Fears over ef­fect of ADHD drugs on child brains

Doc­tors ad­vised to re­strict pre­scrip­tion of med­i­ca­tion for hy­per­ac­tive chil­dren to the most se­vere cases

The Daily Telegraph - - Front page - Health Cor­re­spon­dent By Henry Bodkin

Drugs for at­ten­tion-deficit hy­per­ac­tiv­ity dis­or­der can al­ter the struc­ture of chil­dren’s brains, sci­en­tists have dis­cov­ered, as they warn doc­tors against is­su­ing un­nec­es­sary pre­scrip­tions. In 2017-18, 75,000 chil­dren in Eng­land re­ceived a pre­scrip­tion for ADHD med­i­ca­tion.

DRUGS that counter at­ten­tion-deficit hy­per­ac­tiv­ity dis­or­der (ADHD) can al­ter the struc­ture of chil­dren’s brains, sci­en­tists have dis­cov­ered as they warn doc­tors against is­su­ing pre­scrip­tions un­less strictly nec­es­sary.

Scans of chil­dren with ADHD tak­ing methylphen­idate – most com­monly pre­scribed un­der the trade name of Ri­talin – showed sig­nif­i­cant changes in the dis­tri­bu­tion of white mat­ter, which is im­por­tant for learn­ing and co­or­di­nat­ing com­mu­ni­ca­tion be­tween re­gions of the brain.

The dif­fer­ence be­tween these chil­dren and other ADHD suf­fer­ers given a placebo was ap­par­ent af­ter just four months.

A sim­i­lar trial on adults showed no white mat­ter changes be­tween the methylphen­idate and placebo par­tic­i­pants, sug­gest­ing the brain is vul­ner­a­ble to struc­tural change while de­vel­op­ing.

The study’s au­thors warned that the long-term im­pact of Ri­talin on the brain was un­known, say­ing the drug should only be given to chil­dren who were sig­nif­i­cantly af­fected by ADHD.

In 2017-18, 75,000 chil­dren be­tween the ages of six and 17 in Eng­land re­ceived a pre­scrip­tion for ADHD med­i­ca­tion, ac­cord­ing to the NHS.

This amounts to just over 1.5 per cent of boys and roughly 0.35 per cent of all girls of those ages.

The study also fol­lows grow­ing con­cern in re­cent years that uni­ver­sity stu­dents – whose brains are still de­vel­op­ing – are il­le­gally ac­quir­ing pre­scrip­tion-only drugs to im­prove their con­cen­tra­tion.

Lies­beth Ren­e­man, the study’s se­nior au­thor from the Uni­ver­sity of Am­s­ter­dam, said: “What our data al­ready un­der­score is that the use of ADHD med­i­ca­tions in chil­dren must be care­fully con­sid­ered un­til more is known about the long-term con­se­quences of pre­scrib­ing methylphen­idate at a young age.”

Pub­lished in the jour­nal Ra­di­ol­ogy, the study in­volved 50 boys aged 10 to 12, and 48 adult men aged 23 to 40. MRI scans be­fore and af­ter the four-month pe­riod showed dif­fer­ences in the left hemi­sphere of the brain, in­clud­ing roughly a dou­bling of frac­tional an­isot­ropy, which re­flects as­pects of white mat­ter such as nerve fi­bre den­sity, size and myeli­na­tion – the process of coat­ing nerve fi­bres.

Many ADHD pa­tients are on Ri­talin and other med­i­ca­tions for years, de­spite their be­ing lit­tle knowl­edge about its long-term ef­fect on the brain.

Dr Pu­nit Shah, a lec­turer in psy­chol­ogy at the Uni­ver­sity of Bath, cau­tioned that brain struc­ture was not al­ways re­lated to be­hav­iour, and that doc­tors of ADHD pa­tients should re­main fo­cused on this.

He added: “I agree with the au­thors’ sen­ti­ments about the [over] pre­scrib­ing of med­i­ca­tion for ADHD and re­lated neu­rode­vel­op­men­tal con­di­tions.

“This is a big­ger is­sue in the United States than the UK, but there is grow­ing use of the phar­ma­co­log­i­cal agents in chil­dren and young adults across the world.

“In­deed, ADHD med­i­ca­tions are also in­ap­pro­pri­ately be­ing used by uni­ver­sity stu­dents, whose brains are also still de­vel­op­ing, to boost their aca­demic per­for­mance.”

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