Attention Deficit

ADHD does not seem to be a condition like pregnancy where one is either pregnant or one is not. Rather it is a matter of degree. Some children and adults range from mildly inattentive to profoundly inattentive. The degree seems to be directly affected by a variety of environmental factors including divorce, parenting skills, etc. More frequently than not, drugs are prescribed to allay the symptoms. Obviously, they do not affect core issues that affect the child like divorce, marital discord, or learning disabilities.

Study finds divorce increases Ritalin use in children

HELEN BRANSWELL
Canadian Press
June 4, 2007 at 8:46 PM EDT

TORONTO — Children whose parents divorce are nearly twice as likely to be prescribed Ritalin in the aftermath of the split, a Canadian study reports.

But the author, a sociologist from the University of Alberta, cautioned against concluding that children of divorce are over-prescribed the drug, which is used to treat Attention Deficit and Hyperactivity Disorder, or ADHD.

Lisa Strohschein said the data she used can only identify the phenomenon and cannot reveal why Ritalin use rates are double when children of divorced parents are compared to children whose parents stay married.

"I’ve got the what, but not the why," Ms. Strohschein said from Edmonton.

Ms. Strohschein suggests there may be a variety of answers. Some kids may need the drug to cope with the stress of the split, some kids may have ADHD and some kids may be getting a drug they don’t really need.

"The problem is I can’t be clear about it," she said.

"I mean, I would love to be able to say ‘Yes, it’s divorce. That’s the problem,’ But it’s not necessarily so. It could just be our perceptions about divorce — and that’s the thing that makes me really cautious here."

"(But) I don’t want to come out on the other side, either and say ‘Ritalin is bad’ because I think it clearly does help some kids."

The psychiatrist-in-chief of the Hospital for Sick Children in Toronto said the study should serve as a reminder to doctors to move cautiously when prescribing Ritalin or other methylphenidate-based drugs to children in these circumstances.

"What we need is a deeper understanding of this issue, at the level of the primary care practitioners," said Dr. Abel Ickowicz.

"Because . . . if we are going too quick to prescribe medication, like Ritalin, like methylphenidate, we may not only be masking the normal process of adaptation to divorce, but we may be contributing to the degree of distress the children of divorce are experiencing."

The study, published in the Canadian Medical Association Journal, used data gathered by Statistics Canada through its National Longitudinal Survey of Children and Youth. The survey, which was first conducted in 1994, is completed every two years; Ms. Strohschein used data collected between 1994 and 2000.

Previous researchers had identified the fact that children who live in a household with only one parent or with a parent-step-parent combination were more likely to be on Ritalin than children growing up in households with both parents.

But it wasn’t clear whether the increased use was among all children in a single-parent household — in other words, children whose parents had divorced, children who had lost a parent to death and children born to a single mother — or whether some subset of these children was more heavily prescribed the drug.

Ms. Strohschein compared prescription rates among 4,151 children whose parents hadn’t divorced and 633 children who had. She found that 3.3 per cent of children in the two-parent families were prescribed Ritalin; among the children whose parents had divorced, that figure rose to 6.1 per cent.

The study notes a number of potential explanations for the doubling of the usage rate.

One possibility is that the stress of the divorce aggravated a child’s existing behavioural problems to the point where Ritalin would actually be helpful, she hypothesized.

It is known that ADHD can run in families. In addition to passing on the condition to their children, parents with ADHD-type behaviour might be more likely to divorce — a theory that points towards appropriate use of the drug.

Another possibility is that in divorce, the natural emotions children experience — anxiety, sadness, anger — may manifest themselves in behaviour that is mislabeled as ADHD-like, or that parents and doctors may be anticipating problematic behaviour because of the stress of divorce. The study suggested this type of rationale would reflect inappropriate use.

Dr. Anton Miller, a developmental pediatrician and child health researcher at the University of British Columbia’s Centre for Community Child Health Research, said it’s possible no single answer applies across the board for these children.

"None of them is an outlandish kind of suggestion. They probably all have some validity," he said.

"It’s certainly possible in some instances that ADHD might have been prematurely diagnosed…. But I would caution anybody (against) saying ‘Well that’s why all these children are getting medication.’ "

"But there is a possibility that in a proportion of the cases we need to try and figure out how much that does happen in the real world and try and advocate … for children to have thorough and really in-depth assessments for these kinds of behaviour and emotional problems."

Ms. Strohschein agreed: "I think the take-home message is just to be careful not to make that broad assumption that kids must necessarily be doing poorly when their parents divorce. Some kids will do better, some kids will do worse."