Why our children are taking `kiddy-speed'

The Sunday Star-Times 19.1.2003

By Mark HENDERSON

Hollywood superstar Tom Cruise and other critics say the use of the child-calming drug Ritalin is dangerously out of hand. But desperate parents are hailing the medication. Mark Henderson reports.

The true cost of fare play

CAMERON POU was eight when he first tried to take his life. His horrified mum Linda found him just in time. A few weeks later, the angry youngster tried again.

We met Cameron six years ago in a Sunday Star-Times article on behaviour disorders among children. Cameron, then five, the second of Pou's three boys, had just started school. He was becoming increasingly aggressive.

Older brother William had been a handful since birth: unsettled, a poor sleeper, running into the path of traffic and disappearing from home.

William was diagnosed at age four as having attention deficit disorder (ADD). But while William was "a real worry" for Pou and husband Wi, Cameron's antics rapidly eclipsed those of his brother.

Assessed as having ADHD (attention deficit with hyperactivity), he was suspended from school several times, always in fights, stealing and yelling at teachers, says Pou.

"One weekend we got so desperate I called the police. Cameron had threatened to kill everyone. He was on the roof lighting matches, threatening to jump. I phoned my mum to come and take all the knives from the house."

Soon after, the youngster's suicide attempts forced Pou to make the decision she had been dreading. Cameron joined an estimated 6000 New Zealand children on Ritalin.

"I had always been reluctant to put Cameron on medication," says Pou. "But in the end, it was either him or me."

Pou had put William on Ritalin aged eight, but stopped after six months when he became withdrawn. William, now 13, was put back on the "child calmer" last year to improve his concentration at school.

This followed several episodes of erratic behaviour which finally saw William placed in a boys' home. "His grades have gone from zip to excellent," says his mother.

Life in the Pou household changed overnight once Cameron was also put on Ritalin.

But the so-called "kiddy-speed" has harsh and high-profile critics, alarmed at the sharp rise in Ritalin use.

Film star Tom Cruise, in Taranaki to film The Last Samurai, spoke out last week, claiming the drug was "lethal". The outburst is likely to stem from his Scientology Church's opposition to drugs being used to treat mental illness. Confirms Church of Scientology New Zealand spokesman Mike Ferriss: "We view Ritalin as a from of social control." Other critics accuse parents of using the drug as a quick fix.

More than 72,000 prescriptions were paid for by the government's drug funding agency, Pharmac, in the year ended June 2002, up 13,000 on the previous year. Just 10 years ago, barely 3000 Ritalin prescriptions were issued. New Zealand, with Australia, now ranks third equal in the world - behind the US and Canada - in Ritalin use.

Pharmac spent $1.8 million on Ritalin last year - compared to $50m on asthma medication and $28m on anti-depressants.

Wellington drug addiction agency WellTrust is concerned many children, especially young teenagers, are being misdiagnosed by clinicians.

Executive officer Pauline Gardiner says she has seen many teens with existing drug problems given Ritalin. "Cannabis, for example, can mimic symptoms of hyperactivity."

The steep increase in marijuana use by children, says Gardiner, mirrors the climb in Ritalin prescriptions.

Gardiner knows of children who sell or trade their Ritalin at school. She has been told some parents are putting the child on the stimulant so they can use it themselves.

In December, a Timaru mother was convicted of selling her child's Ritalin prescription to a heroin-making syndicate. But ADHD expert and Auckland University emeritus professor of child and adolescent psychology John Werry says Ritalin critics, including Cruise, "are talking a load of crap".

"Ritalin is one of the safest and most studied drugs. The health risks are practically non-existent."

Werry says follow-up studies on children who have been on Ritalin show it does not increase the chance of drug abuse in adolescence.

"There are no effective alternatives."

Most children, says Werry, are off Ritalin by Year 11 (fifth form).

The stimulant can only be prescribed by a specialist, such as a paediatrician. Most users start in their second year of primary school.

It is rare, says Werry, to prescribe Ritalin to children under four.

Ritalin works for 95% of children, he says, some better than others.

An alarming study released last week revealed more than 6% of American children were taking drugs such as Ritalin and Prozac to control difficult behaviour.

In New Zealand, Ritalin is now prescribed to about 8000 children - 1.6% of the child population. But Werry says several more thousand children would benefit from it.

Friends of Linda Pou criticised her decision to reach for the drug.

Some, like Kim Thornicroft, initially argued there must be an alternative.

Thornicroft put her son, Hunter, 9, on the drug three months ago.

She suspects Hunter was born with ADHD. He grew increasingly aggressive, insolent, and defiant. "Hunter plays chicken with life.

He has no awareness of what he says or does."

Thornicroft took management and parenting skills courses. "I have a holistic outlook and didn't want him to go on drugs." Ritalin immediately transformed Hunter. "I cried with relief," says Thornicroft. "No parent should fall out of love with their child."

Paediatric Society president Nick Baker says Ritalin is being grossly overprescribed in parts of the US and Britain, but not here.

"Many parents I deal with are upset about the latest bad publicity.

But the thought of depriving a child who has the chance of benefiting from Ritalin seems harsh.

"It turns people's lives around. Children are made safe and families no longer live with unbearable stress."

The Ministry of Health concedes Ritalin use has markedly increased, especially during the 1990s. But the ministry's child youth and health chief adviser Pat Tuohy believes use has plateaued, despite prescription figures indicating otherwise.

Tuohy says the latest figures have been skewed with the introduction in 2001 of a slow-release Ritalin.

Many children now take both the 10mg dose of short-acting Ritalin as a "starter" or booster and the 20mg version which gives 10 hours' coverage to get them through the school day.

New guidelines were issued by the ministry in 2001 to assist doctors to more accurately diagnose disruptive behaviour problems. This was not an attempt to dampen demand for Ritalin, says Tuohy, but to rationalise prescribing.

There was concern some regions were over-prescribing - central and lower South Island prescriptions increased from 1100 to almost 15,000 over seven years - and other areas being too conservative.

"By the time most parents get to thinking about Ritalin, they are ready to try anything," says Tuohy. "As a parent, I'm more concerned about the exposure of youngsters to the surge in caffeine-based products."

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