Children are diagnosed with attention deficit with or without hyperactivity when they exhibit various non-specific symptoms such as difficulty concentrating in class, fidgetiness and impulsivity. The boundaries are unclear. At best, methylphenidate (Ritalin° or other), a psychostimulant amphetamine, has a modest efficacy in reducing the symptoms, whereas its cardiovascular and neuropsychic adverse effects are sometimes severe. It should only be prescribed as a last resort, when non-drug measures fail.

Despite these misgivings, in many countries, diagnoses of ADHD in school-age children and treatment with methylphenidate have increased significantly.

Several national studies have shown that the youngest children in the same class at school are about 1.5 times more likely to be prescribed a psychostimulant than older children.

These discrepancies reveal overdiagnosis and overmedication in the youngest children, i.e. the ones most likely to be less attentive and to exhibit disruptive behaviour in the classroom. Parents, teachers and doctors are all partially to blame for these overmedications.

In France, the use of methylphenidate appears to be less frequent than in other countries, but even so, between 2012 and 2014, the number of children aged 6 to 11 taking it increased by 17%. Overmedication in other countries should serve as a warning to health professionals, parents and teachers of the dangers against the abusive prescription of psychotropic drugs to keep children within a behavioural norm.

©Prescrire 1 May 2019

"Normalisation of school behaviour with methylphenidate" Prescrire Int 2019; 28 (204): 139. (Pdf, free).

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