Subject:
Psychostimulants

Short Description:
Is divorce a risk factor for getting a stimulant prescription?

Background:
In a provocative study, rates of Ritalin prescriptions in Canada from 1994-2000 were compared with rates of divorce. The study focused on children ages 2-7, and found that in families that stayed intact during the study period, 3.3% of children were prescribed Ritalin. In families undergoing a divorce, this rate nearly doubled, to 6.1% (Strohschein LA, CMAJ 2007;176:1711-1714).

TCPR's Take:
This finding adds fuel to the fire in the ongoing debate about whether stimulants are inappropriately prescribed. Higher prescribing in divorcing families could simply reflect a genetic component of ADHD, in which parents of ADHD kids are genetically more impulsive or otherwise more vulnerable to divorce. Alternatively, divorce may cause so much disruption that children are more likely to be brought in to the psychiatrist and be evaluated, enhancing case-finding and leading to increased (but appropriate) prescriptions. The worst case scenario is that divorce causes otherwise healthy kids to misbehave, leading to inappropriate ritalin treatment as opposed to more appropriate psychosocial interventions. Choose your own interpretation!