By Andrew M Brown
Are we experiencing an explosion of mental illness among young children in Britain? That is what you’d reasonably conclude, looking at the rise in the number of prescriptions issued for psychiatric medicines for them.
One of the commonest of childhood brain disorders is Attention Deficit Hyperactivity Disorder (ADHD). It is in the news again: Darren Hucknall, from Barrow-in-Furness, Cumbria, has made a formal complaint to the NHS after his 10‑year-old son, Harry Hucknall, hanged himself. Harry was being treated with fluoxetine (Prozac) – an anti-depressant – and methylphenidate, also known as Ritalin or Equasym, the standard treatment for ADHD.
Children with ADHD can be a nightmare to live with. They misbehave, refuse to concentrate on schoolwork and are incredibly challenging. These aren’t mischievous scalliwags, like Just William. Prescriptions for methylphenidate rose to 661,500 last year – from 382,000 in 2005. The question naturally arises: do all these children have something wrong with them or are they simply being fitted with a chemical straitjacket to make them easier for their parents to manage without resorting to good old-fashioned discipline?
Mr Hucknall seems to believe in the second of those possibilities. He doesn’t think there was anything wrong with his son; apparently, he only found out the lad was on the drugs when his mother brought him for a weekend visit. He thinks Harry was “inappropriately medicated” because he was a “bit naughty”. The coroner concluded that the child’s psychiatrist had acted properly, but added that the drugs prescribed for ADHD are “mind-altering” and “powerful”.
Powerful they certainly are. Methylphenidate is a cortical stimulant, a milder version of “speed” or amphetamine. Give a single dose to a healthy person and he or she might experience a slight lift in alertness, a feeling of being perked up, and increased powers of concentration. For years, students in the United States have used illicit supplies of the drug to help them to focus during all-night revision sessions.
However, among patients with ADHD, methylphenidate has a calming effect. There’s no question: this drug can transform a child who has been diagnosed with ADHD. I know a mother of a six-year-old who has been on methylphenidate since January. She thinks the effect is nothing short of miraculous, and says: “These drugs aren’t awful, they’re a lifesaver.”
This woman and her husband adopted a two-year-old from a background in the care system. James (not his real name) had been traumatised by witnessing violence; unbelievably, even his foster carers used to fight. He showed symptoms of ADHD at primary school; at home, he would kick, punch and spit at his mother. “Our world closed down,” she told me.
I’ve met James. He’s not a “bad” child. Often, he was racked with guilt over his behaviour: he once said he wanted the bin men “to take him away and set fire to him”. His parents were against drug treatment to begin with. But since he started on methylphenidate, they say their family life has completely turned around. His teachers see his potential, and he’s a well-liked child.
His parents argue that the increase in cases of ADHD is attributable to better diagnosis. I think that better diagnosis explains part of what’s happening. But there are other things going on, too. Since the pharmaceutical revolution of the 1950s, when drugs that seemed to be chemically targeted at anxiety, depression and psychosis first burst on to the market, we have been living in a vastly more medicated society than at any time before in human history. We really do have a pill for every ill, and there’s no prospect of this changing. Many of us like it this way – we enjoy the convenience of medications that alter our mood. You only have to look at how the share prices of drug companies shoot up the moment they announce that a new psychoactive drug is in the pipeline.
Then there are the developments in society. In the last 50 years, we’ve witnessed changes in the kind of childhood that many children experience. For instance, what is the effect on children of growing up without a stable family life, or of being starved of affection in your earliest years?
Think of James. As he grows to adulthood, as important as any medication will be the unconditional love he has received from his parents. The pills have helped to “build his self-esteem”, as his parents say, but it’s surely also crucial that they themselves have never given up on him. The sadness is that so many children like James are never adopted; instead they are pushed and pulled from one foster home to another.
ADHD is a complex disorder, and its causes are complex, too – I’m not suggesting that all childhood disturbance is the result of neglect. But what’s also certain is that methylphenidate and other drug treatments are not a cure. They are a palliative, like giving aspirin for pain. And as with pain, the vital thing is to find out what’s causing it in the first place.
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