DAVE TRAXSON - SIDE EFFECTS OF STIMULANT MEDICATION - LONG TERM

Nothing is better than a good nights sleep for a child.

If not you often get this:

The most illogical common side effect of all stimulants , as we all know, is sleep disturbance. How crazy is that? As parents or caring adults we all know the critical importance of sleep for a child. Sleep is natures great restorative and changes brain chemistry positively. A child deprived of good quality sleep for even one night can become fractious and anxious for the next day.So why as a society would we encourage this unscientific and unnatural approach.

So why do we use stimulants that affect sleep and cognition?

         Corrupting Cognition

Amphetamines such as Adderall could alter the mind in other ways. A team led by psychologist Stacy A. Castner of the Yale University School of Medicine has documented long-lasting behavioural oddities, such as hallucinations, and cognitive impairment in rhesus monkeys that received escalating injected doses of amphetamine over either six or 12 weeks. Compared with monkeys given inactive saline, the drug-treated monkeys displayed deficits in working memory - the short-term buffer that allows us to hold several items in mind - which persisted for at least three years after exposure to the drug. The researchers connected these cognitive problems to a significantly lower level of dopamine activity in the frontal cortex of the drug-treated monkeys as compared with that of the monkeys not given amphetamine.

Underlying such cognitive and behavioural effects may be subtle structural changes too small to show up on brain scans. In a 1997 study psychologists Terry E. Robinson and Bryan Kolb of the University of Michigan at Ann Arbor found that high injected doses of amphetamine in rats cause the major output neurons of the nucleus accumbens to sprout longer branches, or dendrites, as well as additional spines on those dendrites. A de­cade later Castner's team linked lower doses of amphetamine to subtle atrophy of neurons in the prefrontal cortex of monkeys.

A report published in 2005 by neurologist George A. Ricaurte and his team at the Johns Hopkins University School of Medicine is even more damning to ADHD meds because the researchers used realistic doses and drug delivery by mouth instead of by injection. Ricaurte's group trained baboons and squirrel monkeys to self-administer an oral formulation of amphetamine similar to Adderall: the animals drank an amphetamine-laced orange cocktail twice a day for four weeks, mimicking the dosing schedule in humans. Two to four weeks later the researchers detected evidence of amphetamine-induced brain damage, encountering lower levels of dopamine and fewer dopamine transporters on nerve endings in the striatum - a trio of brain regions that includes the nucleus accumbens - in amphetamine-treated primates than in untreated animals. The authors believe these observations reflect a drug-related loss of dopamine-releasing nerve fibers that reach the striatum from the brain stem.

One possible consequence of a loss of dopamine and its associated molecules is Parkinson's disease, a movement disorder that can also lead to cognitive deficits. A study in humans published in 2006 hints at a link between Parkinson's and a prolonged exposure to amphetamine in any form (not just that prescribed for ADHD). Before Parkinson's symptoms such as tremors and muscle rigidity appear, however, dopamine's function in the brain must decline by 80 to 90 percent, or by about twice as much as what Ricaurte and his colleagues saw in baboons that were drinking a more moderate dose of the drug. And some studies have found no connection between stimulant use and Parkinson's.

Stimulants do seem to stunt growth in children. Otherwise, however, studies in humans have largely failed to demonstrate any clear indications of harm from taking ADHD medications as prescribed. Whether the drugs alter the human brain in the same way they alter that of certain animals is unknown, because so far little clinical data exist on their long-term neurological effects. Even when the dosing is similar or the animals have something resembling ADHD, different species' brains may have varying sensitivities to stimulant medications.

Nevertheless, in light of the emerging evidence, many doctors and researchers are recommending a more cautious approach to the medical use of stimulants. Some are urging the adoption of strict diagnostic criteria for ADHD and a policy restricting prescriptions for individuals who fit those criteria. Others are advocating behavior modification - which can be as effective as stimulants over the long run - as a first-line approach to combating the disorder. Certain types of mental exercises may also ease ADHD symptoms [see "Train Your Brain," by Ulrich Kraft; Scientific American Mind, February/March 2006]. For patients who require stimulants, some neurologists and psychiatrists have also suggested using the lowest dose needed or monitoring the blood levels of these drugs as a way of keeping concentrations below those shown to be problematic in other mammals. Without these or similar measures, large numbers of people who regularly take stimulants may ultimately struggle with a new set of problems spawned by the treatments themselves.

Growing Problems

Drug toxicity lowers growth rate significantly (2cm average difference over 2 years)

So far the best-documented problem associated with the stimulants used to treat attention-deficit hyperactivity disorder (ADHD) concerns growth. Human growth is controlled at least in part through the hypothalamus and pituitary at the base of the brain. Studies in mice hint that stimulants may increase levels of the neurotransmitter dopamine in the hypothalamus as well as in the striatum (a three-part brain structure that includes part of its reward circuitry) and that the excess dopamine may reach the pituitary by way of the bloodstream and act to retard growth.

Recent work strongly indicates that the drugs can stunt growth in children. In a 2007 analysis of a National Institute of Mental Health study of ADHD treatments involving 579 children, research psychiatrist Nora Volkow, who directs the National Institute of Drug Abuse, and her colleagues compared growth rates of unmedicated seven- to 10-year-olds over three years with those of kids who took stimulants throughout that period. Relative to the unmedicated youths, the drug-treated youths showed a decrease in growth rate, gaining, on average, two fewer centimeters in height and 2.7 kilograms less in weight. Although this growth-stunting effect came to a halt by the third year, the kids on the meds never caught up to their counterparts.
This is a profoundly worrying set of findings which reinforce the view of thousands of concerned child professionals in the U.K. as the the potential for toxic harm to children from 4-16 years old.Clearly this highlights the need for a National review of this increasing lazy practice by medics.

Sydney Morning Herald - 17-02-11 - Sedation the cost of taking the boisterous out of boys.

Elizabeth Farrelly journalist.

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I have an acquaintance who, apart from being a practising professional, successful academic and author of several important books, is a pianist capable of rendering entire Bach cantatas as casually as you or I might plunk out Chopsticks. He also has seven equally accomplished children, an undisclosed number of complex relationships, a flourishing side-career as a magician and a personal presence so intensively entertaining that catching up once every few years is enough.

These days, I imagine, he would be diagnosed with ADHD and medicated into normalcy. And it's this that makes me wonder. Assuredly there are those who benefit from Ritalin, but a fourfold increase in seven years? And five times as many boys as girls, almost all of them pubescent? Surely this should give us pause for thought.

The Ritalin wars are usually treated as just another tussle between the pharmaceutical companies and the rest, but is there something else going on here as well? Is it part of a more generalised, covert war on boyhood?
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Thirty years ago Australian primary schools employed five male teachers for every four females. By 2006 there was one male teacher for every four females. This overwhelming feminisation of primary education, and of culture generally, has made boy-type behaviour stuff to frown upon. Are we in danger of seeing boyhood itself as a disorder?

When Christopher Lane, author of Shyness: How Normal Behaviour Became a Sickness, quoted a psychoanalyst saying "We used to have a word for sufferers of ADHD; we called them boys", he probably did not expect it to become the most famous line of his book.

Lane's point was more general, about how personality traits that were once tolerated and even celebrated are now treated as disorders.

What was once introversion is now "avoidant personality disorder", nervousness is "social anxiety disorder" (SAD) or dating anxiety disorder (DAD) and so on. It's not that these disorders don't exist, says Lane, a Guggenheim fellow studying the ethics of psychopharmacology, but that our definitions are so broad that the entire mysterious subconscious is reduced to chemical balance, and any deviation looks like disease.

Why, he asks, is ADHD so commonly diagnosed in boys? Is it new behaviour? Or just a new attitude to that behaviour?

A report last year by Dr James Scott and others in the Australian and New Zealand Journal of Psychiatry suggests the latter. Ritalin prescriptions have quadrupled in seven years, which might be explained by the drug being covered by a government subsidy were not the same thing happening overseas.

There's also this: although, in Australia as elsewhere, the male-to-female ADHD ratio is 2.45:1, Ritalin rates are 5:1. Diagnosis is more than twice as likely in boys, and medication more than twice as likely again.

So the argument is not just about medication or even deviation. It's also about gender. And as the hetero heart-throb morphs from John Wayne into Justin Bieber, it is worth wondering whether our behavioural expectations show a similar shift.

Consider the following story. There is an opportunity class in a public school that prides itself on nurturing the gifted, and displays the usual oestrogen-heavy teacher ranks. In the class is a boy - not mine - who is 10 years old. Let's call him Jack. Opportunity classes are known to collect excitable kids, and Jack, even by opportunity class standards, is unusually clever; bright, funny, literary, sporty and artistic but also intensely emotional.

The school is so highly regarded that its roll swells and swells. With the extra classrooms and then, to top it off, one of Julia Gillard's enormous new school halls, the playground becomes so reduced that lunchtime ball games are banned. Instead, crowded in, the kids play tip.

So when the fight comes it should be no surprise. The only surprise is no one is hurt. Sure, one boy is kicked and another kneeled on, but there is no real damage, no blood. Yet a complaint is made and all hell breaks loose. Violence? In our school? OMG.

There is no physical punishment, heaven forbid. But the substitute, from boy-perspective, is far worse. It's talk. Regulation department-issue talk, certainly, but it spreads what might have been an afternoon's pain (and pride) into half a dozen sessions across a week or more.

With various combinations of parents, teachers and child witnesses, Jack endures a heaping-on of emotional pressure, with dark mutterings about Matthew Newton, the actor accused of assaulting his partner, and recommendations of psychological therapy.

Now, I have nothing against talk, or talk therapy. In fact, being female, I like it. But talk is girl stuff. Not only are Jack's parents made to feel they have a psychopath in their bosom, when it is really just a boy thing and small beer by Tom Sawyer standards, they also come away feeling primary schools in general "expect boys to act like girls".

Jack has now moved on to an all-boy high school where his tutors say he is a pleasure to teach and they wish there were more like him.

Although there is no suggestion that Jack has ADHD, the attitudes are similar, and disturbing. ADHD, Dr Scott says, is characterised by "immaturity of the frontal lobes" the brain site for planning and organisation. This is why Ritalin, a stimulant, is prescribed for hyperactivity; it stimulates the control centres. It's also why most ADHD sufferers eventually grow out of it.

But why the gender imbalance, and why now? We know that boys tend to be late maturers anyway, but Scott concedes there are also social and perceptual factors at play. Teachers with "less structured" teaching style and "more distracting" classroom environments, he says, yield many more of his clients than their more disciplined (my word) colleagues.

Whereas ADHD girls "sit quietly in a corner", the boys are more disruptive and more noticed, more referred, more medicated. And although much the same is true of ''normal'' boys and girls, the upshot is that ''girl'' is a norm to which boys are expected to strive. Scott sees it as "an unintended consequence of how society operates".

But consequences this important should be either clearly intentional, if girlifying boys is really what we want, or remedied. Personally, I reckon the crazily creative are types we'll need more of, rather than fewer of, in the future, even if they are male.

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Guardian article: 30 -10 - 09 :'Tories slam doctors for drugging children.' October 2009.

Tories slam doctors for drugging children

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• Conservatives used FoI act to obtain data from NHS
• Prescriptions issued to 16-18 year olds up by 51% since 2005
            
    * guardian.co.uk, Friday 30 October 2009   

The number of prescriptions issued to children for anti-depressants, anti-psychotic drugs and attention deficit disorder medication has rocketed, according to figures released today.

The increasing use of drugs to treat mental health problems in youngsters is condemned by the Conservative Party which obtained the statistics from the NHS Prescription Pricing Authority.

Following a series of Freedom of Information requests, the authority revealed that more than 420,000 prescriptions of ADHD (Attention Deficit Hyperactivity Disorder) drugs were issued to children under 16 in 2007 – a rise of 33 per cent over the previous two years.

For those aged between 16 and 18, more than 40,000 prescriptions were issued – an increase of 51% compared to 2005. The NHS spent over £17m on ADHD drugs in 2007.

The number of prescriptions is not the same as the number of patients since some children may receive repeat or multiple prescriptions. The increase nonetheless suggests doctors are frequently resorting to pharmaceutical remedies rather than talking therapies.

Around 113,000 prescriptions for antidepressants were issued to children under 16 in 2007 and almost 108,000 to 16 to 18 year-olds, according to the same series of FoI requests. For children under 16, that respresented a 6% increase over two years. The NHS spent around £1.5m on anti-depressant drugs for children in 2007.

For anti-psychotics, in excess of 86,000 prescriptions were issued to children under 18 in 2007. The number given to 16 to 18 year-olds was up 7% since 2005 and the number handed out to under 16s rose by 11%. The NHS spent almost £3.5m on anti-psychotic drugs for children in 2007.

The Conservative health spokeswoman, Anne Milton, said: "We already know that our children suffer the lowest levels of well-being in Europe. This data shows that increasingly health professionals are prescribing drugs to treat child mental health problems, when evidence suggests that talking therapies can have an equal, if not better effect.

"These drugs have significant risks when given to children and young people, making this rise extremely concerning." Some drugs prescribed for mental health conditions have been associated with potentially dangerous side-effects in children, the Conservatives said. In one US study children reported experiencing hallucinations after taking ADHD drugs.

The Prescription Pricing Authority, which has itself since been subsumed into the NHS Business Services Authority, stopped collecting the data in late 2007 and said that it could no longer provide reliable estimates.

Earlier this year the British Medical Journal estimated that up to 5% of school age children in England and Wales have ADHD - as many as 367,000 children.

Responding to the figures a department of health spokesperson said: "NICE guidance is clear that antidepressants should rarely be prescribed to children and young people and only as part of a treatment regime, stressing that other treatment options should be considered first."

In terms of ADHD medication, the spokesperson added: "Treatment with prescribed drugs should only be started after a specialist in ADHD has thoroughly assessed the child or adolescent and confirmed the diagnosis. Once treatment has been started it should be monitored by a GP. Drug therapy should be one part of a comprehensive treatment programme that includes advice and support to parents and teachers."

Guardian article: 11-03-10 :Are drugs the solution to ADHD young people? + Newsweek Cover.

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Are drugs the solution to the problem of ADHD among young people?-Rowenna Davis - March 11th 2010.
Figures revealed to Education Guardian show a huge increase in spending on Ritalin. Are teachers doing all they could to help children without drugs?
  
        There are few statistics for how many young people are taking drugs such as Ritalin There are no statistics for how many young people are taking drugs such as Ritalin, despite the fact that they have lots of side-effects. Photograph: Murdo Macleod

Leon Perry is in trouble for insulting his teacher. Fidgeting on a chair in the assistant head's office of Queen's Park community school (QPCS) in north London, the 13-year-old admits he skipped his medication the day the trouble started.

"I can get a bit hyperactive when I come off," he says. "I'll be honest, I can be violent. When I'm on my tablet, I think before I act, when I'm off, I think after. If teachers get on my nerves, I'll say what I want. When I'm on my tablet, I can't be bothered."

Leon has been taking Ritalin since he was diagnosed with attention deficit hyperactivity disorder (ADHD) when he was six. He's not alone. According to data obtained exclusively by Education Guardian under Freedom of Information legislation, there has been a 65% increase in spending on drugs to treat ADHD over the last four years. Such treatments now cost the taxpayer over £31m a year.*

With such a vast increase in figures, a growing number of academics are raising concerns that some teachers are either recommending these drugs as an easy alternative to dealing with bad behaviour, or simply turning a blind eye to those on medication when they should be investigating the root cause of their problems. In the worst cases, schools have been known to put significant pressure on students or their parents to seek the medication.

Take Leon. He insists he didn't want to start taking Ritalin. His mum didn't want him to, either. It was his last school that gave him an ultimatum: go on the drug and act with more respect, or leave the school. Seven years later, he still relies on Concerta Exel – a slow-release form of Ritalin – to control his moods.

"I know it helps me in some ways, but I hate taking it," he says, "There are days when I deliberately avoid it. You just don't feel yourself, you feel so drained out. It makes you feel disgusted and down. Like you've got no soul or something. My mum doesn't want me to take it, but what can she do? She wants me to get an education."

The drugs most frequently prescribed for ADHD are atomoxetine, dexamfetamine and methylphenidate3 – the last most commonly known by the brand name Ritalin.

Since ADHD first gained recognition as a medical condition in the mid-1980s, professionals have argued over the use of such drugs. Some believe they treat a legitimate problem. Others, such as education expert Dr Gwynedd Lloyd from the University of Edinburgh, refuse to acknowledge that ADHD is even a medical condition.

"You can't do a blood test to check whether you've got ADHD – it's diagnosed through a behavioural checklist," says Lloyd. "Getting out of your seat and running about is an example –half the kids in a school could qualify under that criterion. I know a lot of children have genuine difficulties, and some of these are biological, but most are social and cultural."

The growth in popularity of the drugs throws up serious questions for teachers. There may be a variety of causes for a child's challenging behaviour. Leon, for example, has had problems at home after his mother found it difficult to cope with him. But with huge pressure on time and resources – pressure that is only likely to increase in the current economic climate – teachers have fewer incentives to investigate the root causes of disruptive behaviour.

"Ideally, schools would prefer to offer intensive one-to-one support, but if the resources are limited – which they usually are – then we're pushed into a choice between medication or exclusion," says Tim Bown, assistant head at QPCS. "Hearing a student say that a drug 'takes away his soul' doesn't sit comfortably with us as a school, but permanent exclusion doesn't, either. There is no doubt his behaviour becomes more aggressive and disruptive when he comes off."

Although some doctors are more inclined to recommend the medication than others, Ritalin is fairly accessible through the NHS, although GPs have to refer the patient to a specialist before the initial prescription can be given. Many professionals do not take the recommended step of checking whether ADHD behaviour is exhibited at school as well as at home before signing off the medication.

Getting these decisions right is essential, because ADHD drugs can have significant side-effects, and the long-term effects of them on very young children whose brains are still developing remains unclear.

Twenty-one-year-old Mikaela Green knows all about the costs and benefits of Ritalin. Mikaela sought the diagnosis herself when she was 18, after severe disruption at school.

"The drugs helped me gain more control over my moods," she says. "I was a lot more focused and I didn't get distracted or distract others. I was far less impulsive – I wouldn't shout in lessons and my family life improved."

But after three years on the drug, she wants to come off. "They're not physically addictive, but I do feel dependent on them. If you've not had enough sleep they keep you going, if you're low they pick you up. I'm worried that if I stop taking them my world might fall apart.

"There are physical effects, too. For a good year they suppressed my appetite – and for an 18-year-old girl that's easy to abuse. I got involuntary muscle twitches because I wasn't sleeping or eating enough. I have to take sleeping pills now.

"Sometimes I think they make me more ADHD. If I take it in its pure form I get something I call 'Ritalin golden hour' when I can talk solidly the whole time, a bit like I'm on speed. I might have got some advantages out of the drug, but I wouldn't recommend it for younger children."

Schools like Queen's Park are doing their best to avoid medication. Employing several counsellors and psychotherapists, QPCS is participating in the Marlborough project, which is part of the Brent delivery of Targeted Mental Health in School (TaMHS). This invites challenging students and their parents to discuss poor behaviour once a week after school. Leon says the targets he is set there have helped him to improve. But as Bown points out, although there are only a handful of pupils at QPCS who need this service, it's still incredibly resource-intensive.

"All schools are facing cuts and it may well be these sorts of services – therapists, councillors, mentors – that will be the targets because, understandably, schools don't want to lose teachers."

This isn't the only economic incentive for choosing medication over other treatment methods. Parents whose children are diagnosed with ADHD are eligible for disability living allowance, and drugs companies can make huge profits from selling solutions to children's problems. According to Dr Lloyd, the explosion of ADHD diagnoses in the mid-1990s corresponded with an increase in marketing from US drugs companies, which felt they'd saturated the American market.

No records are currently kept about how many young people are on these drugs in the UK, and little research has been done into what the future might hold for them. Talk to Mikaela and Leon, however, and both of them want to reduce their intake.

"It's difficult to accept that without medication you're not good to be around," says Mikaela. "But I need to figure out what I'm really like. I might be worried about coming off, but I'm not sure I'm comfortable saying I am who I am because of medication."

Some names have been changed

* The figures of 65% and £31m do not include prescriptions dispensed in the private sector. They also do not include prescriptions that are dispensed from hospital pharmacies.

These figures include all prescriptions for methylphenidate, which are sometimes used to treat narcolepsy as well as ADHD. However,this would be for a very small number of patients, and is unlikely to distort the figures.

The figures may also include prescriptions for some older ADHD patients who have remained on the drugs since their youth, but researchers say the vast majority of these users are likely to be young people.

Guardian Article 18-03-11,"Inquiry urged over 'Quick Fix' behaviour drugs at four.

Some young people claim medication affects their personality but it helps to "get their parents off their case."

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Behaviour drugs given to four-year-olds prompt calls for inquiry

ADHD medication given in breach of NHS guidelines as professor says parents putting pressure on GP

    * Rowenna Davis
    * guardian.co.uk, Friday 18 March 2011 21.08 GMT

   


Children as young as four are being given Ritalin-style medication for behavioural problems in breach of NHS guidelines, the Guardian has discovered, prompting the leading psychological society to call for a national review.

Family-based therapy is recommended for treating children with ADHD (attention deficit hyperactivity disorder), with prescription drugs used only for children over six years old and as a last resort.

The figures, based on data from 479 GPs, show prescription rates were highest for children aged six to 12, doubling to just over eight per 1,000 in the five years up to 2008. Children aged 13 to 17 had the second highest rate at six per 1,000, while those aged 25 and over had less than one per 1,000.

Concern is greatest over children under six who should not be receiving drugs at all, says the National Institute for Health and Clinical Excellence (NICE).

There are no reliable figures for how many children under six have been given Ritalin. But Professor Tim Kendall, joint director of the National Collaborating Centre for Mental Health, who chaired the NICE guideline committee, confirmed that he had heard reliable reports of children in nursery and pre-school being prescribed medication unnecessarily, and that it was often parents who were putting pressure on GPs.

He said: "There are two reasons why parents go shopping for a diagnosis. The first is to improve their child's performance at school, and the second is to get access to benefits. There are always GPs that will do it, but it's wrong to give a child a diagnosis without also consulting schools and teachers."

In one case seen by the Guardian, a five-year-old from the West Midlands was found to be receiving a double dose of methylphenidate, commonly known by the brand name Ritalin, the drug used to treat ADHD, despite his school insisting that he is "among the best-behaved children in his class".

In notes seen by the leading educational psychologist in the case, the boy's headteacher reports that the school does not believe he has ADHD, but that the medication is being prescribed "to help mum at home".

In another case in the West Midlands a five-year-old was put on the drugs for three years at the request of his parents without any consultation with teachers or psychologists.

Kendall said prescriptions could continue to rise due to impending health cuts. "It's a false economy … all the evidence says that parent training courses combined with partnership working with schools is what works, but these programmes are being cut by local councils."

Speaking on behalf of the British Psychological Society, Peter Kinderman, chair of the division of clinical psychology, said he supported calls for a review, saying he would be concerned if children were being prescribed medication as a quick fix.

He added that mental health services were already "grossly under-resourced" and that cuts were likely to put services to children at risk.

Kinderman expressed particular worries about the cases uncovered by the Guardian. "Many psychologists are very concerned at the use of psychiatric and medical diagnoses in cases such as mild social anxiety or shyness, not only because of doubts about the validity of many of the diagnostic approaches, but because of the possible adverse effects."

But Dinah Jayson, consultant child and adolescent psychiatrist at Trafford general hospital and a spokesperson for the Royal College of Psychiatrists, insisted that in some cases it could be "cruel" not to treat children of any age if all other options had been exhausted.

She said: "With every child there is a risk of doing something but there is also a risk of doing nothing. We know early [medical] intervention can help children who would otherwise be losing out."

Professor Ian Wong, director at the Centre for Paediatric and Pharmacy Research, who led the prescriptions research, pointed out that prescription rates were still below the expected number of diagnoses for hyper-kinetic disorders.

"GPs and psychiatrists are much more aware of mental illness, and the drugs are so effective and have such a big effect that it's tipped the balance. They [drugs] can make a real difference not just to the child but to households and classrooms where children may be causing real disruption."

According to NICE guidelines, between 1% and 9% of young people in the UK now have some form of ADHD, depending on the criteria used. NHS figures show a rise in all methylphenidate prescriptions across all age groups by almost 60% in five years, rising from 389,200 in 2005 to 610,200 in 2009.

Side-effects include sleeplessness, appetite loss and reduced growth rates. Wong, who says the long-term effects are inconclusive, recently received a €3m (£2.6m) grant from the European commission to investigate side-effects further.

Professor Paul Cooper, a psychologist and professor of education based at Leicester University, who has completed qualitative research with adolescents on psychostimulant medication, expressed concerns about the possible effects of the drugs on personality development.

"Some young people say that it affects their personality but accept it because it gets mum and dad off their case or stops them getting into trouble," he said. "They don't like it, but take it for the benefit of other people."

Medical experts in the West Midlands say over-prescription continues to be a problem. "This whole area needs public scrutiny – there has to be some kind of review," said the educational psychologist who oversaw the cases but did not want to be named. "Handing out strong psychotropic drugs to children should be a last resort, but they're being handed out like sweets."

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