Ritalin use is almost twice as high among children whose
parents divorce compared with those who continue to live
with two biological parents, a Canadian study suggests.
Ritalin, or methylphenidate, is commonly prescribed for
attention deficit hyperactivity disorder, or ADHD, in
children.
Use of the drug has increased rapidly over the past
few decades in Canada, the U.S., the Netherlands, Israel
and Australia, raising questions about whether it is
overprescribed or prescribed inappropriately in
children.
The study in Tuesday's issue of the Canadian Medical
Association Journal attempted to tease apart whether
family structure makes a difference in the higher
prescription rate, but the findings do not explain why
the prescription rates are higher, said the study's
author, Lisa Strohschein.
"I've got the what, but not the why," said
Strohschein, a sociologist at the University of Alberta
in Edmonton.
Stress of divorce?
Previous studies suggest children who live with a
single parent or a parent and step-parent were more
likely to be prescribed Ritalin.
But a child could be living in a single-parent
household because of several reasons — divorce, loss of
parent to death or because they were born to a single
parent. The earlier research was not clear about whether
divorce itself makes a difference in Ritalin
prescription rates.
When Strohschein looked at prescription rates between
1994 and 2000 among 4,151 children whose parents hadn't
divorced and 633 children whose parents had, she found
Ritalin use was significantly higher among children
whose parents divorced.
In two-parent families, 3.3 per cent of children were
prescribed the drug, which rose to 6.1 per cent among
the children whose parents had divorced.
"It is possible that the stress of divorce
subsequently elevated child behavioural problems to a
point that necessitated methylphenidate use,"
Strohschein concluded. "However, one cannot rule out
alternative explanations."
For example, since ADHD is thought to have a genetic
component, there may be a greater likelihood of passing
on the disorder among parents with a history of mental
health problems who divorce, Strohschein proposed.
Or, the anxiety, sadness and other emotions that
children feel after divorce may lead to more contact
with the health-care system. Visits to the doctor after
a divorce occur as parents and doctors are on the
lookout for problematic behaviour, and a child's
symptoms may be mislabelled as ADHD.
The Statistics Canada survey results on which the
study was based did not include questions to test
whether Ritalin is prescribed inappropriately to
children of divorce.
Be cautious in prescribing
Nonetheless, the findings should serve as a reminder
to doctors to be cautious in prescribing drugs for ADHD
to children after a divorce, said Dr. Abel Ickowicz, the
psychiatrist-in-chief at the Hospital for Sick Children
in Toronto.
"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."
All of the explanations Strohschein proposed likely
have some validity, said Dr. Anton Miller, a
developmental pediatrician and child health researcher
at the University of British Columbia's Centre for
Community Child Health Research.
Miller added his own suggestion, saying the stress of
dealing with ADHD behaviour in a child may
contribute to divorce.
With files from the Canadian
Press