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One in 11 children may have ADHD
Up to one in 11 children in Britain may suffer from an attention deficit disorder, government advisers will say this week.
Recommendations on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) say families in which pre-school children have behavioural problems should be given parenting classes, reigniting a debate about whether the condition is a medical diagnosis or the result of poor upbringing.
The guidance by the National Institute for Health and Clinical Excellence (Nice) is expected to say that up to 9 per cent of children and 2 per cent of adults fall within broad definitions of ADHD. It will recommend that the stimulant Ritalin be prescribed to all children and adults with a severe form of the condition and to all moderate cases which do not respond to talking therapies or parenting classes.
Prof Philip Asherson, one of the experts who produced the guidance, due out on Wednesday, said they tried to avoid following the model of ADHD care in the United States, where medication is the norm and routinely used to tackle minor behavioural and educational problems.
He said: "We worked very hard to avoid the approach in the US, where one in 10 children are being treated with stimulants. The guidance makes it clear that medication is the right approach in some cases but that it should not be used for everyone and certainly not to tackle minor educational problems."
The psychologist Oliver James accused psychiatrists of medicalising a problem that was caused by upbringing. He said: "Psychiatrists invented this category to medicalise when in fact it is a social problem linked to low incomes and parenting difficulties." He said the best approach to children with ADHD-like symptoms was to give them more attention and affection.
Andrea Bilbow, chief executive of the National Attention Deficit Disorder Information and Support Service, also attacked the guidance. She said the parenting programmes it recommended were not specific to ADHD and would offer little help to families.
Dr Sami Timimi, a child and adolescent psychiatrist in Lincolnshire, who does not believe ADHD is a valid diagnosis, said Nice had produced no evidence that the condition existed, or that medication worked, despite coming to conclusions supporting its use.
Dr Timimi, author of Naughty Boys: Anti-social Behaviour, ADHD and the Role of Culture, said draft guidance produced by Nice cited a study that showed Ritalin improved the performance of patients after 14 months but did not consider the longer-term results of the same study, which showed that after three years it made no difference.
Stoke uses drug 23 times less than the Wirral
Doctors are 23 times more likely to prescribe drugs such as Ritalin for Attention Deficit Hyperactivity Disorder in some areas of the country than in others.
In the Wirral, one prescription of the drug class methylphenidate, which includes Ritalin, was dispensed for every seven children last year, according to the Health Service Journal. Other areas with high rates included the Isle of Wight, Great Yarmouth and Medway in Kent.
Doctors in Stoke on Trent handed out the drugs least frequently, with one prescription per 159 children.
Latest figures show almost 500,000 prescriptions for stimulants for under-16s last year, more than double the 200,000 issued in 2003. The Department of Health said the figures reflected the number of prescriptions, which could include repeat orders for the same child.