"Lessons on ADHD are needed" by Parents

Parents need lessons in how to cope with their children's unruly behaviour, new guidelines on attention deficit hyperactivity disorder (ADHD) say. The National Institute for Health and Clinical Excellence (NICE) says drugs such as Ritalin should be avoided - and must not be given to the under-fives.

Teachers would also benefit from training to recognise and help children with this condition, it adds. Any primary school class is likely to have a child with ADHD, experts say. Most of the estimated 365,000 children in Britain with ADHD receive no treatment at all. But of those who do, most - about 37,000 - are prescribed stimulants like Ritalin (methylphenidate). Children with ADHD have extreme difficulty sitting still, learning or concentrating. At school they may find it hard to keep friends and suffer from bullying because of their behaviour. Looking after affected children can be exhausting for parents.

The guidelines, which cover England, Wales and Northern Ireland, say parent training and education programmes should be offered as a first-line treatment for ADHD, both for pre-school and school age children. The programmes teach parents how to create a structured home environment, encourage attentiveness and concentration, and manage misbehaviour better. Drugs remain a first option for children over five and young people with severe ADHD, say the guidelines, but only as part of a comprehensive treatment plan that includes psychological and behavioural interventions.

Dr Tim Kendall, a consultant psychiatrist from Sheffield who is joint director of the National Collaborating Centre for Mental Health and helped draw up the guidelines, said: "There is an over-reliance on medicines. Quite commonly, people tend to revert to offering methylphenidate or atomoxetene. When they do that it's not always because there's a good balance of risk and benefits. It's because the child has got what appears to be ADHD and that's what's available. Its easier to prescribe a drug when other options like parent training programmes are not available."

Dr Kendall said it was important to diagnose ADHD correctly, rather than label all bad behaviour as ADHD. The symptoms of ADHD persist in all settings - both at school and at home - and cause real impairment.

ADHD symptoms

Easily distracted

Restlessness

Difficulty remaining seated when required

Difficulty awaiting turn in group situations

Difficulty following instructions

Difficulty in playing quietly

Often shift from one incomplete activity to another

Often interrupts others

Often engages in physically dangerous activities without considering the consequences

Andrea Bilbow, chief executive of the ADHD charity ADDISS, welcomed the NICE recommendations but questioned how helpful the parent training programmes would be to parents. "Parenting programmes are extremely important, but they need to be specific for ADHD. The ones that NICE are recommending were designed for the parents of children with conduct disorder, which is completely different from ADHD," she said.

The Scottish InterCollegiate Guidelines Network (SIGN) is rewriting its guidelines on ADHD diagnosis and treatment and will take the NICE guidelines into consideration. Their new guidance will come out in the first half of 2011.