When I began my career as an NHS psychiatrist more than 30 years ago, I was taught about a rare condition where children had such severe hyperactive behaviour that they had to take powerful medication simply to get through school.
The families and teachers of these children were often at their wits’ end, unable to get them to sit still or stay silent.
These children were classed as suffering from attention deficit hyperactivity disorder (ADHD) and, for many decades, the treatment had been the same: stimulant drugs, like amphetamine tablets.
These pills, the same used by Second World War pilots and long-distance truckers to keep them awake during long nights, had a marked effect on children with ADHD.
Those given the stimulant tablets were more able to sit still through school and focus on their work. The drugs also had the added benefit of keeping them quiet. They didn’t necessarily need to take the tablets at weekends or during the holidays – the aim was to improve their work.
The drugs were also viewed as a temporary fix. The children might take them for a few months or a couple of years, but as they aged and their behaviour improved, they would stop taking them – usually by the age of 18.
However, today this has all changed. The number of children diagnosed with ADHD has surged, with diagnoses for boys doubling since 2000, and tripling for girls over the same period.
There has also been a sea change in how the condition is understood. No longer is it viewed as a temporary behaviour issue, but as a lifelong condition which requires constant, often daily, medical treatment for years, if not for life.
Joanna Moncrieff began her career as an NHS psychiatrist more than 30 years ago, and says she has grown more concerned about the number of children on stimulant pills
Studies now show that ADHD stimulants do not help children perform better in school
Last year, nearly 250,000 people in England received ADHD prescriptions on the NHS – a more than threefold rise from 81,000 in 2015. Of those, more than 60,000 are children.
I am not a child psychiatrist, but I have spent my career doing research into drug treatments for all sorts of mental health problems. And over the years I have grown increasingly concerned about the number of children on these stimulant pills.
One of the main problems is that children do not like taking them.
A US study, which asked children on stimulants how the pills made them feel, found they regularly described the drugs making them feel ‘numb’ or ‘sad’.
Some described how, while on stimulants, they ‘don’t smile’ or ‘feel like myself’.
Then there are the physical consequences to consider.
Another US study found that children on stimulants were, on average, 1.5in (4cm) shorter than their peers who also had ADHD but were not taking the drugs.
Despite these side-effects, many psychiatrists who prescribe the tablets – both on the NHS and privately – say those consequences are a necessary evil. This is because, they argue, the pills help children perform better in school and, ultimately, have brighter futures as a result.
However, growing research has thrown this justification into question. Studies now show that ADHD stimulants do not help children perform better in school.
This is why I, and an increasing number of my colleagues, believe we need to think again about the rising use of these drugs.
So how did we get here?
The NHS defines ADHD as a condition where the brain works differently to most people. Children diagnosed with it are often those who have trouble concentrating or sitting still.
Other common symptoms, according to the Health Service, include being easily distracted, making impulsive decisions and finding it hard to listen to what people are saying or to follow instructions.
This definition of ADHD has long been contested. Many, like myself, point out that you would be hard-pressed to find a child who didn’t show several of these symptoms at one time or another.
There is no blood test or scan you can take to get an ADHD diagnosis. So it’s left completely up to the judgment of the doctor to decide whether a patient has it.
Recent research also shows that symptoms fluctuate, meaning children show them at some times and not others. This flies in the face of the idea that ADHD is a lifelong condition originating in a different sort of brain.
But another contentious issue is the drugs that are used to treat it, which have remained largely the same for nearly 100 years.
The first research into treating ADHD dates back to 1937, when an American psychiatrist experimented with giving children with behavioural issues a daily dose of the stimulant drug amphetamine (then known as benzedrine).
At the time the drug was used by factory workers to help them get through long shifts filled with repetitive tasks. Today, the same substance is taken by recreational drug-takers and is better known by its street name, speed.
But the study, which earlier this month was highlighted in The New York Times, concluded that benzedrine had a ‘spectacular’ effect on problem children. According to their teachers, many children showed ‘remarkably improved school performance’ and, overnight, became ‘placid and easygoing’.
It is this research which has paved the way for millions of prescriptions of these stimulant drugs to be given to children.
The most popular stimulant to be prescribed to children with ADHD is methylphenidate, also known by its brand name Ritalin.
However, in recent years, studies have called into question the benefits of stimulants.
One such study, published in 2022, involved children aged seven to 12 attending a two-month summer camp in the US. Half their time was spent doing classroom learning. Researchers randomly split the children into two groups. Half received a daily dose of Ritalin, while the other half were given a placebo.
While in the classroom, the children taking Ritalin appeared to work faster and were better behaved than those on the placebo. However, at the end of the teaching periods, the two groups underwent tests and the results showed that the children on
Ritalin hadn’t learnt any more than their non-drugged campmates. The drugs don’t improve the brain function of ADHD patients, they simply change behaviour temporarily.
Teachers and parents see hard-working, quiet children. The children may feel they are doing better too, but as the research shows, the drugs do not improve their performance.
There are also the long-term consequences of these pills to consider. We already know that they can stunt growth, and even delay puberty in boys. There are also worries that, in rare cases, stimulants can damage the heart.
But I am also concerned that stimulants might negatively affect children’s personality development. Children who act out need to learn to be responsible for their actions. If they are told they are sick and can only be normal with the help of medication, they may never learn how to control their own behaviour.
Of course, it’s true that many children do have attention problems and struggle in school. The number getting mobile phones has probably only made this issue worse. Some children find a large institution like school difficult. They find the work boring and don’t feel they fit in.
Often, when children diagnosed with ADHD leave school and find something that interests and motivates them, they do really well. This suggests it’s the environment that’s the problem, not the child.
I wouldn’t like to say that no child should ever be prescribed stimulants, but it seems wrong that we are having to give children drugs to enable them to fit into modern-day life.
I hated how these drugs made me feel – but I’d have failed my exams without their help
It was the summer of 2014, I was deep into A-level revision and my mornings all began the same way.
After breakfast I would take two small, white pills. By the time I had showered, my heart would be beating so fast it felt like it was going to burst out of my chest.
But I’d ignore this and sit at my desk, where I’d often stay for four or five hours at a time, not even getting up to go to the toilet or eat.
The pills were Ritalin, a stimulant ADHD medication I had been prescribed two years previously. As a child I’d been quiet and well-behaved. However, at 14 things changed drastically when my parents’ divorce threw home life into chaos.
I would skip school, argue with teachers and disrupt lessons. When I could be convinced to sit still, my mind wandered and I’d spend more time doodling than doing any work.
Six months before my GCSEs (pictured left), I was on course to fail them all. In desperation, my parents took me to see a psychiatrist who diagnosed me with ADHD and prescribed Ritalin.
The idea was to take them every day, but I quickly found that was impossible. When I took them at school, my concentration on tasks would improve, but I also found it challenging to talk or write essays. It was as though the pills dulled my creativity.
They also made me anxious, and anti-social, and took away my appetite. But I discovered the best way to use them: revision.
Previously, revising for exams was so boring that I couldn’t manage it. But on Ritalin it became the most fascinating and important task in the world, and I managed to gain decent grades in my exams.
At A-level, being able to pick my subjects meant I’d begun to enjoy school – particularly English. However, feeling the pressure to get the grades I needed for my university of choice, Edinburgh, I turned again to Ritalin.
These revision days passed in a haze, where I was unable to talk or eat very much at all. However, the tactic paid off. I got top marks and gained a university place.
That was the last time I took Ritalin. It had helped me, but I hated the way it made me feel. The experience also made me realise that it was within my own abilities to sit down and revise. So I decided to go drug-free at university.
More than a decade on, I often forget that I was once labelled with ADHD. I work long hours and find my job incredibly engaging.
While I’m thankful that the drugs helped get me through exams, I firmly believe my behaviour problems were a temporary issue triggered by what was going on at home.
And, eventually, I simply outgrew that behaviour.
