By Sarah Boseley
August 7, 2018
Methylphenidate drugs safest and most effective, while adults do better on amphetamines.
Ritalin and other drugs of the same class are the most effective and safest medications to prescribe for children with attention deficit hyperactivity disorder (ADHD), according to a major scientific review.
The review of ADHD drugs shows that they work, and work well, in spite of concerns among the public and some doctors that children in the UK are being overmedicated. Ofsted’s chief inspector, Amanda Spielman, has likened the drugs to a “chemical cosh” and claimed they were being overprescribed, disguising bad behaviour among children that could be better dealt with.
The authors of a major study in the Lancet Psychiatry journal say that methylphenidate, of which Ritalin is the best-known brand, is the most effective and best-tolerated treatment for children while amphetamines work best for adults.
While the number of children on medication has risen as ADHD has become better understood, many do not get the treatment they need to cope in life and get through school, they said. The Guardian has revealed that getting help in the U.K. can take as long as two years.
Emily Simonoff, a professor of child and adolescent psychiatry at King’s College London, one of the authors, said the perception that children were overmedicated was not accurate. “Clinicians are very cautious about using medication in this country,” she said. “The problem in the U.K. is predominantly about undermedication and underdiagnosis.”
The idea that ADHD drugs were a “chemical cosh” was “an unfortunate misapprehension” in the U.K., she said. The drugs are stimulants which aid normal functioning of the brain in children and adults. Parts of the brain that are responsible for planning and organising activities are underactive in people with ADHD, she explained.
“The medications go part of the way to normalising and making more active those areas of the brain,” she said.
|Critics of ADHD drugs say behavioural therapies are preferable.|
The study compared drugs licensed for ADHD, such as amphetamines, methylphenidate and guanfacine, and also some that are used even though they are not licensed for ADHD treatment, such as clonidine and buproprion.
The research supports the recent guidance issued by the National Institute for Health and Care Excellence (Nice). Nice said that environmental modifications, such as putting the child in the front row at school or doing homework in short bursts of attention at home, should be introduced and medication offered where the doctor judges it appropriate.
Critics of the drugs say behavioural therapies are preferable. Psychiatrists behind the report say the evidence suggests those can help with other problems children may have, such as behavioural issues, but do not impact on the actual symptoms of ADHD. Those symptoms are broadly inattention, overactivity and impulsivity. The condition affects an estimated 5% of children and 2.5% of adults worldwide.
Another author, Dr. Andrea Cipriani, from the University of Oxford, said their conclusions were robust because they had collected all the published and unpublished data on trials of the drugs, which had taken them four years. But trials had not been carried out on long-term use.
“It is important to note that the data available only allow us to compare the effectiveness at 12 weeks, when we know that both children and adults can be on these medications for longer,” he said.
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Treatment breaks are occasionally recommended to see whether the drugs are still necessary, but the team says the adverse effects do not outweigh the benefit that adults and children get from them in being able to concentrate better, be less impulsive, feel calmer and learn and practise new skills.
The drugs cause some weight loss and do have an impact on a child’s growth, but not more than 2cm over the course of their life, said the authors.
While methylphenidate is already the most commonly used ADHD drug in the U.K., that is not the case in the U.S., where a much higher number of children are diagnosed and treated.
“Our findings will hopefully help people with ADHD in the U.S.A. find the best treatment for them by clarifying which drugs should be first, second and third line treatments,” said Cipriani.