Transcript: What Next for Craig?

Reporter: Shelley Jofre

RECORDED FROM TRANSMISSION: BBC ONE

DATE: 12:11:07

CRAIG: (yelling and punching door)

VINE: A55,000 of them are treated with medication, many for years at a time.

YAZ SHAH: It keeps me calm and helps me concentrate, that looks good for the doctors.

VINE: But now new research shows drugs may not be the answer.

PROF PELHAM: In the short run it will help the child behave better, in the long-run it won't, and that information should be made very clear to parents.

VINE: Children with attention deficit hyperactivity disorder - ADHD - have it tough. They don't just fidget and have a short attention span, they're more likely to fail at school and go to jail. They're usually prescribed drugs and that has led to the so-called Ritalin generation. But now some are asking whether we haven't let that generation down.

SHELLEY JOFRE: It's an important day for Craig Buxton. He's due in court this morning accused of assaulting three of his school teachers. He's 14.

SHARON: Craig, come on then, we've got to get up. Come on matey.

CRAIG: XXX

SHARON: Hey, that's naughty.

CRAIG: XXX

SHARON: Craig, I don't want you swearing.

CRAIG: (screams) Go away!

SHARON: Come on son.

CRAIG: [Slams bed-head]

SHARON: Hey, pack it in.

JOFRE: What's your worst case scenario?

ALAN HUDSON: There is a chance that he could be sent away for up to four months which we don't want because that would only do him damage. He could not cope if he was locked up. That would be the end of Craig. I'd say he would go suicidal.

JOFRE: Are you all ready then for court? What do you think is going to happen?

CRAIG: I don't know.

JOFRE: What do you hope is going to happen? I mean you are in trouble, aren't you.

CRAIG: Yeah.

JOFRE: And you can't like being in trouble. That can't be a good feeling. Is it?

CRAIG: No.

ALAN HUDSON
Craig's step-dad
If we don't get the help we need now - forget it. It's not going to happen and it's such a shame because he can be a lovely boy - he can.

PANORAMA: April 2000

JOFRE: This is Craig aged 6, already a mini tornado wrecking everything in his path. I first met him in 2000 at home in Stoke on Trent. He'd been diagnosed with the behavioural condition ADHD and was taking Ritalin, a powerful stimulant which can calm ADHD symptoms, but it can also disrupt appetite, sleep and has even been linked to suicide.

SHARON: I thought long and hard before saying yes, medication has got to be the only thing, and it was the only thing. With a drug that's powerful you can't mess about with it.

JOFRE: Seven years ago Ritalin was all that was on offer to bring some normality to family life, and early on it seemed to calm Craig down. What's happened since, Craig and his family agreed last summer to record on video the highs and the lows of living with ADHD.

[VIDEO]

CRAIG: I want to go on the computer.

SHARON: You're not going on the computer. You can scream and shout as much as you like.

VIDEO DIARY
CRAIG: Well I get angry for no reason. I get angry because I take my tablets. I get angry because I've got no friends. It's like Big Brother this is.

SHARON HUDSON
Craig's mum
He's broke down and he's cried and he's.. you know, when he gets into situations he says: "Why am I like this, mum? I don't want to feel like this. I don't want to be like this. Help me." And all I can do is go back to the doctors and say: "Look, is there anything more you can do?" All they say is: "Well we're doing what we can."

JOFRE: Craig takes Concerta now, a slow release version of Ritalin that's supposed to moderate his behaviour all day. But the effects aren't always that obvious.

CRAIG: Have you got a problem?

ALAN: Who?

CRAIG: Him.

ALAN: Why?

CRAIG: He keeps on xxxxx staring at me.

ALAN: Stop swearing and he isn't staring at you. He's done nothing Craig, nobody's staring at you...it's terrible lad.

The family life that we have got with having Craig is very, very poor. He controls anything and everything. We all suffer, the whole family suffers for it. We can't plan anything. We've got to see how Craig is that day, that minute.

JOFRE: A day out with his mum and step-dad at Alton Towers. Craig's had his medication and kids with ADHD get a priority wrist band here, so there are none of the frustrations of queuing. But still Craig is impulsive and very impatient. Frustration only turns to anger when we force him to sit still for half an hour.

ALAN: It can be very embarrassing at times because you're attracting people's attention with Craig's behaviour and it's so embarrassing, you know, you don't really want to be in places like this all the time because....

CRAIG: You can't be arsed to come, that's why. We're wasting time now.

JOFRE: What do you mean wasting time?

CRAIG: I want to go back on some rides.

JOFRE: Emotionally Craig often behaves more like a toddler than a teenager. He's been on medication since nursery school yet still he has little self-control, in fact sometimes it's as if nothing has changed. Now Craig is older he's harder to restrain. His outbursts can be a threat to others, but more often to himself. He's just been told he can't go fishing and is threatening to kill himself. His mum calls Social Services and her GP for help, but neither can come and see Craig, instead an emergency prescription for two tranquilisers is issued. But after taking them, Craig is still angry. Then he loses it big time.

CRAIG: (screams) Do you think I give a shit! (slashes out slams door, continues banging door). Don't touch me. Don't touch me, Alan?don't touch me any more. Hit me with it, go on. I don't care."

JOFRE: Do you know why you're angry sometimes? Does it just sort of build up?

CRAIG: Yeah

JOFRE: And does that happen when you've taken the pills as well?

CRAIG: Yeah, and I don't want to eat.

JOFRE: You don't want to eat. Would you be happier if you could find a way not to take the medication?

CRAIG: Yes.

JOFRE: What difference would that make to you do you think?

CRAIG: Loads. The family?

JOFRE: What, the family could be better if you didn't take the medication?

CRAIG: Yeah?and I stayed out of trouble.

JOFRE: When I first met Craig Ritalin was considered a more effective treatment than behavioural therapy. The evidence for this came from an American research project that compared the two. Called the NTA study it looked at 600 children over a year and was carried out by some of the world's top experts on ADHD.

DR PETER JENSEN
MTA Study co-author
We did the best study that's ever been done on Planet Earth, helping parents and teachers with these children - and what did we find? We found that the medicine was still a great deal more effective for these children.

JOFRE: The MTA study was clear. For children like Craig, drugs worked better than therapy. The findings, shaped the way doctors worldwide treated ADHD.

DR TIM KENDALL
Royal College of Psychiatrists
It was a big study and because its initial findings were that medication was as good as, if not superior to, any combination treatments, I think people have relied more on medication as a result of it, and ignored psychological treatment.

JOFRE: Since the MTA conclusions were published, prescriptions for ADHD drugs have more than tripled in Britain. The Department of Health doesn't know how many of our children are on these drugs but we've discovered nearly 55,000 were prescribed them by their GPs last year alone. The cost to the NHS was 28 million pounds but are they actually helpful in the long-term? Seven years on I've come back to the US where the experts have continued to monitor the 600 children in the MTA study. They looked at what happened to the children who stayed on drugs for three full years and the results have come as a surprise even to them.

PROF WILLIAM PELHAM
University of Buffalo
The children had a substantial decrease in their rate of growth, so they weren't growing as much as other kids, both in terms of their height and in terms of their weight. And the second was that there were no beneficial effects - none. I think that we exaggerated the beneficial impact of medication in the first study. We thought that children medicated longer would have better outcomes. That didn't happen to be the case.

JOFRE: Until now parents concerned about putting their children on medication have been reassured that the benefits far outweigh any risks. These new findings call that advice into question.

PELHAM: There's no indication that medication is better than nothing in the long-run. In the short-run it will help the child behave better, in the long-run it won't, and that information should be made very clear to parents.

JOFRE: We've got a generation of children who have been on these kind of pills now for some time.

PELHAM: There's no evidence that it's helped them.

JOFRE: As simple as that.

PELHAM: It's as simple as that.

JOFRE: Some children of the Ritalin generation have worked this out for themselves. Back in the UK on the edge of the Lincolnshire Wolds Yaz Shah enjoys her Saturday job just like any other 16 year old. She's been off medication for six months now and has never been happier. But things were quite different a year ago.

[Film on mobile phone of Yaz in seizure]

What's happening here?

YAZ: Well I was watching Coronation Street and I just laughed, went into the kitchen, went to get a knife and just turned nasty.

JOFRE: You sound like a wild animal there, what was happening?

YAZ: It's anger and upset from nothing. I was watching telly, that's it.

JOFRE: And this was a year ago. Do you recognise that Yaz?

YAZ: No

Yaz was first diagnosed with ADHD aged 4 and put on Ritalin. She's had a difficult relationship with her mum growing up and her dad left home when she was still a baby.

YAZ SHAH
I think it damaged me, him not being there constantly when I fell out with my mum and she was with her boyfriends or something, I think I needed that.

JOFRE: What age were you when your behaviour started to get really bad?

YAZ: 14, 15, my teen years, I was a rebel I think, you know. Bad Yaz.

JOFRE: And what sort of things would Bad Yaz do?

YAZ: Bad Yaz would steal, fight, bully, self-harm, take... do drugs, smoke, the lot, you know.

JOFRE: Bad Yaz was eventually assigned her own full-time teaching assistant who could immediately spot in class whether she had taken her medication.

HELEN TOZELAND
Learning Support Assistant
It made her concentrate better and keep her in her seat, but it actually zombified her. If she hadn't had a tablet, you know, bouncing about the class, chatting, shouting out, so yeah, I saw a complete difference. It was nice because she was quiet but... it wasn't nice because it wasn't Yaz.

JOFRE: What did it feel like when you were on the medication?

YAZ: Trapped. Trapped. Fake, not me. Rubbish. It didn't make me feel good because it wasn't me. Everything I did well in I felt ashamed then because I felt like I hadn't succeeded in it, it was the medication. So I wanted to prove a point you know.

JOFRE: And last year she did, but only after she'd reached rock bottom, suicidal after the sudden death of her brother Yaz voluntarily went to a psychiatric unit for three months, there she met Dr Sami Tamimi.

YAZ: I think I bonded with you quite well from the start, that's why I trusted you and that's why I spoke to you, opened up to you because otherwise it could take weeks for me to trust somebody.

DR TAMIMI: I think you have a real capacity to look back over all sorts of things that have happened in your life and I think you've got some pretty sophisticated ideas about what it is that helps you.

JOFRE: Yaz says she felt secure enough in the unit to finally come off the pills. Dr Tamimi helped her.

Were you surprised to have a psychiatrist who was saying: "You can do this without the medication"?

JAZ: Yeah, yeah, I didn't think it was possible because otherwise I would have done that a long time ago, definitely.

JOFRE: Have any of the psychiatrists or paediatricians in the past tried to help you do it without medication?

JAZ: They've always tried to help me but no.. they've always thought it was best to stick to medication.

JOFRE: That's because for years it's been considered best practice. So Dr Tamimi, who describes drugs only as a last resort, has been accused by colleagues of denying children essential treatment.

DR SAMI TIMIMI
Child and Adolescent Psychiatrist
It almost felt like there's some mythical quota that if I wasn't fulfilling this quota I wasn't doing my job properly. I kind of wonder what the hell did kids used to do, what the hell did families used to do before this mass use of drugs was all around? I mean do we have any evidence to say that since we've started using these drugs that our children are better behaved, that our society is happier? Exactly the opposite.

JOFRE: Almost a decade on medication doesn't seem to have made life any happier for Craig Buxton. Like Yaz, he too had a tough time as a baby. His dad left even before he was born, and he spent some time in foster care.

Would it be fair to say then that you had difficulty bonding with him when he was first born?

SHARON: Yeah, I did. I found it really hard to bond with him because I was so depressed and I had such a bad time carrying him and the pregnancy was a bad pregnancy, and I had no support.

JOFRE: When Craig was 5 Sharon met Alan who's been a supportive father figure for Craig ever since. Things began to look hopeful for the whole family a year later when Craig got a place at a primary school for boys with emotional and behavioural problems.

HOME VIDEO

He stayed over two nights a week, giving his parents a regular break and Craig some self-confidence.

SHARON: They were brilliant. They did therapy work with him, they did work to encourage his confidence, tried to teach him how to read other people's emotions and reactions, gave him little bits of responsibility. The involvement with the parents as well with the school is excellent, they involve you in everything, don't exclude you from nothing. It was a brilliant school.

JOFRE: With their support Craig even came off medication for a while, but it wasn't to last. The transfer to secondary school has been disastrous and his behaviour has gone rapidly down hill.

SHARON: Everything has been undone, absolutely everything. It's sad because in a way it's been a complete and utter waste of time Craig doing that schooling. Since he left that school he's learnt absolutely nothing.

JOFRE: Things couldn't be much worse now. After assaulting his teachers Craig is out of school altogether. Medication is all that's on offer to him. Earlier this year he was put on yet another powerful drug, an antipsychotic normally prescribed to adult schizophrenics. Craig was given it to calm his impulsive behaviour. It didn't work.

CRAIG: I've got a scar down there, I've got all the way to up there. I've got loads under there. I've got one across there, the most in this arm. But they've all gone now because I've got hairy arms.

SHARON: He was self-harming, he threatened suicide, depression very bad, saying he was hearing voices in his head. His night terrors were terrible.

JOFRE: Antipsychotic are known to cause insomnia, diabetes and even brain damage in adults. Again the Department of Health doesn't know how many children are on them, but we've discovered around 8,000 were prescribed them by their GPs in 2005, often for behavioural problems - not good practice according to the man who writes mental health guidelines for doctors.

DR TIM KENDALL
Royal College of Psychiatrists
I think a generous understanding would be to say that doctors have reached a point where they don't know what else to offer, and they haven't got the right supports to help parents and children in difficult circumstances. But I think perhaps even that is no real excuse for the use of drugs which are associated with such severe side-effects.

JOFRE: Craig is off the antipsychotic now but his violent night terrors have continued.

ALAN: They are really, really bad and he's suffering. He wakes up some mornings and he's still sobbing. It's really bad for him.

SHARON: You went walkabouts last night again.

JOFRE: When you first agreed to give him medication when he was just 4 years old, did you ever imagine that you'd be here now in this situation?

SHARON: Oh no, not in a million years, you know, I thought well by time he hits high school, maybe 12, 13, you know, we'll have the real Craig to be in a worse situation than what we were then, you know, it's crippling for us.

JOFRE: Do you think you've done all you could?

SHARON: Well yeah, but I think, you know, maybe.. I'm not saying we're perfect, and I'm not saying that.. you know, we have done everything. There's probably things we have missed, but that's where the experts come in, you know, that's where we are asking their advice, we want their advice, we want them to tell us where we're going wrong - if we have gone wrong - and to help us to put things right and do things differently.

JOFRE: So you're truly open to that as a parent?

SHARON: I take any criticism from anywhere and any help from anywhere.

JOFRE: Over in Upstate New York Professor Pelham runs intensive ADHD summer camps to help not just the children but their parents and teachers too. By targeting families with a support package as soon as a diagnosis is made, he believes all but the most troubled children can be helped without the need for drugs.

PROF WILLIAM PELHAM
University of Buffalo
We're teaching the kids two things, better skills and also a better cooperativeness and team sportsmanship for how to better get along with children while they're doing a football or a soccer activity.

JOFRE: While the children are put through their paces outside, inside their parents are taught how they can help.

PELHAM: We actually teach parents good parenting skills. We teach them what to do if their child misbehaves. How to respond appropriately to the child's misbehaviour and it will help the child learn to behave better in the future. They come to ten weeks of classes where we teach these skills to them. We go out to schools, the teachers had to establish interventions in the classroom that can benefit children with ADHD like daily report cards.

JOFRE: And there's good evidence that all of these approaches actually make a difference?

PELHAM: There's very good evidence that all these approaches will.

JOFRE: What do you think your son benefits from?

JENNIFER POYDOCK
I think he benefits a lot from us having a consistent schedule at home, and then working it into the school with his daily report card and the constant feedback and the monitoring. He really has improved and has turned around 180%

PELHAM: Any child and adolescent mental health service could do this, it's very easy to do. It's not rocket science. It's good commonsense.

JOFRE: Families here though complain they often don't have access to therapy or parenting programmes. Dr Kendall is heading a team for the National Institute for Clinical Excellence that's considering what treatment should be available. They're writing new guidelines based on all the latest research including the new MTA findings.

DR TIM KENDALL
Royal College of Psychiatrists
I hope that we will be able to make recommendations that will give people based on the best evidence we've got, a comprehensive approach to treatment that will advise about the use of parent training programmes, the use of behavioural interventions of other kinds that will advise about what teachers might be able to do within the classroom when they're trying to deal with kids that have difficult problems of this kind. I think the important thing is that we have a comprehensive approach which doesn't focus just on one type of treatment.

JOFRE: But what if psychological treatments just aren't available?

KENDALL: If we were talking about cancer, no one would accept an answer which said well there aren't many treatments available so what do we do. The right answer is we need to make these things available for the children that need it, whether it's cancer or it's hyperactivity or it's childhood depression or whatever.

JOFRE: This time last year Yaz was just scraping by at school. Ditching the pills six months ago was a bold move but she wanted to see if she could manage her behaviour herself. Apart from a tablet on exam day to help her focus she's been drug-free ever since. The result? She passed all eight GCSEs and even got two A's.

YAZ: I'm amazed I've come through it to be honest, but I am so happy. So happy. I could have gone so the wrong way and ended up a mess. But I think it's quite an achievement that I've managed to do it.

JOFRE: What next for Craig though? When I met him seven year ago medication was supposed to help his behaviour. But, just as the latest scientific research has found, it's made little difference long-term. In court Craig pled guilty to assault and was put on a supervision order. Do you understand what happened? What have you been charged with? If he's to avoid ending up in jail, Craig's family hope he'll now FINALLY be offered MORE, than just medication.

Alan video diary
One day Craig's going to get himself in a lot of trouble and then we won't be able to help him. I just hope that day doesn't come but I can see its well on its way. As he's getting older he's getting much stronger and who knows what he's going to do.

Craig video diary
I'm happy when I'm not angry, I'm happy when I don't swear, I'm happy when I see my parents and I'm happy when they're happy.

VINE: Craig Buxton, ending that report by Shelley Jofre, and if you are the parents of an ADHD child please don't take any drastic action without consulting your doctor first. For more information on the condition there will be a special helpline number on the screen in just a moment.

Next week, Madeleine McCann. Richard Bilton who's followed the case for the BBC since the start goes in search of the truth in a Panorama Special.

Panorama returns next Monday at 9 here on BBC1.