert, told the Sunday Star-Times there was still a lot of uncertainty around the long-term impact methylphenidate had on a child's developing brain.

She said the few studies that had been carried out suggested the drug stunted physical growth.

Although that was clearly worrying, the potential damage had to be weighed against the damage caused by not treating the condition, or using alternative treatments that even less was known about.

"There are always concerns when it comes to medicating children. The biggest concern is that we never know exactly what medications are going to do to the developing brain," Rucklidge said.

Last year the Ministry of Health tightened the safety guidelines for prescribing methylphenidate because of growing concerns over links to heart, brain and psychiatric disorders.

The ministry said it was important to remember that the long-term effects of methylphenidate treatment in children were not fully understood.