Electronic letters to:

Research:
Lisa A. Strohschein
Prevalence of methylphenidate use among Canadian children following parental divorce
CMAJ 2007; 176: 1711-1714 [Abstract] [Full text] [PDF]
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[Read eLetter] Author's response
Lisa A. Strohschein   (15 June 2007)
[Read eLetter] Potentially misleading
Brandon K Schultz   (7 June 2007)

Author's response 15 June 2007
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Lisa A. Strohschein
University of Alberta

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Re: Author's response

lisa.strohschein{at}ualberta.ca Lisa A. Strohschein

I would like to provide clarification about my analysis in relation to comments offered by Brandon Schultz in a recent e-letter. I did distinguish between divorced and non-divorced children by assessing whether a divorce occurred at any point between 1994 and 2000, and Ritalin use as any Ritalin use after initial interview on a sample of kids who, at initial interview, were ages 2-7, living in a two-biological-parent household and not using Ritalin. In the majority of cases, there was a clear pattern of Ritalin use after the divorce occurred. However, for some cases, the causal order could not be determined. That is, the NLSCY interviews kids every two years and so there are several cases where divorce and the first instance of Ritalin use occur in the interval between observations (for example, parents remain married in 1996 and report no Ritalin use for their child in 1996; then in the next interview in 1998, a parent reports that a divorce has occurred since the last interview and that the child now takes Ritalin). I don't have information about the day of divorce nor the day of first usage of Ritalin to say definitively which came first.

Having said that, it is well recognized that divorce is a process such that some of the effects of divorce are likely to occur before or coincide with the actual transition. That is, if the first step in the divorce process is heightened tensions and emotional disengagement between spouses while they are still in the same household, children may respond with their own stress reactions. As I argue in the article, as researchers, we should be more interested in family dynamics as they unfold over time rather than a child’s social address (married versus single parent household) at a given time point. The contribution of this article is that it shows that it is not simply residing in a single-parent household, but parental divorce that is a predictor of methylphenidate use. As I acknowledge in the paper, determining why this relationship exists (divorce is stressful and leads to mental health problems, genetic links for ADHD suggest parent mental health problems are related to both parental divorce and child ADHD, and/or parents and clinicians exhibit increased sensitivity to mental health problems in children of divorce) is an important area for future research, and one that I hope to pursue using other data sources.

Although not explicitly mentioned by Schultz, his comments raise the question as to whether children with mental health problems are potentially the cause of the divorce. Is it possible that ADHD children pose such immense childrearing difficulties that they threaten marital stability? Although I excluded children who were taking Ritalin in 1994 in my original analysis (my best effort within the constraints of the data to ensure that mental health problems didn’t precede the divorce), I conducted subsequent analyses to evaluate whether the likelihood of experiencing parental divorce is greater for these children relative to the rest of the sample. I found that the risk of divorce is not significantly higher among parents whose children are taking Ritalin in 1994. The lack of differences corresponds with previous research showing that parents of disabled or mentally ill children are not at greater risk for divorce.1,2 It is likely that child health problems represent a contested battleground for parents who are already dissatisfied in their marriages, and far less likely that children themselves cause their parents to divorce.

1. Devine D, Forehand R. Cascading toward divorce: The roles of marital and child factors. J Cons Clin Psych 1996;64:424–7.

2. Sobsey D. Marital stability and marital satisfaction in families of children with disabilities: Chicken or egg? Dev Disabilities Bulletin 2004;32:62-83.

Conflict of Interest:

None declared
Potentially misleading 7 June 2007
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Brandon K Schultz
James Madison University

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Re: Potentially misleading

schultbk{at}jmu.edu Brandon K Schultz

This research is likely to be misinterpreted due to the author's procedures and interpretation. In her analysis, the author categorized divorced and non-divorced families based on divorce occurring at any point from 1994-2000, and categorized medication usage based on initial prescriptions occurring at any point from 1994-2000. Given these procedures, it is puzzling that the title is “Prevalence of methylphenidate use among Canadian children FOLLOWING parental divorce” [emphasis added]. It appears that the analysis simply uncovers unusually high rates of MPH use before, during, OR after divorce, which is not that surprising given evidence for a genetic link for ADHD and clear associations between ADHD and parental strain. In the article, further confusion is created by the use of the word “subsequent[ly]” several times throughout the background and results sections. For example, the author makes the claim that "...divorce itself is a predictor of subsequent methylphenidate use" (p. 1713); however, the predictor (divorce) and outcome (MPH use) variables did not necessarily occur successively.

I bring this to your attention because of the intense controversy surrounding the use of stimulant medications, based in part on misinterpretations of the relevant research. Although the author takes great care in offering alternative explanations for her findings, one can easily imagine how this article could be widely misinterpreted without further clarification.

In short, this article (beginning with the title) seems to presume a sequence of events that the analysis does not support. To avoid misinterpretation, readers should be strongly discouraged from assuming that divorce precedes or causes increased MPH use, based on these data alone.

Conflict of Interest:

None declared