National Institute for Health and Clinical Excellence (NICE)
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Avoid drug treatment for children and young people with moderate ADHD

NICE advises against using drugs as a first-line treatment for children and young people with moderate attention deficit hyperactivity disorder (ADHD), as latest figures suggest a sharp rise in the number of drugs prescribed for the condition.

ADHD is the most common behavioural condition in the UK, affecting between 2 to 5 per cent of school-aged children and young people. It is characterised by hyperactivity, impulsiveness and inattentiveness, with common symptoms including a short attention span and being easily distracted.

A new report by the Care Quality Commission (CQC) reveals that over the past six years, prescribing of methylphenidate for ADHD, which is included in drugs such as Ritalin, has risen by 56 per cent in primary care.

This is despite the fact that NICE does not recommend drug treatment as a first-line treatment for school-age children and young people with moderate ADHD, or for any pre-school children.

To tackle this rise in prescribing, the CQC suggests careful monitoring, which could also help avoid the abuse of such drugs, of which the long-term risks of are unknown.

The CQC report follows standards recommended by NICE in its recently published quality standard on ADHD, which includes seven statements to improve the care and management of adults, children and young people with ADHD.

The quality standard calls for people with ADHD who are taking drug treatment to be given a specialist review at least annually to assess their need for continued treatment.

NICE says that people taking the drugs need to be monitored regularly due to the number of side effects associated with drug treatment for ADHD, which can also have the effect of reducing adherence to treatment.

Furthermore, without regular monitoring there is a greater risk that drugs prescribed to treat ADHD will be misused.

The quality standard also recommends that children and young people with moderate ADHD are offered a referral to a psychological group treatment programme.

NICE says such programmes can improve daily functioning and relationships with family members, carers and peers.

Courses should consist of cognitive behavioural therapy or social skills training, and cover topics such as problem solving, developing the ability for self-control, and improving relationships with friends and other children.

Dr Matt Hoghton, Medical Lead for the Clinical and Innovation Research Centre of the Royal College of GPs, said: "The new NICE quality standard for ADHD in children and adults is an important development in ensuring consistent high quality coordinated care with appropriate prescribing.

"Statement 7 specifically identifies the need for a yearly specialist review for people with ADHD, who are taking drug treatment."

He added: "The seven quality statements will help give patients, their families, GPs and commissioners clear standards for this high priority area and ensure that safe systems are in place. I strongly support this NICE standard."

Professor Tim Kendall, consultant psychiatrist and member of the group that developed NICE's clinical guideline on ADHD, spoke to BBC Radio 4's Today programme about the rise in prescriptions.

When asked whether the whether there were any long-term risks among people who take methylphenidate drugs, he said: "In children, without doubt. If you take Ritalin for a year, it's likely to reduce your growth by about three-quarters of an inch.

"I think there's also increasing evidence that it precipitates self-harming behaviour in children, and in the long-term we have absolutely no evidence that the use of Ritalin reduces the long-term problems associated with ADHD."

For fast access to all that NICE has recommended on this topic, and to see the associated products it has developed, visit the NICE pathway on ADHD.