Background: When Leah Kouara was told that her son Jameel had attention deficit hyperactivity disorder (ADHD) she was not too surprised.

When Leah Kouara was told that her son Jameel had attention deficit hyperactivity disorder (ADHD) she was not too surprised.

Almost from birth, she knew something was wrong because he was constantly restless.

"For about the first four years of his life I don't think he ever slept a full night. He only took 20-minute snatches of sleep and I told the health visitor right away something was not right," said Ms Kouara.

"He never kept still and his concentration wasn't good. He was walking at nine months, he didn't crawl, just went at full pelt into everything."

Now eight, Jameel was four when he was diagnosed with ADHD.

By then nursery nurse Mrs Kouara, 43, of Glenrothes in Fife, had read enough about the disorder and its treatments to convince her that she would not let her son be treated with Ritalin.

She said: "I would never put him on Ritalin. I think there are too many side-effects and unless it's absolutely necessary I don't think you need to do it. I think how you handle them is more important."

So she welcomes new guidelines from Nice out today which recommend that parents such as her are given training in psychological techniques to help them manage their children's behaviour.

Ideas, which Nice said had proven to be very effective in some parts of the UK, include teaching mothers and fathers to use shorter, more precise sentences when asking their child to do something, and tips on handling their mood swings.

Mrs Kouara said: "I think that's a good idea. If you understand what's going on in their head it makes it easier for you and for them."

Despite the difficulties, Mrs Kouara is determined not to turn to medication, and relies on her own parenting skills and homeopathy to cope with Jameel's behaviour.

She said: "He is much more settled after the homeopathic remedies. I don't think he would be as good as he is now if he had been on Ritalin."

The guidance comes against a background of soaring numbers of children being prescribed Ritalin in Scotland, with recent figures revealing a 20% increase in prescriptions.

Treatment with pills such as Ritalin has been climbing for more than a decade but figures released last year showed a sharper rise in 2006-07, with an estimated 4939 taking pills for ADHD daily - up from 387 in 1995-96.

Experts and parents are divided over both Ritalin and the prevalence of ADHD, with some believing it is a misdiagnosis of bad parenting while others fear it is widely under-reported.

The drug's existing side-effects and fears of as-yet undetected problems have fuelled concerns about its use, but doctors remain convinced that it is the best way to treat the chemical imbalance suffered by youngsters with ADHD.

Warning against Ritalin and questioning the levels of ADHD, Dr Gwynedd Lloyd, an honorary fellow at Edinburgh University's School of Education, said: "We really don't know what the long-term implications are going to be of this mass medication of children.

"We know sometimes it works in the short-term but I would like people to be much much more cautious about prescribing it. The difficulty is that it's the easiest thing to prescribe."

Considering the guidelines, she added: "The good thing is that they do seem to be encouraging people to use alternative methods other than just medication, which is sensible.

"But I still think the guidelines don't go far enough.

"They still accept the general idea of ADHD.

These children are also the children most likely to be excluded from school (and to suffer a range of other problems).

"My view is that there are more complex reasons why they are behaving as they are, down to their family life, parental alcohol (abuse) cycles (rather than putting it all down to a disorder)."

ADHD expert and member of the Royal College of Paediatrics and Child Health, Dr Somnath Banerjee, yesterday stressed that the drug remained the best way of treating a significant number of youngsters, including those aged under six.

He said: "If a child has been clinically diagnosed with ADHD due to a chemical imbalance, rather than diagnoses made on the basis of collecting information from parents and teachers, then as a clinician I do believe that Ritalin is going to help."

He added: "It's unfortunate that Ritalin is not licensed for children under six (apart from in extreme cases).

"I do sometimes use it for five or five-and-a-half year-olds, it does have a place, but we need to be extremely careful."