Ritalin-type medications best to treat ADHD in infants, shows study

Methylphenidate narcotics 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 revealedthat getting help in the UK can take as long as two years.

Emily Simonoff, a prof 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 drug in this country ,” she said.” The problem in the UK is predominantly about undermedication and underdiagnosis .”

The idea that ADHD drugs were a” chemical cosh” was ” an unfortunate misapprehension” in the UK, she said. The narcotics are stimulants which assistance normal functioning of the brain in children and adults. Proportions of the brain that are responsible for planning and organising activities are underactive in people with ADHD, she explained.

” The drugs run part of the way to normalising and constructing more active those areas of the brain ,” she said.

School
Critics of ADHD medications say behavioural therapies are preferable. Photograph: Alamy Stock Photo

The study compared medications 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 adopted and medication offered where the doctor magistrates it appropriate.

Critics of the narcotics say behavioural therapies are preferable. Psychiatrists behind the report say the evidence indicates 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 medications, 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 drugs for longer ,” he said.

Treatment transgresses are occasionally recommended to see whether the narcotics 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 UK, that is not the case in the US, where a much higher number of children are diagnosed and treated.” Our findings will hopefully help people with ADHD in the USA find the best treatment for them by clarifying which medications should be first, second and third line treatments ,” said Cipriani.

Read more: www.theguardian.com

Don’t be in any doubt- ADHD is an illness and it must be treated | Ann Robinson

Britain is right to take a more cautious approach than the US, but we should be prepared to fund a range of treatments, says GP Ann Robinson

Imagine a neurological condition that affects one in 20 under-1 8s. It starts early, causes significant distress and ache to the child, injuries families and limits the chances of leading a fulfilled life as an adult. One in 20 children are affected but only half of these will get a diagnosis and a fifth will receive treatment. If those stats related to a familiar and well-understood illness, such as asthma, “theres been” little debate about the need to improve intervention rates. But this is attention deficit hyperactivity disorder( ADHD ), and the outcry is muted. If anything, we hear warnings that too many children are being labelled this route, and too many given prescriptions.

In the United States, ADHD is diagnosed at more than twice the incidence in Britain. The true prevalence is likely to be the same on both sides of the Atlantic. So what’s the story? Is the US too gung-ho, or is the UK dragging its heels? Are American doctors too quick to medicate infants, or British physicians too slow?

Emily Simonoff, co-author of a new meta-analysis in the publication the Lancet Psychiatry, says the problem in the UK is” predominantly about undermedication and underdiagnosis “. Her study examined a range of drug treatments compared to placebo, and it shows that methylphenidate( better known by for the purposes of the brand name Ritalin) works best for children and amphetamines for adults.

It can seem counterintuitive that stimulants work for ADHD. In fact, both therapies are thought to increase the activity of the chemicals dopamine and noradrenaline in the brain, neurotransmitters that play a role in executive functions such as learning, planning and exerting control over our behaviour and believes. The side-effects such as agitation, weight loss, sweating, sleep disorder and high blood pressure can occur whether you take the drugs for ADHD or recreationally. The difference is that people with ADHD are more likely to benefit, and prescribed dosages are carefully controlled and monitored. As an NHS GP, I can only prescribe these medications employing a special protocol that lays down follow-up arrangements. The idea that we dole them out in a cavalier manner is just not true.

ADHD isn’t some sort of catch-all term for bad behaviour, but a clearly identifiable defined of symptoms( including inattention, impulsivity and hyperactivity ), with strict diagnostic criteria and evidence-based treatment alternatives. People with neurodevelopmental disorders such as ADHD, autism, dyslexia, dyspraxia and dyscalculia have brains that are structurally and functionally different to those of neurotypical people. It’s a widespread misconception that ADHD equates to disruption in classrooms; a more common presentation is anxiety and difficulty with learn.” A kid with ADHD may be well-behaved and academically able ,” says Tony Lloyd of the ADHD Foundation. Identifying that there is a problem and providing the right subsistence is critical.

So where does the scepticism about ADHD come from? Perhaps it’s an understandable reluctance to label kids while they are still developing, or a wariness about medicalising normal variation in behaviour. Oftsted’s chief inspector, Amanda Spielman, speaks for many when she voices concerns that the narcotics used in the treatment of ADHD are a” chemical cosh”, are overprescribed and disguise bad behaviour that should be managed in other ways.

There is no doubt that rates of prescription for ADHD in the UK have risen significantly since the 1990 s. The prospect of a US-style situation in which one in ten children aged two to 17( rising to one in five sons aged 14 to 18) are diagnosed with ADHD, and two-thirds of those diagnosed are on medication, creates justifiable questions. But this scenario is a long way from current realities in the UK, where the NHS enforces vigorous diagnostic guidelines and, crucially, there are no financial incentives for NHS doctors to write prescriptions.

Caution about the action of psychoactive drugs on developing brains is entirely appropriate. The short-term safety data we have is reassuring, though more research is needed into long-term impacts. But this caution has to be weighed against the harms, if other therapies aren’t suitable or effective, of doing nothing. Without diagnosis and treatment, infants become prone to anxiety, self-harm and school failing. Around a third will continue to have problems into adulthood and some people will only be diagnosed once they are adults.

Earlier this year a Demos report highlighted the social and economic cost to society of adult ADHD, as impulsivity, poor concentration and risk-taking behaviour interfere with work and relationships. The inability to regulate feelings and tendency to become overloaded by external stimulu has been described as” like driving a Ferrari with bicycle brakes “.

Treatment for ADHD doesn’t always or only mean drug; the National Institute for Health and Care Excellence’s guidelines recommend a multimodal approach including support for mothers, cognitive behavioural therapy( CBT) and stress-reduction strategies. Lloyd says the Nice guidelines are great but mostly aren’t being followed. My experience as a GP would certainly back that up. Children tend to be seen quicker than adults, but often the only treatment dedicated is medication, with other interventions such as parenting support and CBT failing to materialise.

The cautious UK approach to ADHD may be preferable to the more enthusiastic US one. But it would be a shame to let scepticism get in the way of good medication. And that entails casting aside any doubt that ADHD is a medical condition, and demanding funding for a range of treatments, including but not limited to drugs. Unfortunately, it seems that is still a long way off.

* Ann Robinson is a GP

Read more: www.theguardian.com

Ritalin-type drugs best to treat ADHD in children, depicts study

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 narcotics shows that they run, and work well, in spite of concerns among the public and some physicians that children in the UK are being overmedicated. Ofsted’s chief inspector, Amanda Spielman, has likened the medications 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 revealedthat getting help in the UK can take as long as two years.

Emily Simonoff, a prof 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 UK is predominantly about undermedication and underdiagnosis .”

The idea that ADHD medications were a” chemical cosh” was ” an unfortunate misapprehension” in the UK, she said. The medications are stimulants which assist 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 drugs go part of the way to normalising and building more active those areas of the brain ,” she said.

School
Critics of ADHD drugs say behavioural therapies are preferable. Photograph: Alamy Stock Photo

The study compared medications 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 explodes of attention at home, should be adopted and medication offered where the doctor magistrates it appropriate.

Critics of the drugs say behavioural therapies are preferable. Psychiatrist behind the report say the evidence suggests those can help with other problems infants 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 have still 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 drugs for longer ,” he said.

Treatment breaks are occasionally recommended to see whether the medications 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 narcotics cause some weight loss and do have an impact on a child’s growth, but not more than 2cm during the course of their own lives, said the authors.

While methylphenidate is already the most commonly used ADHD drug in the UK, that is not the case in the US, where a much higher number of children are diagnosed and treated.” Our findings will hopefully help people with ADHD in the USA find the best treatment for them by clarifying which drugs should be first, second and third line therapies ,” said Cipriani.

Read more: www.theguardian.com

Ritalin-type narcotics best to treat ADHD in infants, shows analyze

Methylphenidate medications safest and most effective while adults do better on amphetamines

Ritalin and other drugs of the same class are the most effective and safest drugs to prescribe for children with attention deficit hyperactivity disorder( ADHD ), according to a major scientific review.

The review of ADHD drugs shows that they run, and work well, in spite of concerns among the public and some physicians that children in the UK are being overmedicated. Ofsted’s chief inspector, Amanda Spielman, has likened the medications 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 exposedthat getting help in the UK can take as long as two years.

Emily Simonoff, a prof 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 use drug in this country ,” she said.” The problem in the UK is predominantly about undermedication and underdiagnosis .”

The idea that ADHD medications were a” chemical cosh” was ” an unfortunate misapprehension” in the UK, she said. The drugs are stimulants which assist normal functioning of the brain in children and adults. Portions of the brain that are responsible for planning and organising activities are underactive in people with ADHD, she explained.

” The drugs go part of the way to normalising and constructing more actively involved those areas of the brain ,” she said.

School
Critics of ADHD narcotics say behavioural therapies are preferable. Photograph: Alamy Stock Photo

The study compared medications 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 adjustments, 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 magistrates it appropriate.

Critics of the medications say behavioural therapies are preferable. Psychiatrists behind the report say the evidence indicates 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 medications, which had taken them four years. But trials had not been be put into practice 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 drugs for longer ,” he said.

Treatment transgresses 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 medications 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 UK, that is not the case in the US, where a much higher number of children are diagnosed and treated.” Our findings will hopefully help people with ADHD in the USA find the best treatment for them by clarifying which narcotics should be first, second and third line therapies ,” said Cipriani.

Read more: www.theguardian.com