Children of Divorce and Ritalin

    Children of divorced families are twice as likely to be prescribed Ritalin – a drug commonly used to treat children diagnosed with Attention Deficit Hyperactivity Disorder – than those whose parents stay together, according to the results of a study completed last year.             

“The question was whether divorce itself is a trigger for receiving a prescription for Ritalin,” said Lisa Strohschein, an assistant professor who conducted the study. “The results of my study showed that it was not just living in a single-parent household that created risk for Ritalin use, but more specifically, that experiencing divorce was associated with a nearly two-fold increase in the odds of taking Ritalin.”     

The study, titled “Prevalence of methylphenidate use among Canadian children following parental divorce,” appeared in June 2007 in the Canadian Medical Association journal. Strohschein, an assistant sociology professor at the University of Alberta in Canada, looked at Ritalin prescription rates between 1994 and 2000 for children surveyed through the National Longitudinal Survey of Children and Youth in Canada. Prior to the survey, the children were between ages 2 and 7, living with both parents and not taking Ritalin.
 
Among the 4,151 remaining with both parents at the end of the survey, 3.3 percent had been prescribed Ritalin compared to 6.1 percent of the 633 from divorced homes Previous studies had shown that children in single-parent households were more likely to be on Ritalin, Strohschein said, but they did not focus specifically on divorce.             

The reasons for the results are not cut and dry, Strohschein said. “It would be premature to say that divorce itself causes Ritalin use, although it is certainly one plausible explanation,” she said. “That is, the stress of divorce may overwhelm coping resources of the child and lead to a diagnosis of ADHD.”            


OTHER EXPLANATIONS  

Strohschein pointed to at least two other possible explanations for the link between Ritalin use and children whose parents divorce. The question of which is most likely is for future study, she said. The other explanations are:  

1. Genetics.
There is evidence of a genetic link for ADHD. “Parents who transmit the disorder to their child themselves – directly through genes or indirectly through socialization – may also be at greater risk for experiencing divorce themselves,” Strohschein said. “Their personalities may make it difficult for them to remain married.”  

2. Overprescribing.
Strohschein said it’s also possible both parents and doctors are more sensitive to the behavior of children experiencing divorce, which may lead to inappropriate prescriptions of Ritalin. “Children are more likely to come into contact with the health care system following divorce and this contact – coupled with the assumption that divorce is necessarily harmful – may increase the likelihood that a physician will prescribe Ritalin,” she said.  

One explanation that is not valid, she added, is that the child already had ADHD and caused the parents to divorce. Though their data was not used in the main study, Strohschein compared children who were using Ritalin at the beginning of the study to those who were not, and both groups had an equal chance of their parents divorcing.  


WHAT IS ADHD?              

The National Institute of Mental Health defines ADHD as a condition that makes it difficult for children to control behavior or pay attention. An estimated 3 to 5 percent of children – or about 12 million in the U.S. – have been diagnosed with ADHD.            

Dr. Ben Vitiello, a psychiatrist with expertise in psychopharmacology – including drugs like Ritalin – said the study was interesting and illustrates the need to make sure a child’s behavioral problems aren’t tied to a stressful situation like divorce. 

“ADHD has a natural developmental history that goes back to the preschool years,” he said. “Children start having problems when they’re 3 to 5 years of age. One does not usually develop ADHD when they are 8, 9 or 10. When that happens, it’s usually not ADHD as we consider it.”            

There are several criteria, said Vitiello, who is also chief of the NIMH’s Child and Adolescent Treatment and Preventive Interventions Research Branch, including:  

• Symptoms appear before age 7 and continue for at least six months.
• Symptoms include hyperactivity (excessive motor activity), impulsivity (acting without thinking) and inattention.
• The level of the symptoms exceeds that of the child’s peers.

The behaviors create a handicap in at least two areas of life, such as the classroom, playground, social settings, community or home. “All children move a lot, act without thinking and have problems sustaining attention,” Vitiello said. “The question is, are the problems so severe that they are considered developmentally abnormal.”