Study Shows More Kids with Divorced Parents on Ritalin than Other Kids
If you are currently going through (or have gone through) a divorce, has your child been diagnosed with ADHD? Recent research has uncovered a potential link to such diagnoses. 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 recent study.
“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 says. “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 for future study. 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 says 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 three to five years of age. One does not usually develop ADHD when they are eight, nine, or ten. 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. These criteria include:
- Symptoms appearing before age seven that 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 says. “The question is, are the problems so severe that they are considered developmentally abnormal.”
RISING PRESCRIPTION RATES
Strohschein decided to study divorce and Ritalin use because some people feel the drug is over-prescribed or wrongly prescribed. “There has been a lot of debate about whether Ritalin is being prescribed inappropriately for children,” she said. “Prescription rates have skyrocketed over the 1990s and early part of this decade, so there has been concern about what factors are associated with taking this medicine.”
In March 2007, a study published in Health Affairs, The Global Market for ADHD Medications, found that global use of ADHD medications rose threefold between 1993 and 2003. Vitiello said Ritalin is the most common treatment for ADHD and works to help a child improve motivation, pay attention to tasks, and increase concentration. Ritalin stimulates the chemical dopamine, he said, boosting the ability of the brain to focus.
After reading the results of Strohschein’s study, Vitiello said it potentially raises the question of whether Ritalin is over-prescribed. Parents, he said, should be careful. “Medication should be considered when there is good evidence from a clinical evaluation,” he said. “It’s not a band-aid used to control symptoms in a stressful situation.”
THE RITALIN DEBATE
There are some who object outright to the use of Ritalin with any child and even to a diagnosis of ADHD. Dr. David Stein has published five books on child behavioral issues, including Unraveling the ADD/ADHD Fiasco, and he spent 22 years as a psychology professor at Longwood University in Virginia before becoming associate professor of criminal justice at Virginia State University. Stein said that the results of the study are not surprising.
“Children do not require quality time, they require lots of time,” he said. “But sadly since the 1970s, both parents are working and the stress of everyday hassles is destroying loving relationships between marriage partners and with children.”
In his book Unraveling the ADD/ADHD Fiasco, Stein points to divorce as a reason for an increase in ADHD diagnoses. He states that children’s hearts are torn when they see the two people they love and rely on going at each other. “Under those conditions, a child’s spirit breaks. He stops caring. Work and school aren’t worth the trouble, since to him life is so bleak anyway. Then we call him ADD/ADHD. ADD/ADHD is a label for misbehaving children.”
He attributes the rise in Ritalin use to the fact that it works quickly. “Drugs are the quickest solution for subduing behaviors in both adults and children,” he says. “Drugs do not correct chemical imbalances; they only constrain behaviors. Thus, for a single parent, drugs are the easiest solution, but sadly the least healthy solution for the children.”
Stein has developed a method for helping children with these types of behavioral problems, which he calls Caregiver’s Skills Parenting or CSP. He said he often sees divorced parents looking for help with their child.
DIVORCE AND PARENTAL HELP
“I get many cases of parents divorcing,” says Stein. “The worst thing they can do, which is all too frequent, is use the children as weapons against the other parent. It is best to not make disparaging remarks about the other parent, and most importantly I require that for the sake of the children, they both learn my CSP program — with both parents on the same page it stabilizes the life of a child.”
Stein maintains that ADHD is not a true condition, but actually a symptom of increasingly stressful lifestyles. “I focus on behaviors rather than diagnoses,” he said. “They learn how to discipline and set clear boundaries on behaviors, and they learn to socially reinforce behaviors with praise, hugs, and kisses. Over time the positives increase and the need for discipline decreases. The child performs well and earns true positive self-esteem.”
It is critical, Vitiello says, for parents to seek the advice of a physician they trust and who won’t jump to conclusions. “Typically, one should avoid making a diagnosis about an illness that is chronic during a period of acute stress, like death or divorce,” he says. “ADHD is not an acute condition. It’s a chronic trait. It unfolds itself over the years.”
Strohschein, who is planning future research on predictors of Ritalin use and the long-term effect of the drug, also cautioned parents to give children time to adjust. “Negative responses to parental divorce are to be expected,” she says. “Children, just as much as their parents, need time to adjust to their changed circumstances. Some children may develop mental health problems as a result of divorce, but we shouldn’t be too quick to assume that all children will be necessarily harmed.”
This article was contributed by Stephanie Obley, who worked for several years as an award-winning journalist in Kansas, Florida, and Utah, covering everything from crime to the environment.
