Parents of children with ADHD should be trained to help their children cope, and Ritalin should only be prescribed as a last resort, a health watchdog in Britain said Wednesday.

The drug shouldn't be used in children under five, and should be prescribed for older children only when they have severe attention deficit hyperactivity disorder, the National Institute for Health and Clinical Excellence said in its guidelines for parents and doctors.

Treatment with Ritalin — a brand name for the pharmaceutical methylphenidate — or other drugs "should be reserved for those with severe symptoms and impairment," the guidelines say.

Symptoms of ADHD can include a short attention span, a low level of organization, excessive talking, aggressive gestures and irritability. It affects an estimated five to 12 per cent of Canadian children.

When drugs for the disorder are prescribed, it should be along with psychological therapy and support for the child to develop problem solving, listening, coping and peer relationship skills, the group said.

The guidelines also say parent training and education programs should be offered as a first-line treatment for ADHD in both preschool and school-aged children.

Parents learn techniques

The programs teach parents, usually in groups, about how to create a structured home environment, encourage better concentration and attentiveness and manage misbehaviour.

Doctors shouldn't delay prescribing the medication for children with severe ADHD, but the drugs should be given along with parental training.

When the drugs are prescribed, the treatment should start with very low doses. The child should also be closely monitored for side-effects and to determine what the best dose is.

The treatment should also be reviewed annually to see whether the drugs are still needed or if changes should be made, the guidelines to doctors said.

The release of the guidelines comes as parents, educators and medical researchers have expressed concerns about overprescribing the medications to children.

Ritalin can have side-effects such as nausea, fatigue and mood swings, and the long-term effects of the drug are not yet known.

In 2006, Health Canada warned that Ritalin, Adderall and all other drugs used to treat ADHD have the potential to cause uncommon psychiatric side-effects — including rare cases of agitation and hallucination in children.

Ritalin use higher in U.S. than Europe

A study published in Thursday's issue of the journal Child and Adolescent Psychiatry and Mental Health found children in the U.S. are about three times more likely to be prescribed stimulants like Ritalin and antidepressants such as Prozac, compared with children in Europe.

Julie Zito of the pharmaceutical health services research department at the University of Maryland in Baltimore and her colleagues in the U.S., Germany and the Netherlands looked at prescription levels in the three countries.

"Direct-to-consumer drug advertising, which is common in the U.S., is also likely to account for some of the differences. The increased use of medication in the U.S. also reflects the individualist and activist therapeutic mentality of U.S. medical culture," Zito said in a release.

The study's authors also pointed to differences in government regulatory restrictions and cost restrictions on Europe and the larger number of child psychiatrists per capita in the U.S.