The ADHD Epidemic

Children’s author William Sutcliffe (left) has recently written a book called Concentr8 (top), which he describes as “a satire on the ADHD epidemic.” Last week, in the Times Educational Supplement, William published a serious article, in which he expressed his concerns about the extent of the “epidemic” in British schools.

William began his article by pointing out that: “The classroom is not a natural environment. Children did not evolve to sit obediently in rows listening to an adult tasked with dispensing knowledge. Highly artificial though it is, the classroom has been adopted by more or less every culture, as the most appropriate setting to prepare children for adulthood.”

The majority of children manage to adapt to their setting, leaving school enriched or, at the very least, relatively unscathed. But, in just about every classroom, there is likely to be at least one child who finds it difficult to conform to expectations. How that child has been treated during the past half-century has changed dramatically.

When I was at school in the 1950s and 60s, the priority for the teacher was to be more a controller than an educator. In the boys-only secondary school that I attended, taught exclusively by male teachers, I frequently witnessed (and occasionally experienced) assaults on children by teachers with a variety of weapons, such as sticks, straps or plimsolls. The buttocks were their favoured target, perhaps to compound the pupil’s humiliation, or perhaps to ensure that any marks would remain unseen.

By the time I began teaching in the 1970s, corporal punishment was beginning to be phased out and, thankfully, was eventually banned. At the same time, many more children had hyper-activity unwittingly thrust upon them by the growing presence of additives such as tartrazine in their diet.

Teachers began to move the emphasis away from different forms of punishment, developing in their place reward systems in the hope that, as in the old song, to “accentuate the positive” would help to “eliminate the negative”. Before the days of self-funding and austerity, support staff could be employed to help those who still found it difficult to perform or conform.

More recently, however, external pressure on schools and their teachers has increased considerably as the dictatorial Ofsted regime has become all-powerful. Schools may be sanctioned if they fail to maintain measurable improvements on a series of statistical criteria of dubious validity.

I have previously written elsewhere about the number of suicides of teachers which have been linked to antidepressants. The pressure to achieve pre-ordained targets is passed on from Ofsted inspectors to governors, to headteachers, to teachers, until it reaches the children themselves.

Pupils who do not perform or conform have always been a concern to teachers, but now they can threaten that teacher’s livelihood. A pupil’s lack of progress must be justified to inspectors, and this can be done effectively with an official diagnosis of special educational needs and disability (SEND). Parents, moreover, are happy to accept an explanation for their child’s poor behaviour or lack of academic success which doesn’t reflect on their parenting. Few teachers or parents find themselves in a position to question the criteria by which success is being measured.

So now, a child who fails to pay attention and keep quiet in class is likely to be given a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), and with it a prescription for Methylphenidate, aka Ritalin, or some other stimulant medication. Behaviour that was once described as naughty or disruptive is now categorised as a mental illness, and “treated” with drugs.

Incidentally, one of the characteristics of gifted children is that they may find it difficult to concentrate on matters that don’t interest them. As a consequence, they are often mis-diagnosed as having ADHD, and prescribed Ritalin for their “condition”.

Sami Timimi (left), a consultant child psychiatrist and university professor, agrees that those children who are given an ADHD diagnosis are exhibiting behaviours which are often challenging. But he points out: “There is no robust evidence to demonstrate that what we call ADHD correlates with any known biological or neurological abnormality.”

There is still no diagnostic test that can identify a person with ADHD. Furthermore, no conclusive pattern in brain activity has ever been found to explain or identify ADHD, which raises the question of whether this is truly a brain disorder that should be treated with a psychotropic drug, or is simply the blame-free label linked to non-compliant behaviour.

Just as the efficacy of corporal punishment was accepted for centuries as a means of control, Ritalin now goes mostly unchallenged as the method of choice for controlling difficult children.

Dana Smith (right), a doctor in psychology, says that we are “Pathologising the Norm”. Dana also refers to the fact that “the referring clinician may have a financial investment in writing these prescriptions, receiving perks or consulting fees from the very drug companies whose medications they are prescribing.”

Matthew Smith (left), a university lecturer and author of Hyperactive: the controversial history of ADHD, says we have reached a point where: “All sorts of children, simply those that daydream and don’t pay attention, can now be diagnosed with ADHD and placed on medication.”

William Sutcliffe tells us: “ADHD is reaching epidemic proportions. UK prescriptions for Ritalin and other similar ADHD medications have more than doubled in the past decade, from 359,100 in 2004 to 922,200 last year. In America, some estimates say 15 per cent of children now have the diagnosis. It generates pharmaceutical sales worth $10 billion (£7.4 billion) per year, a 50-fold increase in 20 years. Yet clinical proof of ADHD as a genuine illness has never been found.”

William goes on to ask: “Do these figures correlate with our belief that we are developing into an increasingly tolerant, child-friendly society? What does it say about us that more and more of our children are being told they have brains that are so defective they require a powerful long-term psychoactive drug intervention to render them tolerable members of society?”

A label of mental illness may appear to absolve parent, teacher and child of blame, but can also leave deep, long-lasting scars in that child’s self-esteem. The chemical treatment of it is very likely to have a permanent effect on a child’s well-being and physical development.

Last November I was at an international conference in Copenhagen, where I was privileged to be in the audience for a presentation on “Medicating ADHD” by Robert Whitaker (right). Robert is an award-winning science journalist & author of books such as Anatomy of an Epidemic (below). He is also one of the world’s foremost experts in the study of ADHD.

Robert explained that ADHD is medicated with methylphenidate, usually marketed as Ritalin. This stimulant drug increases dopamine activity in the child’s brain. It acts in the same way and with the same potency as cocaine, although it clears more slowly from the brain than cocaine does. In the short term, the drug will affect the child so that he/she moves and speaks less, which may please the teacher, although at the same time the child will become less interested and more withdrawn. In the long-term, however, the medication causes a deterioration in behaviour, as shown in the 3-year follow-up of the MTA study. Many physical problems were also noted, including motor abnormalities, liver disorders and stunted growth.

Robert stated that, under the influence of ADHD medication, the developing brain is continually attempting to re-balance itself. Changes made to the brain may not be reversible, and children who take Ritalin are much more likely to suffer from mania, psychosis and bipolar disorder in later life than those who are unmedicated.

Perhaps, if teachers were aware of this evidence, they would be less inclined to have their pupils referred to practitioners, who seem to get most of their limited information about the efficacy of the drug from sources linked to pharmaceutical companies.

While researching self-inflicted deaths linked to antidepressants for AntiDepAware, I have also come across children who have taken their lives while on medication for ADHD.

The youngest of these was 9-year-old Taylor Smith (left), whose tragic story I told in detail last year. His inquest heard that, when he hanged himself, Taylor was on medication for ADHD, and that his medication had recently been increased.

A Serious Case Review by Stockton-on-Tees Local Safeguarding Board followed Taylor’s death in 2014. The review, in which Taylor was referred to as “Gavin”, revealed that: “The parents expressed clear concern about the medication regime that Gavin was subject to. Gavin’s mother commented that Gavin’s medication level had been changed a couple of weeks before the incident which led to this review. She described that she had voiced concerns about the change, but had been told by the CAMHS health professional that Gavin would be monitored. She did not feel that she had been given clear guidance or help to manage Gavin.” Neither the Serious Case Review, nor the coroner at Taylor’s inquest, acknowledged that the increased dosage of his unnamed medication was of any significance.

In 2010, 10-year-old Harry Hucknall (right), from Cumbria, hanged himself. After his inquest the following year, the Daily Mail interviewed Harry’s father, who “blamed his death on two ‘mind-altering’ drugs that his son had been prescribed by a psychiatrist to cure his boisterous behaviour and low spirits.

“An inquest was told in April that the boy had more drugs in his body than the normal level for adults suffering from the same problems. Now, a distraught Mr Hucknall is to make a formal complaint to the NHS for prescribing his son Ritalin, a cocaine-like stimulant which, paradoxically, is said to calm down a child, and Prozac, a powerful antidepressant.”

Mr Hucknall  said: “When I was growing up there were lots of kids like Harry — a bit over-active, a bit naughty, who didn’t always do as they were told. Now they are branded with a complaint called attention deficit hyperactivity disorder…What is it? What has changed? Is there some weird disease in the air? Harry was just a normal little boy. But because we live in 2011 he, and many other kids, are on tablets. It seems nearly every child has suddenly developed this ADHD. What a load of nonsense. It’s an easy get-out for parents and schools who can’t control children.”

At the inquest, Mr Hucknall had taken the chance to challenge child psychiatrist Sumitra Srivastava, about why he had put Harry on drugs. “This doctor said at the inquest my son had a chemical imbalance in his brain. I asked him: ‘How do you know? Did you take chemicals from his brain?’

“He told me it was a theory. So based on a theory — and seeing my son five times at the most — he decided to put him on this drug, Ritalin, which is as powerful as cocaine. Harry ended up taking two drugs that work against each other — the Prozac that fights depression and the Ritalin that can cause it. How can that be right?”

Coroner Ian Smith somehow arrived at the conclusion that Mr Srivastava had acted appropriately.

Inevitably, the self-inflicted death of a 10-year-old boy created a lot of interest in the media, even more so because Harry was related to Simply Red vocalist Mick Hucknall. In Parliament, Theresa May (right), who in 2010 was Shadow Leader of the House of  Commons, warned of the dangers of ADHD drugs: “They are powerful prescription drugs and we don’t know what their long-term effects on a child will be.” She related the story of a six-year-old on Ritalin. “He experienced low moods and marked depression and tried to throw himself out of a window within two months of starting treatment. He only recovered once the drug had been withdrawn.”

Like Harry, schoolgirl Alanta Collins (left) was only 10 years old when, in October 2011, she hanged herself in her bedroom in Kent. Her inquest the following year heard that Alanta had spent the afternoon at Brownies, and “had taken ADHD medication before going to bed.” A Serious Case Review revealed that: ”In February 2010 (Alanta) was diagnosed as having ADHD and was started on medication for this.” The SCR examined “associations between suicide and the ADHD medication taken by (Alanta).” The review found that: “The incidence of suicidal ideation is uncommon, and incidence of suicide attempts not known”, and concluded that “there was no reason not to use this medication because of possible risk of suicide.”

14-year-old Ashley Banks (right), from South Yorkshire, died by hanging in 2013. At his inquest, Ashley’s mother talked about his medication for ADHD: “His behaviour improved when he took his medication correctly…When Ashley was not taking his medication correctly he wrote a letter detailing how unhappy he felt and stating he wanted to harm himself. But medical professionals said the depression was a side-effect of his medication and changed the dose.”

15-year-old Joshua Maddox (left), from the West Midlands, hanged himself in 2014. He had been diagnosed with ADHD and autism, and had transferred to another school after being bullied. At Joshua’s inquest, a clinical psychologist said that “his ADHD was complicated and difficult to manage,” while his family considered that his medication for ADHD, which had been changed shortly before his death, “was not working.”

In 2010 Gwen Morgan (right), a 16-year-old schoolgirl from South Wales who was a talented singer and dancer, hanged herself at home. The coroner at her inquest could see no reason for her to be depressed, as: “Her exams did not seem to be causing her any worry and she was entering a relationship.” Earlier, the inquest had heard that Gwen had been taking methylphenidate “for more than two years because she suffered ADHD.” The coroner did not make the link.

A Serious Case Review, published last year by Walsall Safeguarding Children Board, told how 17-year-old Kelly Button (left) died in a fire in a care home in 2012. She had locked and barricaded the door to her room, then set fire to her mattress. She had already been prescribed Risperidone (an anti-psychotic) when, three months before her death, a child psychiatrist decided that it would be appropriate to prescribe her Atomoxetine.

Incidentally, I have also recorded incidences where adults have taken their lives while on medication for ADHD. These include Ben Morris (20) on Atomoxetine, Michael Morrey (28) and Pierre Gurdal (42)  on Ritalin, and Matthew Stubbs (38) on Concerta.

Last month, the United Nations Committee on the Rights of the Child (CRC) published their investigation into children’s rights in the UK. The Guardian reported on it, under the headline “Poorer children disproportionately affected by austerity measures”.

Sections 59-62 of the report dealt with mental health. Here, the committee voiced their concerns over the treatment of ADHD:

They reported that ”The actual number of children that are given methylphenidate or other psychotropic drugs is not available”, and that: “There is reportedly a significant increase in the prescription of psycho-stimulants and psychotropic drugs to children with behavioural problems, including for children under 6 years of age, despite growing evidence of the harmful effects of these drugs.”

One of their recommendations was to: “Ensure that prescription of drugs is used as a measure of last resort and only after an individualized assessment of the best interests of that child, and that children and their parents are properly informed about the possible side effects of this medical treatment and about non-medical alternatives.”

It is absolutely clear that psychotropic drugs like Ritalin, Atomoxetine and Concerta are not being used as “a measure of last resort”, but are being vastly over-prescribed in the UK as a means of behaviour modification. Not only are they ineffective, but they have been shown to lead to conditions like bipolar disorder via what Robert Whitaker called “The ADHD to Bipolar Pathway”.

To give the last word to William Sutcliffe: “We may seem more child-centred and more compassionate, but are we? In 50 years’ time, will the drugging of millions of unco-operative children with docility-inducing amphetamines seem as brutal as physical beating does now? There is a chance that it may.”

Footnote (January 2018)

An inquest in Birmingham this month heard that 12-year-old schoolboy Connor Robertson was found hanged at his home following an argument with his parents over using a computer.

Connor’s mother Jacqueline told the court that her son was a lovely boy and “was an active child, a bit of a joker who loved his computers.” She said he had been diagnosed with ADHD in 2011 and was on medication.

On October 23^rd 2017, soon after Connor and his family had just returned home from a short holiday, Connor asked if he could have his laptop, He was refused and he went upstairs. He was found by his brother.

In her conclusion, Coroner Louise Hunt (left) said: “We know Connor suffered from ADHD. He lived with his brother at home and we know he was on medication for his disorder. It seems as if things were settling down a little bit.” She gave the medical cause of death as hanging and concluded: “He suffered from ADHD which could make him impulsive.”

Related Articles:

A Reflective Checklist…

Teachers, Stress and Antidepressants

Other Prescription Drugs Linked to Suicide

Further reading:

The Hazards of Treating “Attention-Deficit/Hyperactivity Disorder” with Methylphenidate (Ritalin) by Peter R. Breggin, M.D. and Ginger Ross Breggin

ADHD drugs, MHRA and the Concerta scandal – suicides, suicide attempts and self-harm – Open letter to MHRA from Janne Larsson (Sept 2017)

Using ADHD drugs to control ‘non-compliant’ pupils is ‘inhumane’, say experts – article by Adi Bloom in TES (Jan 2018)