Five - and under a drug's control
Ritalin prescriptions for children now over 250,000
Jo Revill, health editor
Sunday August 17, 2003
Callum English has just turned five and his favourite treat is to be
taken to the river with the small fishing rod his father has given
him. But first he has to take his daily medication, a small brown
capsule containing a psychostimulant to keep his behaviour under
He has no school to go to - the last one excluded him because of his
tantrums and destructive tendencies. The drug is given to treat him
for his attention deficit hyperactivity disorder (ADHD). But the drug,
Concerta, a reformulation of the drug Ritalin, is not supposed to be
given to any child under six because there is no evidence it is safe
or effective at such an age.
Callum is one of the youngest patients ever to be on the drug. Its
active constituent, methylphenidate, works by increasing concentration
levels and decreasing hyperactivity. He was first put on Ritalin just
before his fourth birthday. There are thought to be dozens of children
like him across Britain, but no one knows because there is no official
The drug is increasingly popular among parents whose children are
being diagnosed with ADHD or the related ADD (attention-deficit
disorder), conditions that account for more than half of all referrals
to child or adolescent psychiatry services.
Latest figures show that over the past five years, the number of
prescriptions for Ritalin written out for children has rocketed by 102
per cent to 254,000 items. In the past year alone, statistics gleaned
by the Liberal Democrats from parliamentary written answers show that,
from 2001 to 2002, prescription rates rose by 22 per cent.
Concerta is preferred by many specialists because it is slow-acting,
working over a 12-hour period, instead of children having to take
Ritalin tablets three or four times a day. But the drug, which acts as
a stimulant to increase children's level of concentration and to
decrease their impulsive behaviour, is designed to be given as part of
a package of treatment, alongside behavioural therapy. Many children
receive only the capsules.
Robert Donnelly, medical director of the pharmaceutical manufacturers
Jansenn-Cilag, said: 'We know that some children under six receive
Concerta, but think it is only a small number. Our recommendation is
that it should not be given to the under-sixes, because we have not
actually performed any studies to show whether or not it is safe at
Lib Dem MP Paul Burstow said: 'There is a very big debate about the
rights and wrongs of Ritalin, but we need to look at why the
prescription rates have gone up so steeply. It has become the option
of first choice rather than a last resort for some families, but it
needs to be given appropriately and only if it is really necessary.'
Although ADD or ADHD clearly can wreck family life and hinder
schooling, Burstow added: 'Questions remain over the implications of
giving such a powerful drug to very young children.'
The number of prescribed doses of Ritalin (methylphenidate
hydrochloride) in England have leapt. In 1997 there were 92,100
prescription items; last year there were 254,000.
In a written parliamentary answer, Health Minister Rosie Winterton
said that last year around 91 per cent of the prescription items were
dispensed to children under 16 and young people aged 16 to 18 in
full-time education. An estimated 1 per cent of the items were
dispensed to people aged 60 and over, with the remainder going to
Callum's mother, Lynette Hillhouse, and her husband, Paul English,
worry about the effect the medication may have, but feel they have
little choice but to use it, as it is the only help on offer. They
have been advised to double the dosage, but have not done so.
'His behaviour has improved recently, but I believe that's because
I've been going on to the American websites and learning to adapt my
own behaviour to respond correctly to him,' she said. 'I don't
automatically tell him off now for every little thing. When he's
really bad, I give him "time out" in his room. It's possible that the
drug has calmed him down a bit, but he can still be unpredictable.'
When Ms Hillhouse told the psychiatrist she thought it wasn't supposed
to be prescribed to the under-sixes, she was told not to worry. The
drug can be prescribed off-licence by psychiatrists in exceptional
'But I do worry,' said Ms Hillhouse, who lives in Sutton, Surrey.
'Sometimes he gets bad headaches and it suppresses his appetite. At
one point I took him off the drug, just so that he would eat normally.
But I don't feel that I can do without it because his behaviour was so
When he was three, before he was diagnosed, he was a nightmare to live
with. 'Callum's an intelligent boy, and I think with the right support
he could learn anything, but sometimes he just lashes out.'
Andrea Billbow, who runs a support group for families, said there was
no evidence the drug would harm young children.
Ms Hillhouse, who has a seven-year-old daughter with no behavioural
problems, does not know how her son will fare if no school place is
available for him. 'Once every six months we see the psychiatrist,
some medication is thrown at us, and that's it."