How are the children in Spain doing? Good in general, yet, some need help, more help than other children. Life is not always easy, also not for children. Children especially the younger ones depend on their parents and guidance in a world, they do not fully understand. To ensure these and every child in Spain will be helped and protected when needed Spain have signed the International Convention on the Rights of the Child.

The #United Nations human rights body, the Committee on the Rights of the Child is a body of independent experts that monitor and report on the implementation of the Convention on the Rights of the Child by governments.

It just completed the review of human rights for children in Spain. And what does it look like?

Good and not good. The Spanish Government reported to the UN that the Strategy Plan for Children and Adolescents includes “a measure dedicated to the prevention of over-medication and accidental poisonings through diagnosis and adequate treatment in order to prevent substance abuse for children diagnosed with Attention Deficit Hyperactivity Disorder (#ADHD) and other behavioral disorders.” The government is concerned about the drugs used by child psychiatrists to control the symptoms labeled as hyperkinetic disorder (ADHD).

One of the reason is that there has been an increased focus on ADHD in the country and that many indicators show there has been an increased use of #Psychostimulant Drugs for many years.

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Expert studies show the explosive increase in the use of psychostimulant drugs comes entirely from the use of one drug sold as Concerta. This drug contains methylphenidate, a psychoactive substance similar to amphetamine.

The use has been very strong in many regions. The overall consumption of psychostimulant drugs used in the management of active behaviour of children in the region of Castila-La mancha, for example has increased from 1992 to 2015 with an annual average percentage of 10.3%.

The diagnosing and psychostimulant drug prescription pattern in Spain follow tendencies also found in some other European countries and the USA. Among these is the pattern of a significantly higher number children born late in the year having been diagnosed with Hyperkinetic disorder compared to the children born early in the year. In the Basque Country, it is more than three times as likely that a child born in November would be prescribed a drug to manage what is called hyperkinetic disorder than if the child would be born in January.

The reason for this is that the diagnosis is a subject diagnosis not based on any clinical scientific tests or malfunction in the body but entirely based on the interpretation of the child’s behaviour compared to other children.

The younger children in a school class thus are more likely to be considered “immature” and thus as suffering from what is called hyperkinetic disorder or ADHD.

This has become a problem and the NGO coalition of more than 50 Spanish NGOs in the Platform for Children (plataforma de infancia españa) has recommended that the government establish “a protocol for the diagnosis and treatment of ADHD, limiting the use of pharmaceuticals and including psycho-educational attention.”

The Platform for Children noted this in view of the Guide to Clinical Practice about Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents, which the Ministry of Health, Social Services and Equality published in 2011 should get updated. This is to be done among others because “abuse of pharmacological treatment of children and adolescents, especially for mental health disorders” has been found and “there is no regulation on a national level that limits the use of specific medication for ADHD”, the platform reports.

The Spanish chapter of the Citizens Commission on Human Rights (Comisión Ciudadana de Derechos Humanos de España, CCDH), a government recognized public benefit group further noted that the government had not provided all the expected information to the United Nations as part of the review of human rights for children. The group especially pointed to the lack of actual information related to the ADHD scene and use of psychotropic drugs including psychostimulant drugs used to control the behaviour of children.

The national health statistical service related to publications of medications including psychostimulant drugs is incomplete and inconsistent, which may be one of the reasons. New measures were implemented by 2013. Prior to 2012 figures were calculated based on extrapolations based on health surveys done in a few regions and representative numbers were calculated. Despite inconsistencies, these nevertheless do give an indication of a trend.

That the use of psychostimulant drugs is very common is evidenced among others in a study from the region of Navarre. The study found that 46% of 352 newly diagnosed children between 6-17 years between January 2012 and August 2013 were being given psychostimulant drugs. Children are very fast being given the psychostimulant drugs without looking for real long-term solutions that would work for that individual child.

In view of all of this the United Nations Committee on the Rights of the Child during a full day meeting on 22 January 2018 in the UN headquarters for Human Rights in Geneve, Switzerland discussed these problems along with other human rights concerns with the government of Spain.

The Spanish Ministry of Education as represented by Ms. Violeta Miguel Pérez, Director of the National Center for Educational Research and Innovation, told the UN “Obviously in the Ministry of Education we are concerned about increased diagnosis of this disorder in Spain. We think that this is a behavioural problem.”

Ms. Violeta Miguel Pérez added “We haven’t got a longitudinal survey in Spain on the effects of medication on these pupils, but the Ministries of Education and Health are particularly concerned by this increased number of diagnosis. So we have immediate measures in the national plan for neuroscience applied to education. We are being advised by the best experts in the field on the needs of these pupils.”

The Ministry further noted that “we are looking at the relationship between a healthy diet with low sugar content, and physical activity in sports as factors for prevention. We have the national neuroscience plan applied to education which is being used to support these children.”

The UN Committee on the Rights of the Child following up on the meeting in February issued a Recommendation to Spain stating that the Committee recommends that the government of Spain: “Establish a protocol for the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD) and other behavioural disorders in children and encourage the development of alternatives without medication, ensure that diagnoses are thoroughly examined, that prescription of psychotropic and psychostimulant drugs is a measure of last resort and only after an individualized assessment of the best interests of the child, and that sufficient information is provided to children and their parents about the medical treatment, its possible side effects and non-medical alternatives.”

It is now up to the government to implement these.