Callum English has just turned five and his favourite treat is to be taken to the river with the small fishing rod his father has given him. But first he has to take his daily medication, a small brown capsule containing a psychostimulant to keep his behaviour under control.
He has no school to go to - the last one excluded him because of his tantrums and destructive tendencies. The drug is given to treat him for his attention deficit hyperactivity disorder (ADHD). But the drug, Concerta, a reformulation of the drug Ritalin, is not supposed to be given to any child under six because there is no evidence it is safe or effective at such an age.
Callum is one of the youngest patients ever to be on the drug. Its active constituent, methylphenidate, works by increasing concentration levels and decreasing hyperactivity. He was first put on Ritalin just before his fourth birthday. There are thought to be dozens of children like him across Britain, but no one knows because there is no official tally.
The drug is increasingly popular among parents whose children are being diagnosed with ADHD or the related ADD (attention-deficit disorder), conditions that account for more than half of all referrals to child or adolescent psychiatry services.
Latest figures show that over the past five years, the number of prescriptions for Ritalin written out for children has rocketed by 102 per cent to 254,000 items. In the past year alone, statistics gleaned by the Liberal Democrats from parliamentary written answers show that, from 2001 to 2002, prescription rates rose by 22 per cent.
Concerta is preferred by many specialists because it is slow-acting, working over a 12-hour period, instead of children having to take Ritalin tablets three or four times a day. But the drug, which acts as a stimulant to increase children's level of concentration and to decrease their impulsive behaviour, is designed to be given as part of a package of treatment, alongside behavioural therapy. Many children receive only the capsules.
Robert Donnelly, medical director of the pharmaceutical manufacturers Jansenn-Cilag, said: 'We know that some children under six receive Concerta, but think it is only a small number. Our recommendation is that it should not be given to the under-sixes, because we have not actually performed any studies to show whether or not it is safe at that age.'
Lib Dem MP Paul Burstow said: 'There is a very big debate about the rights and wrongs of Ritalin, but we need to look at why the prescription rates have gone up so steeply. It has become the option of first choice rather than a last resort for some families, but it needs to be given appropriately and only if it is really necessary.'
Although ADD or ADHD clearly can wreck family life and hinder schooling, Burstow added: 'Questions remain over the implications of giving such a powerful drug to very young children.'
The number of prescribed doses of Ritalin (methylphenidate hydrochloride) in England have leapt. In 1997 there were 92,100 prescription items; last year there were 254,000.
In a written parliamentary answer, Health Minister Rosie Winterton said that last year around 91 per cent of the prescription items were dispensed to children under 16 and young people aged 16 to 18 in full-time education. An estimated 1 per cent of the items were dispensed to people aged 60 and over, with the remainder going to other adults.
Callum's mother, Lynette Hillhouse, and her husband, Paul English, worry about the effect the medication may have, but feel they have little choice but to use it, as it is the only help on offer. They have been advised to double the dosage, but have not done so.
'His behaviour has improved recently, but I believe that's because I've been going on to the American websites and learning to adapt my own behaviour to respond correctly to him,' she said. 'I don't automatically tell him off now for every little thing. When he's really bad, I give him "time out" in his room. It's possible that the drug has calmed him down a bit, but he can still be unpredictable.'
When Ms Hillhouse told the psychiatrist she thought it wasn't supposed to be prescribed to the under-sixes, she was told not to worry. The drug can be prescribed off-licence by psychiatrists in exceptional cases.
'But I do worry,' said Ms Hillhouse, who lives in Sutton, Surrey. 'Sometimes he gets bad headaches and it suppresses his appetite. At one point I took him off the drug, just so that he would eat normally. But I don't feel that I can do without it because his behaviour was so bad.'
When he was three, before he was diagnosed, he was a nightmare to live with. 'Callum's an intelligent boy, and I think with the right support he could learn anything, but sometimes he just lashes out.'
Andrea Billbow, who runs a support group for families, said there was no evidence the drug would harm young children.
Ms Hillhouse, who has a seven-year-old daughter with no behavioural problems, does not know how her son will fare if no school place is available for him. 'Once every six months we see the psychiatrist, some medication is thrown at us, and that's it.'
