Divorce Increases Risk Of Ritalin Use

Dr. Lisa Strohschein found that there is a "significantly higher" risk of Ritalin use--nearly twice as high--for children whose parents divorce compared to children whose parents remain together. It is the first study to follow children over time and evaluate whether experiencing parental divorce increases the risk for subsequent Ritalin use, a drug commonly prescribed for Attention Deficit Hyperactivity Disorder (ADHD). Previous studies have only compared the proportion of children taking Ritalin in two- biological parent homes versus single parent households. While such studies showed that living in a single parent household was a risk factor for Ritalin use, Strohschein suggests that a snapshot comparison across different family types provides an incomplete picture. There are a number of other ways--including being born to a never-married mother--that a child can come to live in a single-parent household.

"So the question was, 'is it possible that divorce acts a stressful life event that creates adjustment problems for children, which might increase acting out behaviour, leading to a prescription for Ritalin"'" said Strohschein.

She was drawn to look at Ritalin usage because prescriptions to children for Ritalin have skyrocketed over the past two decades, leading to concern over whether it is being appropriately prescribed.

Using data from the National Longitudinal Survey of Children and Youth (NLSCY) from 1994 to 2000, Strohschein restricted her sample to almost 5000 children who, at initial interview, lived in a two-biological parent household and were not Ritalin users. Between 1994 and 2000, 633 of these children (13.2 per cent) experienced the divorce of their parents. The percentage of children taking methylphenidate, or Ritalin, during that time was 3.3 per cent for children whose parents remained married and 6.1 per cent for children whose parents divorced during this time period. The findings complement previous research by showing that it is not just living in a single parent household, but parental divorce that is associated with greater risk.

One potential explanation for the higher use of Ritalin could be that divorce is stressful and some kids develop mental health problems and are then appropriately prescribed the drug, says Strohschein. "But a second possibility could be that ADHD has a genetic component so the association between parental divorce and Ritalin use in children exists because parents themselves have personality features that make it less likely their marriages will last," she said. "On the other hand there is also the very public perception that divorce is always bad for kids and so when children of divorce come to the attention of the health-care system--possibly because parents anticipate their child must be going through adjustment problems--doctors may be more likely to diagnose a problem and prescribe Ritalin.

"If this latter case is the real explanation, then there is the possibility that Ritalin is being prescribed inappropriately."

The message, says Strohschein, is to educate parents and doctors that not all kids develop mental health problems when their parents divorce. Instead, there is a need to look at the circumstances in the child's life before, during and after the divorce event to determine if the child is actually having problems coping. "In other words, it's too extreme to assume all children are adversely affected by divorce," she said. "We want to be very careful in ensuring that children who really need help receive treatment and avoid giving medication to kids who may not be well served by it."

This research was funded by the Social Sciences and Humanities Research Council of Canada.