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Germany

Are Drugs the Solution?

According to an international study recently published by the University of London, Germany is witnessing an increase in prescriptions of mind-altering drugs to children. Is a generation being over-medicated?

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Are doctors too willing to prescribe Ritalin to over-active children?

When Leon was 10 years old, he had serious difficulties keeping up with the rest of the fourth grade. He couldn't concentrate, tired quickly, often interrupted others, and his poor coordination meant he even performed badly in sports. At home, his parents were exhausted by their clumsy, often irascible young son.

After consulting a doctor, who diagnosed Leon with Attention Deficit Hyperactivity Disorder (ADHD), they decided to try Medikinet, a brand name for methylphenidate.

"Thank god for Medikinet," his mother wrote in a chat-room for parents of ADHD sufferers. "Our son's grades have improved and so has his social behavior. People might be shocked when they hear we give our son Medikinet, but no one who hasn't experienced a child with this condition can understand what a blessing it is."

An ideological battle

Others are less positive. In 1999, the German pharmaceuticals industry marketed six times as much Ritalin (8.4 million daily doses) as in 1995, thereby increasing Ritalin sales from €1.2 million ($1.7 million) to €12.8 million.

According to the University of London report, Germany then saw an increase of 13 percent in prescriptions of medication such as Medikinet and Ritalin to treat ADHD between 2000 and 2002.

Ritalin Medikament Hyperaktivität

Ritalin is often prescribed for children with ADHD

Some 40,000 of Germany's 400,000 children between five and 15 years old diagnosed with ADHD regularly take Ritalin -- an issue which has evolved into an ideological battle.

While some parents and sufferers say the mild stimulant -- an amphetamine that works on the central nervous system to improve concentration -- has changed their lives, others insist the drug is a modern scourge, used by those too lazy or too busy to explore alternative therapies.

Stefanie K., whose son was diagnosed with ADHD when he was nine, understands both sides of the issue. But she told DW-WORLD that parents have to recognize their own limitations. "When you've reached the point where you can no longer stand your own child, then trying Ritalin is probably a good idea," she said.

Over-prescribed?

Barbara Högl from the AÜK, a national workgroup for overactive children, insists the problem is first and foremost that Ritalin isn't always prescribed correctly -- and can be dispensed by any general practitioner in Germany.

"These drugs are not necessarily over-prescribed, but they aren't always issued as accurately as they should be," she told DW-WORLD. "Doctors can be too quick to prescribe Ritalin, for example, without a categorical diagnosis."

The dangers of the backlash

However, the Ritalin backlash can also be detrimental.

"Some parents are reluctant to give it to their child because of the public controversy -- even when it would be of great benefit to the child and everyone around him or her," Högl pointed out.

But she also argued that Ritalin is all too often a first choice rather than a last resort. "Parents and teachers need to understand what they're dealing with," she explained.

"The child's entire environment has to be geared to coping with him or her. The child should first of all be offered a cognitive, talk-based therapy that helps him or her develop strategies for dealing with weaknesses. In extreme cases, however, the child risks complete social exclusion, and in those cases, medication is the only way forward," she said.

Over-hasty conclusions

Berlin Charité

The Charité hospital in Berlin

Dr. Michael Huss is head doctor at the Charité hospital's Department of Child and Adolescent Psychiatry in Berlin. He agrees with Högl. "I'd always advise beginning with non-pharmacological intervention such as counselling and behavior therapy and only using medication as a supplement," he told DW-WORLD. "I don't recommend using medication exclusively."

He believes that although there has been an increase in use of Medikinet and Ritalin, its use in Germany is firmly under control.

"Criticism tends to come from people who don't deal with the problem on a daily basis," he said. "The number of Ritalin prescriptions is definitely rising, but that's not automatically cause for concern. It would be a mistake to draw over-hasty conclusions," he added.

Pills don't solve the problem

While their detractors insist drugs like Ritalin can have serious side-effects, leaving children lethargic, depressed, or withdrawn, Dr. Huss rules out the possibility of addiction and argues that the long-term benefits are considerable.

"Many cases went unrecognized in the past. But prevalence studies show that hyperactive children manifest very unusual behavior," he pointed out. "Failing to diagnose and treat these problems in children has far-reaching repercussions. They can turn to addictive drugs, they can trigger a rise in crime."

He admitted there's a concern that doctors are prescribing the drug too soon, and without considering alternative treatments.

"Pills don't solve the problem," he said. "But it's a lost opportunity for the children if they're ruled out from the start."

Unnecessary panic

Drogist mit Ritalin Medikament Hyperaktive Kinder

Druggists warn parents about over-prescribing Ritalin

Public debate surrounding use of mind-altering drugs has escalated in recent years, but many experts believe the media has stirred up unnecessary panic.

"There's a general worry that children are simply being sedated. Society is getting more stressed and fast-paced, and children are forced to adapt. If they don't, they're given a pill," Dr. Huss said. "Not surprisingly, people feel that's not right."

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