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Children with ADHD are being put at risk by poorly regulated private clinics that prescribe powerful stimulants without key physical examinations, doctors have warned.<\/p>\n
A surge in remote-only assessments has led to what one clinician described as \u201cwidespread and unsafe practice\u201d, where children are being diagnosed and medicated via video link. The clinical warnings have now forced health authorities in Greater Manchester<\/a> to overhaul prescribing rules, mandating face-to-face checks to protect the safety of children.<\/p>\n Rashad Nawaz, a consultant paediatrician with clinics in Manchester<\/a> and Liverpool, has written to national regulators and health bodies. He warned that he had treated young patients with potential underlying heart conditions who had been prescribed stimulants by national online providers without a single in-person check.<\/p>\n Doctors can prescribe stimulants, such as methylphenidate, of which the best-known brand is Ritalin, as well as non-stimulant alternatives.<\/p>\n The benefits of taking drugs for attention deficit hyperactivity disorder outweigh the impact of increases in blood pressure and heart rate, according to a study from the University of Southampton<\/a>.<\/p>\n But National Institute for Health<\/a> and Care Excellence guidelines say a full physical assessment, including a cardiovascular history and a physical examination of the heart, is mandatory before treatment begins.<\/p>\n Nawaz said he had identified three children in the past year with previously unknown heart murmurs. One was already taking ADHD medication prescribed by a large national provider. After referrals to paediatric cardiology, two of the children were found to have \u201cinnocent\u201d murmurs but one was diagnosed with a ventricular septal defect (VSD), commonly known as a hole in the heart.<\/p>\n \u201cNone of them had symptoms, but the one with a VSD may do in the future,\u201d Nawaz said. \u201cBased on feedback from parents and reports I have seen \u2026 children are not having thorough physical assessments prior to medication. This worries me greatly. It is serious clinical risk and negligent.\u201d<\/p>\n