Ritalin, the controversial drug used to calm down hyperactive children, should not be routinely prescribed by doctors and never given to the under-fives, experts say today. They also advise that it should be given to older children only if other help has not worked.
The use of Ritalin and similar drugs is extensive and, some argue, employed indiscriminately for children diagnosed with attention deficit hyperactivity disorder (ADHD). The guidance says it should not be used at all in children under five and used for older children only when they have severe ADHD or as a last resort.
Guidance issued by the National Institute for Health and Clinical Excellence recommends instead training for parents as a first step towards helping children.
About 55,000 children in the UK are thought to have been prescribed drugs for ADHD. The numbers have been soaring; prescriptions almost doubled between 1998 and 2004.
Some parents and teachers say the drugs have transformed children unable to learn and causing huge difficulties for themselves and others. But there have been widespread concerns that the drugs are over-used. They also have side-effects, including stunting growth.
The Nice guidelines say that drugs, where they are given, must be used alongside psychological therapy and support. They rule out, however, omega 3 fish oils and say that while children need a good nutritious diet, adding special foods or avoiding others makes no difference.
The new guidelines for the first time attempt to get help for children in both the classroom and at home. They advise that teachers should get training for supporting children with ADHD, a condition thought to affect up to 3% of the school-age population.
Christine Merrell, an education specialist and guideline group member, said affected children could be disorganised and forgetful, and find it hard to make friends because of their apparent lack of consideration. "They won't have pencils, pens, exercise books or their PE kit. You lend them a pencil and it comes back broken. They disrupt other children, have quite short attention spans, push into queues and butt into conversations. The child with ADHD will blurt out the answer before anybody else has had a chance."
Nicola Salt, a GP and another group member, confirmed such children were "always on the go, driven by a motor, fidgety", and like that "all the time and in all circumstances".
Parents will be offered education and training programmes lasting eight to 12 weeks to enable them to help children, some of whom will have been hyperactive since learning to walk.
Tim Kendall, joint director of the National Collaborating Centre for Mental Health, said training would enable parents to understand what was ADHD and what was not, and what could "focus the child and manage the child's behaviour without getting locked into big battles".
If consistent help from parents and teachers did not work or the ADHD was severe, children could be given methylphenidate (Ritalin), the guideline says. But they still had to be continuously monitored and assessed.
Kendall said the numbers given drug treatment probably would not alter much. If 30 in 1,000 had ADHD, about a third of those would already be getting drugs. The guidance would mean drugs going to more children who really needed them.
The guidance, however, is controversial. Sami Timimi, child psychiatry professor at Lincoln University, said there was no evidence that stimulant drugs worked in the long-term for those with severe ADHD. The guideline group had classified ADHD as a neurological disorder, a problem in the development of the brain - which meant the condition would continue to be treated by paediatricians, who were prone to prescribing drugs, rather than by psychiatrists who might tackle it as a behavioural disorder.
Ritalin is a stimulant that works on the brain in a way not dissimilar to amphetamines and cocaine. It was first used in the 1950s for depression. During the 1960s interest developed in its potential to calm hyperactive children. Diagnosis of ADHD and treatment are controversial. But sales of Ritalin (methylphenidate) continue to boom, especially in the US, where in 2006 doctors wrote 2m prescriptions a month for children. Some parents ask for Ritalin just because they believe it helps their children's schoolwork.