Children with attention deficit hyperactivity disorder (ADHD) should be treated with drugs such as Ritalin only in severe cases and never when they are younger than 5, under official health guidelines issued today.

Widespread concerns that medication is used too freely to calm hyperactive children have been recognised by two clinical practice watchdogs, which are now advising doctors not to prescribe drugs whenever possible.

Most children with ADHD should instead be offered psychological therapy to improve their behaviour, backed up by training to support their parents and teachers, the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health (NCCMH) recommend.

Drugs such as Ritalin and Concerta (brand names for methylphenidate) and Strattera (atomoxetine) should be used as frontline treatments only when severe ADHD is diagnosed, or when other options have failed.

While up to 3 per cent of school-age children in Britain are affected by ADHD, only about a third to a quarter of these would qualify as severe cases. In a typical school of 1,400 children, between 30 and 40 would have a diagnosis of ADHD, and about 10 would be classed as severely affected.

The symptoms of ADHD include an inability to concentrate for long periods, hyperactive and restless behaviour, and impulsive actions, such as speaking without thinking of the consequences or failing to wait and take turns. It also affects about 2 per cent of adults.

ADHD support groups welcomed the guidelines, but said that they would have to be backed by increased resources for behavioural therapy if they are to have the desired effect.

Andrea Benbow, chief executive of the Attention Deficit Disorder Information and Support Service, said that many parents had to wait months or even years to be given psychological therapy and training, and that many programmes were not designed for ADHD or effective for it.

“There are huge waiting lists, and many training programmes are not ADHD-specific and they're useless,” she said. “We need these interventions - drugs are not the be all and end all - and parents would welcome them if they were there.

“This needs to be backed by better resources. Lots of the good programmes are delivered by the voluntary sector, but the problem is, who funds them?”

The new guidance follows growing disquiet among some parents, teachers and doctors about the number of children taking medication for ADHD, who often remain on drugs for years.

More than 600,000 prescriptions for the three drugs were filled in 2007 in England, though the number of children who received them is estimated at between 50,000 and 100,000 because only a month's supply is generally prescribed at once.

Ritalin is the most common ADHD drug, with 461,000 prescriptions filled in England in 2007. This compares with 199,000 in 2003, 26,500 in 1998 and 3,500 in 1993. The growth has alarmed some observers, concerned that some doctors are turning to medication too quickly to control a disorder that often responds well to other treatment strategies.

Ritalin and Concerta can have side-effects that include nervousness, insomnia, appetite loss and weight loss. Strattera can cause nausea, dizziness, fatigue and mood swings. There has also been little research into the implications of taking them as long-term treatments.

Prescription rates vary widely. In July a study by the Health Service Journal found that some primary care trusts offer Ritalin up to 23 times more than others: in Wirral, pharmacists dispensed one prescription for every seven children under 16, compared with one for every 159 children in Stoke-on-Trent.

Other treatment options include sending children on courses of cognitive behavioural therapy or social skills training, and training parents in how to cope with the condition and improve their children's behaviour. Teachers can also be trained to manage children with ADHD.

These can be highly effective, but drugs are often used instead because they offer a quicker solution and are not subject to long waiting lists.

The guidelines recommend a sparing approach to drug use when possible. Tim Kendall, a consultant psychiatrist in Sheffield and joint director of the NCCMH, who sat on the expert panel, said: “Quite commonly, people tend to revert to offering methylphenidate or atomoxetine.

“When they do that, it's not always because there's a good balance of risk and benefits. It's because the child has got what appears to be ADHD and that's what's available. It's easier to prescribe a drug when other options like parent-training programmes are not available.”

Gillian Leng, deputy chief executive of NICE, said: “Today's guideline, which is published during ADHD Awareness Week, is the first guideline to address the diagnosis and management of ADHD within both clinical and education settings. At its heart is the recognition of the importance of establishing a multidisciplinary team, including the person with ADHD, their family and their teachers in order to help support the person with ADHD achieve their full potential.”

Professor Eric Taylor, of the Institute of Psychiatry in London and chairman of the guideline development group, said: “I believe these guidelines will make people with ADHD, and their families, more confident that their problems will be recognised and can often be helped, and that they will provide professionals with a framework for good practice nationally.”

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