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5 Oct 2013

Twice As Many ADHD Kids As 10 Years Ago

From Amy Corderoy SMH
A nine-year-old boy has killed himself and two other children have attempted suicide while taking a drug used to treat attention deficit hyperactivity disorder, federal drug authorities have said.
In a safety update, the Therapeutic Goods Administration urged doctors to ensure parents are aware that suicidal thoughts can be an extremely rare but disastrous side-effect of the ADHD medication Strattera.
The news comes as figures obtained by Fairfax Media show NSW is Australia's ADHD drug capital, with medication use continuing to rise.
Medications, including Strattera and the stimulant Ritalin, are prescribed in NSW at almost double the rate of Victoria, Department of Health and Ageing data indicates.
Experts say doctor attitudes and a lack of alternative options such as counselling could be behind the higher prescribing rates in NSW. Child psychiatrist and University of Adelaide Professor Jon Jureidini said the numbers of children on ADHD medications should be “orders of magnitude lower".
“The reality is that there is still bad prescribing going on, lazy prescribing,” he said. Parents should be informed there was no evidence proving medication gave long-term benefits, and it was used for managing symptoms, not treating the underlying condition, hesaid.

 More than 28, 000 NSW children, or 1.6per cent, took ADHD medications in 2012, a Fairfax analysis found. Since 2005 that number has risen 133per cent, while the child population increased 4per cent.

But Florence Levy, a conjoint professor of child and adolescent psychiatry at the University of NSW, said research showed NSW doctors almost always prescribed according to guidelines.

“It's very easy to take the moral high-ground and say 'don't prescribe these medications',” she said. “But if a child and their parents are not coping ... there are not always easy answers.”
Professor Levy said prescribing tended to be influenced by medical leaders, and one explanation for the difference between Victoria and NSW could be that Victorian doctors took a more psychological approach, whereas NSW took a more biological one.

NPS MedicineWise chairwoman Janette Randall said despite the increase in drug use there was no rise in ADHD. Instead, its impact had increased, as children faced more demands to sit still and concentrate.
“We want to pin them down to a desk for hours every day,” she said, adding other states could be under-medicating. “The less we can influence the environment the more likely we are to use medication to help that child cope.”

The federal Department of Health told Fairfax an arm of the Pharmaceutical Benefits Advisory Committee identified the “small but steady” increase in medication, and prescribing differences, in October. It referred them to state health departments and NPS MedicineWise.
Acting NSW Health chief pharmacist Bruce Battye said NSW Health had seen no need to act on the information. "The system we have in place is appropriate," he said. Only paediatricians and psychiatrists complying with strict guidelines could prescribe to children, he said.

"This is … something we spend a lot of time on," he said. "In line with the accepted rate of ADHD diagnosis, of 3 to 5 per cent of children, the medication rate in NSW remains quite modest."
The TGA update says it also received 28 reports of children and teenagers who had suicidal thoughts on Strattera, which can increase suicide risk. A spokesman said the update included all adverse event reports since the drug was Australian Register of Therapeutic Goods in 2004, and that the benefits of the drug outweighed the risks, which were very low.

''The decision to use a particular medicine should be made between the prescribing medical practitioner and the patient, and involve discussion of the relative risks and benefits of the therapy compared to other possible treatments or no treatment at all,'' he said. ''The risks of suicidal thoughts and behaviour associated with atomoxetine are well known and are already reinforced through a black box warning and other … product information''.

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