Drugs such as Ritalin should be a last resort for treating children with attention deficit hyperactivity disorder and should never be prescribed to kids of preschool age, new guidelines suggest.

The new guidelines, issued by the National Institute for Health and Clinical Excellence in the United Kingdom, recommend that parents and other caregivers receive training in the care and management of the disease as a first line of treatment.

If parental management proves ineffective for ADHD patients between the ages of 11 and 18, group or individual counselling should be the next option considered for treatment, the guidelines suggest.

"Drug treatment is not indicated as the first-line treatment for all school-age children and young people with ADHD," the guidelines say.

Treatment with Ritalin or other drugs, "should be reserved for those with severe symptoms and impairment," or for those who have refused or not responded to parent training or psychological treatment.

For children with severe ADHD, medication is still recommended as a first-line treatment, with parent management as a supplementary treatment.

ADHD is a behavioural syndrome that leads to symptoms such as hyperactivity, impulsiveness and an inability to pay attention. It affects anywhere from five to 12 per cent of Canadian children.

Symptoms can range from mild to severe and can overlap with other behavioural or mood disorders.

"With this guideline we are providing the most comprehensive approach to diagnosing and managing children with ADHD right across the spectrum of care," Dr. Tim Kendall, psychiatrist and a joint director of the National Collaborating Centre for Mental Health in the U.K., said in a statement.

The new guidelines fall into step with widespread concerns that too many children are given medication to manage hyperactive behaviours.

Ritalin can cause a variety of side effects, such as nausea, fatigue and mood swings, and the long-term effects of the drug are not yet known.

When children do need drug treatment, physicians should start them on very low doses and closely monitor side effects as they determine the correct dose for each child, the guidelines suggest.

Doctors should also conduct an annual review of children on medications to determine if they should continue with drug therapy or otherwise have their treatment altered.