Chris, aged six, can't concentrate and he can't keep still. At home, he is a nightmare. He runs around, screams and throws toys. He cannot share or take turns with other children, so he finds that they don't want to play with him. Every night he keeps the family awake. At school he is disruptive and falling behind because he cannot concentrate on reading, writing or any other task.
Chris is not just a 'naughty' child and his mother is not a bad parent, she has two older children who are not like this and who have done very well at school. So what is wrong with Chris? Like an increasing number of children in this country and in the US, he has been diagnosed with ADHD, attention deficit (hyperactivity) disorder.
It is difficult to put an exact figure on how many children are affected. Surveys show that as many as 30 per cent of parents describe their child as 'hyperactive' at least some of the time. American researchers have estimated that between five and eight per cent of children have this problem, while some experts in the UK believe the number of children with true ADHD to be as few as one in 100.
There has been controversy over many years about the diagnosis and treatment of ADHD. To make it more complicated, there is a basic disorder, known simply as Attention Deficit Disorder (ADD), for which the symptoms are usually a short attention span, failing to follow instructions and finish tasks, being unable to organise and finding it difficult to listen. When children with this beha- viour are hyperactive as well, always on the go, talking excessively and fidgeting, then they are said to have ADHD. With either diagnosis, a child can get a statement of special educational needs and classroom help.
In the past, doctors tended to recognise only the most extreme cases of ADD and ADHD, where the children may have had low IQ and other learning difficulties. But now both disorders are increasingly being diagnosed and treatment is being offered, mainly in the form of an amphetamine-type drug called Ritalin. The number of prescriptions for this drug in the UK has soared from 2,000 a year six years ago to 90,000 last year, and the figure is still rising.
More than 45 double-blind, placebo-controlled trials were carried out on Ritalin between 1984 and 1994, making it the most well-researched psychotropic drug used for children, and, possibly, in the whole of psychiatry. Each study showed that Ritalin was effective for a wide range of problems including attention deficit, impulsiveness, aggression, hyperactivity and short memory.
However, there are side-effects. One of these is that it can affect children's growth, a child on Ritalin for some years may end up an inch or so shorter than he would have done if he had not taken the drug. In some children, Ritalin can have the opposite effect to that intended, making them aggressive or even more difficult to manage. Some experience sleeplessness or abdominal pain, and there is also often a 'rebound' effect when the medication wears off at the end of the day.
Problems with the drug are particularly common with pre-school children. In one study all but three out of 28 pre-school children came off medication after a trial because of irritability, clinging, decrease in sociability, poor appetite and insomnia, while in another, over 30 per cent discontinued treatment. Children aged five or six and up seemed to experience fewer side-effects.
Pre-school children in America are increasingly being diagnosed with AD(H)D and treated with Ritalin, even though there are doubts about whether the drug is safe for this age group. A diagnosis is also hard in this age group, statements such as 'fails to finish tasks' can hardly apply to a toddler, and many toddlers who appear hyperactive do not go on to develop ADHD. Another problem is that giving Ritalin is increasingly being used to form a diagnosis, if the child's behaviour improves on the drug, then it is decided that they have ADD or ADHD. So younger and younger children are being put on the medication just to see whether it works.
It has been suggested that the reason for more children being 'hyperactive' may in fact be because their lives are more sedentary. Fewer children walk to school, more time is spent in the classroom and many schools have poor facilities for outdoor sports and play. Children spend more time in front of the television or computer rather than running around out of doors. It may be that children who need plenty of physical exercise are not getting it and therefore have energy to spare.
For more information contact Hyperactive Children's Support Group, 71 Whyke Lane, Chichester, West Sussex PO19 2LD (01903 725182, from 10am-1pm). Hyperactivity: What's the alternative? by Maggie Jones is published by Element Books, price 7.99.