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A bad case of the fidgets

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NINE-YEAR-OLD James is restless, impulsive, impatient, and disorganised. He's constantly losing his homework and finds it hard to watch a video for more than 15 minutes. He fidgets through his classes at school and his work is often careless. Ten years ago, someone like James might have been regarded as a difficult, challenging or naughty child. In 2003, he has been diagnosed as a victim of attention deficit hyperactivity disorder (ADHD) and is a candidate for methylphenidate, a drug that is taking the world by storm. Prescriptions for Ritalin - a brand name for methylphenidate - are soaring alongside diagnoses of ADHD, the condition used to describe a range of behaviour including inability to pay attention, impulsiveness and fidgeting.

Although experts say that ADHD is strongly hereditary and only 3 per cent of children have the condition, Ritalin is taken by a staggering one in five children in the US and - if the trend continues - one in seven British children by 2007. The drug is a mild central nervous system stimulant, with its effects described as being similar yet more potent than caffeine but less potent than amphetamine. In children suffering from ADHD, it is said to have a calming effect that helps regulate impulsive behaviour and improve concentration, which in turn enables children to act 'normally'. The drug has been termed a life-saver when used as directed.

Take Vince, who describes the effect the drug has had as striking. 'I never before realised that 'normal' people didn't have constant dialogues, images and melodies flying through their mind while trying to carry on a conversation, or perform a simple task,' he says. 'Previously, no one spoke quickly enough, so I was constantly finishing other's sentences. Now I actually hear complete sentences and stay with conversations until they reach a logical conclusion.'

But there have also been cases of Ritalin misuse, mainly among high school students in the US, where it has been abused because of its ability to stimulate, suppress appetite, increase attention span and cause a feeling of euphoria. In extreme cases, it has been mixed with heroin to produce a 'speedball'.

And given that most children are often fidgety, inattentive and disorganised anyway, how can we distinguish between a normal child and a potential case for Ritalin?

The crux of the problem is that there is no quick test for ADHD and diagnosis is based on a group of inattention and hyperactivity symptoms - many of which exist to some degree in a large proportion of young children. This had led some experts to claim ADHD is a fraudulent title for a non-existent condition. One British behavioural scientist has gone even further, arguing that many children prescribed Ritalin are victims of poor parenting.

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