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NP: Friday morning means it's the ego's turn

In this week's National Post column I analyze the implications of new Canadian data on Ritalin prescriptions and divorce. (You can read the original study here.) If you're a child, negative life events at home seem to have a lot to do with whether you get diagnosed with attention deficit-hyperactivity disorder. Which would seem to be a bit of a blow to those who insist that ADHD is a neurological illness which has nothing at all to do with parenting—indeed, it would seem to make that view nearly insupportable—and an important point in favour of those who have argued that the explosion of ADHD diagnoses is part of a trend toward medical modification of personality traits. Send angry e-mails to the usual address, not that you need to be told.


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Comments (15)


I haven't read the study; but in your reporting of it, don't you fall for the ole "correlation shouldn't equal causation" problem.

In addition to the problem you did identify (i.e., given that ADHD's is apparently highly heritable, parents of ADHD kids might, themselves, have problems that predispose them to be lousy marriage material), why isn't it equally possible that kids with ADHD are hard to handle, hard to discipline, exhaust their parents, generally create more stressful home lives, and contribute to divorce, rather than the reverse?

That's an interesting theory--and I'm not one to fear blaming the victim!--but if it were true, and the effect had the magnitude necessary to create Strohschein's results, one would expect parents of male children to be markedly more likely to divorce because most ADHD-diagnosed children are male. And in fact, it's just the opposite.


"Markedly more likely to divorce" seems a tad strong to me. What percentage of worldwide divorces involve kids with ADHD? Enough to have a "marked" effect on the overall numbers?


Our 10 year old boy has a slight ADD situation (not ADHD). He's been on various dosages of Ritalin or equivalent for about 3 years now, and it has been an incredible step forward - for him. He's can focus on class, not be a bother to other students, and achieve what he is very capable of doing, without the ADD monkey on his back. In other words, he's on a level playing field in terms of behaviour, performance and, very importantly, self-esteem.

It's unfortunately far too easy for disengaged or uninvolved observers to glibly write off use of Ritalin as a behaviour control tool for the benefit of parents and teachers.

He'll undoubtedly soon be off this medication, as he is at an age where his awareness of his abilities, and his will to not use the prescription, are increasingly evident. We'll work on that with him, but until that time, he's an outstanding student, rather than a "trouble-maker", "misbehaver", or "special needs" student.

I'm going to leave aside the implication that "negative life events at home" (the study only looked at divorce) imply some sort of faulty parenting. I don't want to get worked up. But to the meat of your assertion:

negative life events at home seem to have a lot to do with whether you get diagnosed with attention deficit-hyperactivity disorder.

Without a doubt, as I remember well from both myself and my sister. Negative life events at home can, especially for kids, can help to exacerbate behavior that had been manageable or non-debilitating before, and push it over the edge. Kids who might have been able to control (more or less) their behaviours before, may well react by relaxing the superego and letting the id - and the ADHD that can form a part of it - take full flight. I know I did (but I didn't have ADD/ADHD). Parents get concerned, and take the kid to the doctor.

Also, stress can act as a trigger of mental illness that may have lain more or less completely dormant.

Children who have ADD/ADHD (or any other mental illness) are frequently able to control their behaviour for shorter or longer periods so that intervention is not deemed necessary.

Which would seem to be a bit of a blow to those who insist that ADHD is a neurological illness which has nothing at all to do with parenting—indeed, it would seem to make that view nearly insupportable

Not at all, as people with certain conditions but are not in observable poor health (including mental health) just don't get diagnosed. ADD/ADHD to "normal" is a continuum; lots of parents don't see aqnything particularly wrong with their ADD/ADHD-affected child's behaviour, and so don't go to the trouble of getting a clinical diagnosis, until the behaviour becomes unmanageable - divorce/separation/high levels of family stressors will often push kids, including those like me who don't have ADD/ADHD, over a behavioural boundary where a shrink or doctor is consulted.

It will also reduce parents' ability to cope with bad behaviour, leading to the same result... clinical intervention and diagnosis.

There would be a very high correlation with people diagnosed with hepatitis C, for instance (and therefore taking hep C related meds), and a recent blood donation. It would be a mistake to look at those numbers and say "you can't tell me that hep C is caused solely by the HCV virus, and that giving blood has nothing to do with it." Why? Because the blood donation engages a HCV screen, and will therefore get the person diagnosed and into treatment.

What *does* makes that view insupportable is the same thing that makes any absolutist proscriptions about the source of mental illness insupportable, which is that the mind (and the brain, too) is *fucking complicated*, and if one insists that our crude diagnostic tools have (through blind chance) got it "exactly right", you're a crackpot...


By the way, that comment above should not at all be taken to imply that I disagree one iota with the last paragraph of your Post piece.


"why isn't it equally possible that kids with ADHD are hard to handle, hard to discipline, exhaust their parents, generally create more stressful home lives, and contribute to divorce, rather than the reverse?"

I agree.

I don't understand you can say this:

"Which would seem to be a bit of a blow to those who insist that ADHD is a neurological illness which has nothing at all to do with parenting"

And in the article you mention this:

"Strohschein suggests that there might be "an indirect tendency of parents with a history of mental health problems to divorce" --i.e., your ADHD child isn't wacky because your marriage was lousy; both happened because you were sort of crazy to begin with."

Perhaps heritable traits that contribute to divorce among the parents is a contributing factor in the manifestation of behavioural difficulties in their offspring.

You mention twin studies. Were they the Minnesota Twin studies done by Bouchard et al. ?

You're probably already aware of this paper:

And no, i haven't read the actual study yet. It's Friday at 9:00 pm - i'm single in downtown TO.



"i haven't read the actual study yet"

For clarification, I was referring to Strohschein's study and not the Cochran-Harpending study.


"...is part of a trend toward medical modification of personality traits."

Something I'm fully in favour of. Have they invented a pill that can nudge a complete @$$hole over towards the light side of the Force yet? 'Cuz if they have, I'm gonna start buying them in bulk and force feeding them to some of my customers.


I was very disturbed by your column for many reasons. Your argument, as I understand it, is this: The results of one study suggest that children of divorce are more likely to be prescribed Ritalin than children in two-parent households. Therefore, you conclude, ADHD is not a neurological condition but rather some kind of personality quirk, and that children with this "personality" are routinely prescribed Ritalin mainly so that their parents can go to work and so that they will be behave in school. That's quite a leap, don't you think?

Here's what I know: I have two daughters; my husband and I are not divorced and our home is stable. My older daughter has extraordinary powers of concentration and has since she was a toddler. She has no trouble focusing or figuring out where to begin a complex task. She is organized; rarely loses anything; needs little help in organizing her time or her possessions. My younger daughter, Hailey, on the other hand, spent the first 7 years of her life unable to remember instructions, unable to figure how to begin tasks, unable to keep track of her possessions, losing everything that wasn't attached to her with a safety pin. An extraordinarily bright child, musically and athletically talented, but performing way, way below her potential simply because she could not focus on any task long enough to complete it. Most troubling, she began to refer to herself as "stupid" and "bad", neither of which, of course, are the case. In late 2004, we had Hailey tested and results were unequivocal - she was diagnosed with ADHD.

Contrary to your generalizations, my husband and I did not immediately rush out to get a prescription for Ritalin, nor did Hailey's teachers pressure us to medicate her. On the contrary, we desperately wanted to avoid medication and we tried, and tried, and tried, every possible method we could come up with to try and teach Hailey to focus and to be organized. The problem, of course, is that despite our best efforts, Hailey is simply unable to filter out irrelevant stimuli and focus selectively on what she needs to. The more we tried, the more Hailey failed, and the worse she felt about herself. We talked with our pediatrician, who has a reputation for being extremely conservative when it comes to medication. His recommendation took us completely by surprise: his concern was primarily for Hailey's emotional well-being, which was clearly suffering. He acknowledged that medication was not the answer for all children, but he urged us to consider it, because his clinical experience was that many, many children's lives had been transformed by the wide variety of medications available to treat this condition. We left his office upset, frightened, confused. We were still not ready to make a decision, but after another meeting with the psychologist who had tested Hailey, we felt we were ready to try her on Concerta, which is a long-acting form of Ritalin. We started Hailey on Concerta on a Saturday in February. I spent the entire weekend crying and feeling like Nurse Ratched in One Flew Over the Cuckoo's Nest. Two years later, I can tell you that we saved Hailey's psyche, if not her life, by putting her on the medication.

There are two important ways of thinking about these children and their condition which I would urge you to consider. First, I suspect that like many other diseases, some children are born with a biological predisposition to ADHD, and that whether or not the disease presents itself is a function of both nature and nurture. The stress of a divorce, for example, might trigger whichever genetic mutation is responsible for ADHD in susceptible children. As you've noted, there is a heritable component to ADHD, as borne out by twin studies. Second, it's useful to think about Ritalin et al in the same way we think about anti-depressants or anti-anxiety medication: people who suffer from depression, for example, often need to be medicated in order to be receptive to other forms of therapy. Similarly, the goal of medicating a child with ADHD is to give him/her the ability to focus, to pay attention, and to develop coping mechanisms which will compensate for the attention deficit so that in time, those medications will no longer be necessary.

All that said, I have perfect confidence that some of the time, children are aggressively misdiagnosed; some of the time, teachers recommend medication because they don't want to deal with difficult behavior; some of the time, parents medicate their kids because it's easier than trying to teach discipline and self-control. Some parents are woefully blind to the environment in their homes and its impact on their children. Some parents, sadly, as per your colourful description, "...shovel speed into children of a particular (inherited) personality type...". However, I am equally confident that most parents, physicians, psychologists and teachers act responsibly and professionally, out of love and respect, and in the best interest of their children / patients / students. To suggest otherwise is irresponsible, unfair, and disingenuous, and simply demonstrates that you haven't done enough research.

Carolyn Cosh:

Seems to me, I remember you being "diagnosed" as an unteachable little shit by some of your teachers. Fortunately some others understood that you were not being challenged enough, or you were just plain bored. Do you think you'd have gotten a recommendation for medication, had you been born later?

Oh, look, it's my sister, helpfully turning up to encourage the tendency to make this discussion less personal. I did create a ton of behaviour problems for teachers after the age of 10, but most of them were a consequence of a conscious decision to do so, and I'm extremely doubtful anyone would ever have described me as "unteachable." Nor do I think I'd be medicated nowadays.

Only your sister could remember you as "an unteachable little shit." I had the same problem of not being challenged enough in school. I was diagnosed with ADHD as an adult (before having it became trendy) and I take Ritalin every day, and it helps my writing enormously. P.S. My parents have been married for 45 years.

Personally, I see ADHD not as a disease, but as a different sort of brain functioning. I have the ability to make some pretty wild humorous connections, which I put in my syndicated column and other writing, but I'm highly disorganized, confused and forgetful...far beyond what the normal, ordinary person experiences. I cannot, for example, remember what time is the flight my boyfriend usually comes in on, and we've been together for almost five years, and he takes this flight every few weeks.


An addendum to Amy's comments. One of my friends in college was diagnosed with ADHD. To focus on his nuclear engineering HW, he often needed the aid of Ritalin. However, he hated being on Ritalin because of how drastically it changed his personality (i.e. he was more withdrawn, less humorous, etc.).

Sean F:

alpha male said what I was thinking:

"Perhaps heritable traits that contribute to divorce among the parents is a contributing factor in the manifestation of behavioural difficulties in their offspring."

Or in my words, there might be a link between:
1. the genetics that result in personality traits that contribute to divorce and
2. the genetics that contribute to ADHD in offspring.


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