Read my op-ed with Miles Corak on how to reduce inequality and child poverty here.
Now that our kids are back in the classroom, parents across Canada will again be faced with the pressures and anxieties that come with a child’s diagnosis of ADHD (Attention Deficit Hyperactive Disorder).
An often difficult question for parents of children who suffer from ADHD is whether to put their child on either Ritalin or Adderall (the drugs most commonly used to treat ADHD and its features of hyper and impulsive behaviors).
Experts estimate that currently ADHD affects five percent of children worldwide.
However in North America, the diagnosis rates are significantly higher.
Research suggests that in Canada, seven to ten percent of children have ADHD and pharmaceutical sales in Canada for ADHD medications have increased by more than 55 percent in four years.
For some children, Ritalin and Adderall are essential and life-changing options – but for many children the benefits are not as obvious.
I am part of a research team that conducted a study on the medium and long-term effects of Ritalin on child outcomes. The study uses the 1997 drug insurance expansion in Quebec as a starting point.
Within a decade of this expansion, children in Quebec were using Ritalin at twice the rate of children in the rest of Canada and by 2007, 44 per cent of Canada’s ADHD prescriptions were being written in Quebec.
We compare the children who were part of this large increase in Ritalin use to those who were not. We went into the study thinking that medicating for ADHD would result in improved academic and performance benefits over time. But that’s not what we found.
Performance indicators such as math scores and graduation rates showed no improvement. Some of the boys who were part of the Ritalin use expansion were more likely to drop out of school and girls were more likely to be unhappy and depressed.
The study concluded that the corresponding increase in Ritalin use had no visable long run benefits on school outcomes and behavior, and may have had some negative consequences.
Why would this happen? It very unlikely that medication for ADHD actually harms children. However, medication alone, without any behavioural therapy may help keep the problem quiet while the underlying social or personal issues with the child or his environment remained unaddressed.
A review of our study and others in the Wall Street Journal makes another interesting observation:
“The medicine may help with focus, but it doesn’t help with deciding what to focus on, experts say. Rather, it needs to be coupled with skills training, such as learning how to organize or prioritize… Many students report they find themselves absorbed in cleaning their rooms rather than studying.”
So what does this mean for parents faced with the decision of whether to medicate a child or to continue for another academic year on prescription drugs?
Drug treatment may be very helpful for many children, but it isn’t for everyone. Parents should be sure that they are combining drug treatment with behavioural training, that they are working with care givers experienced with ADHD, and that they are following the prescribed treatment carefully. Our study showed that those who ever report going on Ritalin in our data, children are on Ritalin for about 30% of the survey years we observe them. Moreover, the average child who is ever reported to be on Ritalin, switches twice over the period we observe them (between the time they are ages 4-7 and age 15). And while we had no information about dosage, it seems likely that many children are taking doses of ADHD which are not calibrated to achieve optimal results, even in the short term. It suggests that observers of the large increases in the use of medication for ADHD in the U.S. and Canada are probably right to be concerned.