Ministry endorses Ritalin-type drugs for behavioural problems

By MARTIN JOHNSTON health reporter

The Government has endorsed the use of controversial Ritalin-type drugs as a first-line treatment for children with certain behavioural problems.

The endorsement came with the Ministry of Health's release yesterday of its guidelines for assessing and treating attention-deficit/hyperactivity disorder (ADHD).

"Studies show that a carefully executed regimen of medication is more effective than behavioural treatment alone," said Dr Pat Tuohy, the ministry's chief adviser on child and youth health.

"Whether combined treatment - medication and behavioural treatment - is more effective than medication alone is less clear," he said.

Methylphenidate (brand names Ritalin and Rubifen) is the main drug used to treat the disorder in NZ.

Emeritus Professor John Werry, a child psychiatrist who helped to write the guidelines, said about 4000 New Zealand youngsters were on methylphenidate when he last checked in December.

He said that meant too few children were receiving it, except in some smaller areas - the Bay of Plenty, Wanganui, Dunedin and Southland - where prescription rates were higher.

Up to 5 per cent of schoolchildren suffered ADHD and nearly half of them were the "hard core" who could not be managed without the medication.

The ministry says ADHD is a biological disorder characterised by persistent overactivity, impulsiveness and inattention.

The Teacher Registration Board director, John Langley, a critic of the extent of methylphenidate use, said that while it might help with some children's undesirable behaviour, it was important to address the "bigger picture".

"We have to pay very great attention to teacher education, both in terms of initial teacher education and professional development, and how we work with families.

"That's how we make a difference to a community. You don't do that by shoving pills at kids."

Dr Langley, who will become principal of the Auckland College of Education in September, has previously complained that methylphenidate renders some children "semi-catatonic" in class.

But child psychiatrist Dr Sally Merry, of the University of Auckland, disputes this.

"It actually improves concentration and improves social interactions. It's not a sedative," she said, although it did have side-effects, which could include reduced appetite and sleeping difficulties.

The guidelines are aimed at paediatricians, GPs and child and adolescent psychiatrists but the ministry expects they will be helpful to child-health workers and parents.

Ministry of Health