Tag Archives: cognitive behavioural therapy

Ritalin and ADHD

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Many are concerned that Ritalin and similar drugs, which aid concentration in those with Attention Deficit Hyperactivity Disorder, are chemical straightjackets that prevent children from taking full responsibility for themselves.

But Dr Ilina Singh of King’s College London said she and colleagues found no evidence this was the case, after interviewing scores of children on the drug.

Instead she found children commonly thought it benefited them, by helping clear their heads to make the right decision. It did not “make the decision for them”, she insisted.

One 10-year-old boy told her that Ritalin acted “like a blocker” to his usual disruptive course of action.

“But you still have the choice of going the wrong way,” he said.

Others told Dr Ilina, a reader in bioethics, that it gave them a moment to consider before lashing out at fellow pupils who were trying to wind them up. She said children with ADHD in British schools were routinely taunted.

She said: “Children value the medication because it puts them in a place where they can make good moral decisions, which is exactly what the ethicists are worried about.”

However, she claimed her report, ADHD Voices, was “not a blanket endorsement” of Ritalin – and she said its prescription to solve social problems or improve grades was “a bad idea”.

Ritalin

Ritalin

The number of prescriptions in England for the drug methylphenidate hydrochloride, of which Ritalin is the based known branded version, has risen from 382,000 in 2005 to 715,000 in 2011.

Medical side effects range from loss of appetite, to intense headaches and depression.

Too few ADHD children were offered alternatives to Ritalin such as meditation or cognitive behavioural therapy, a type of counselling, said Dr Singh.


Nor were mothers and fathers offered parenting classes to help them make life more structured and less fractious at home.

Studies that tested the efficacy of these alternatives were lacking because pharmaceutical companies “don’t want to fund them”, she said.

Her research also found that children with ADHD frequently knew little about their condition – with many not knowing what it stood for and some thinking it was even linked to cancer.

Doctors failed to talk to them about, she said, often because they felt they didn’t have the time. Appointments were filled with side-effect checks and weighing them, said the children.

The research was based on interviews with 151 children in the US and the UK, and was part-funded by The Wellcome Trust.

Insomnia should be treated with therapy

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Tens of thousands of insomniacs could be helped to sleep better every year if NHS staff were trained to provide safe psychological therapies, according to a leading specialist in the field.

One in four Britons suffers from poor sleep and one in 10 has a sleep disorder, but the vast majority suffer in silence or turn to potentially harmful drug treatments.

Sleep problems can exist in isolation, but are more common in people with mental health problems and chronic physical conditions such as heart disease, dementia and Parkinson’s disease.

Cognitive behavioural therapy (CBT), which is increasingly used to treat people with depression and anxiety, is also clinically proven to help insomniacs to sleep better.

But while CBT has been rolled out across England to treat those with mental health problems by training 3,500 practitioners based in GP surgeries, it is rarely available to insomniacs. Kevin Morgan, a professor of gerontology at the University of Loughborough, has been researching the condition for the past 20 years.

He says at least £3m of taxpayers’ money has been spent on research into CBT and insomnia, with little to show for it in access to treatment. Instead, tens of millions of pounds are spent on over-the-counter and prescription sleeping tablets, which work only in the short term, can lead to addictions and cause accidents and falls.

Sleep

Sleep

Last year, more than 12 million prescriptions for sleeping tablets were dispensed across England, Scotland and Wales. “The evidence is undisputable, we have a workforce and we have training programmes that work, yet access to treatment for patients is very patchy. Insomnia has never really been on the Department of Health’s radar and there is no central drive to improve access,” Professor Morgan told The Independent.

Current practitioners need training in order to correctly adapt the CBT for insomnia. This includes understanding the two processes that can be manipulated to improve a person’s sleep: learnt behaviours such as spending too long in bed awake trying to get to sleep, and the over-thinking that goes on before sleep.


Professor Morgan and his team have trained some health workers in the East Midlands and Oxfordshire, but with no national guidelines, the roll-out has been patchy. “It is not the ideal health service response to a chronic disabling problem; it needs central coordination,” he said.

The latest research examined the effectiveness of self-help CBT for 55 insomniacs with long-term physical health problems.

Patients were sent booklets explaining how sleep works and how to gain control over it, and were provided with telephone support.

“Subjectively, people reported better sleep, a decrease in insomnia symptoms and in some cases less reliance on medication. It is still better to see a therapist but in their absence, the self-help training programme is an effective alternative,” he said.