http://www.news.com.au/sundaymail/story/0,,21052984-5007191,00.html

Out of control

Daryl Passmore

January 13, 2007 11:00pm

 

THE scourge of drugs in our schools is one of the big fears facingall parents as their children grow up.

But increasingly concern is turning to the cocktail of mind-alteringsubstances being fed to youngsters before they leave home in the mornings.

Tens of thousands of children are being prescribed drugs for a series of moodand behaviour disorders ranging from attention deficit hyperactivity disorder(ADHD) to depression.

"There is a medical civil war going on and the victims caught in thecrossfire are the kids who have no say in it," says Dr George Halasz, aMelbourne-based psychiatrist.

Lined up on one side are the GPs, child psychiatrists and other specialistswho believe medication is a safe, simple and effective way of relieving thesuffering of children and adolescents, and controlling symptoms that cause themto struggle at school and socially.

On the other side are colleagues who criticise what they see as massiveover-diagnosis and unnecessary use of potentially dangerous drugs that have alargely unknown long-term effect on developing brains. No anti-depressant hasbeen approved in Australia for the treatment of depression in anyone aged under19, but they are still prescribed.

Federal figures for 2003 show 250,000 prescriptions forProzac and similar drugs – selective serotonin reuptake inhibitors (SSRI) – wereissued to children and adolescents. That was 30,000 more than the previous year.Three-quarters of them went to people aged 15 to 18, with about 15,000 going tochildren under 10.

The figures do not indicate how young the children onanti-depressants are, but a 2004 study that tracked more than 5000 mothers andtheir children found that "it is common for children as young as five to beperceived to manifest a variety of symptoms of depression and/oranxiety".

Black Dog Institute chief Professor Gordon Parker has prescribed Prozac to aneight-year-old boy, reluctantly and only after consulting with two other childpsychiatrists.

"His mother, who also had a very bad depression, had several children andthey were all happy except this one boy who would come home from school and say,'I want to be dead.' "

After about three weeks on Prozac, the boy was "wonderful". Several attemptswere made to take him off the medication but within three or four weeks hiscondition deteriorated each time.

The use of anti-depressant drugs for children under 12 "should be done rarelyand by specialists and with great care", cautions Prof Parker.

A study by Professor Jon Jureidini of the Adelaide Women's and Children'sHospital concluded children and adolescents should not be placed onanti-depressants.

"The drugs do not work and there is a possibility they may be dangerous for asmall group," he says.

In 2004, the UK banned the use of all SSRIanti-depressants except Prozac for young people and the US Federal Drugs Agencyasked manufacturers to include warning labels after experts found a link betweenanti-depressants and increased risk of suicide in children and teenagers. Thedanger was said to be greatest at the start of treatment, when there was achange in dosage or if it was suddenly withdrawn.

Australia's Therapeutic Goods Administration gave asimilar warning and reiterated that the drug companies advise against the use ofthe medications to treat people under 18 for depression.

The Australian Adverse Drug Reactions Advisory Committee recommended thatwhere anti-depressants were prescribed for children and adolescents it should becarefully monitored and done only as a part of "comprehensive" patientmanagement, preferably with cognitive behaviour therapy.

ADRAC documents show that since close monitoring ofprescriptions to children began in 2005, more than 1600 adverse reactions hadbeen notified. Of these, 827 related to children aged under 10 and the drugs hadbeen linked to two suicides and a death from heart failure.

Another 833 adverse reactions were logged for youthsaged 10 to 19, including links to three deaths.

Dr Brett McDermott, director of the Mater Child and Youth Mental HealthService in Brisbane and spokesman for the Royal Australian and New ZealandCollege of Psychiatrists, says: "I think Australia has got it right. There arevery safe anti-depressants and we are not prescribing them lightly.

"Depression is a severe condition and I don't think you can withholdtreatment because a small amount have side effects."

Dr McDermott said GPs were competent to prescribe to adolescents but theyounger the child, the more important it was they saw a child psychiatrist.

"I would be very reluctant to prescribe anti-depressants to kids in primaryschool," he said.

Dr Halasz and others fear the use of drugs to treat depression could followthe explosion in ADHD medication.

"The US, Canada and Australia are the world gold, silver and bronzemedal-holders in terms of prescribing drugs to children," he said.

Prescriptions in Australia for the most commonmedication – dex-amphetamines– rose from 96,000 a year to 232,000 between 1994and 2004.

In August 2005, the other popular ADHD drug Ritalin wasadded to the Pharmaceutical Benefits Scheme, reducing the cost from $49 to aslittle as $4.70 for concession card-holders. Over the next six months, thenumber of Ritalin scripts issued soared from 523 a month to more than 5800, withno apparent decrease in other medications. Queensland prescription numbers havegrown at a rate second only to that in Western Australia.

A world authority on ADHD, Professor David Hay from Curtin University inPerth, says one possible reason for the high number of cases is that GPs areallowed to diagnose ADHD in those two states. Elsewhere, it can be done only bychild psychologists or psychiatrists.

ADHD is "extraordinarily complex", with a high risk of mis-diagnosis, saysProf Hay.

"We have to make sure we are measuring a problem in the child and not theparent's perceptions. I don't think it's done well enough."

A Federal Government study found 11 per cent of parents reported theirchildren had symptoms consistent with ADHD. Dr Halasz says the true figure ismore like 1 per cent and that many are being wrongly diagnosed.

"Parents are between a rock and a hard place. They always want to do the bestfor their children," he said.

In the US, it is not uncommon for schools to insist parents medicate theirchildren to modify their behaviour as a condition of remaining at theschool.

Youth Affairs Network of Queensland director Siyavash Doostkhah says it alsohappens regularly here – even though it is illegal.

Denise, a Brisbane northside mother, says that happened to her son John whowas branded a "bad" child all through pre-school.

"This came to a head when he had only been in Grade 1 for approximately fourmonths when the principal came to me and told me I either put my son onmedication or he would be expelled."

Queensland University of Technology education PhDstudent Linda Graham recently completed a study of school responses andconcluded that children who do not fit the "norm" are madescapegoats.

"Parents of children who can be described as 'hyperactive' or 'distractable'are under pressure to medicate their children so they can fit into anoverwrought, under-funded public education system," she said.

"The load is lessened when difficult kids are diagnosed with something thatqualifies for support funding or when parents oblige the school by shifting theproblem to their local pediatrician."

She backed claims by child psychiatrists to The Sunday Mail ofparents being pressured by schools to get diagnoses of conditions such as AutismSpectrum Disorder.

Students with ASD qualify for teacher-aide support funding while those withADHD do not.

Proponents of ADHD medication point to the fact that it has helped thousandsof children to control their impulsive or hyperactive behaviour, to focus andconcentrate better, to improve their school performance and to increase theirsocial skills.

Dr Halasz agrees it would be unethical to withhold the drugs from the verysmall group of children who really require them but argues that just because achild functions better after taking them is not proof that the child was ever"ill".

And he warns there have not yet been any long-term follow-up studies of theeffects.

"There could be a sleeper effect. In 20 years we couldhave a whole generation acting differently."