Are we medicating a disorder or treating boyhood as a disease?

Carolyn Abraham

From Tuesday's Globe and Mail

Last year, more than two million prescriptions for Ritalin and other ADHD drugs were written specifically for children under 17, and at least 75 per cent of them were for young males. Part 3 of a 6-part series.

For school children across the country – most of them boys – taking a drug for attention deficit disorder each morning has become as commonplace as downing a vitamin. But the daily ritual has been quietly growing in Canada, year after year – a trend that's dwarfing rates in other countries and raising disturbing questions about the forces driving it.

Figures compiled for The Globe and Mail by IMS Health, an independent firm that tracks pharmaceutical sales, show prescriptions for Ritalin and other amphetamine-like drugs for Attention Deficit Hyperactivity Disorder shot up to 2.9 million in 2009, a jump of more than 55 per cent in four years.

More than two million were written specifically for children under 17 – a leap of 43 per cent since 2005 – and at least 75 per cent of them were for young males – a ratio some see as evidence that society is making a malady of boyhood itself.

“What if we were drugging girls at the same rate?” asks Jon Bradley, education professor at McGill University. “What if [the majority] of these prescriptions were being written for girls? There'd be a march.”

The figures seem to suggest a spike of epidemic proportions. But an analyst with IMS Brogan, a division of IMS Health, says the four-year snapshot is emblematic of a drug category that for more than a decade has surged annually in Canada by 10 to 13 per cent. While total prescriptions, worth $249-million, do not represent the number of people taking the drugs, a per capita breakdown of daily doses shows a similar escalation.

“It certainly suggests the drugs are being abused,” says Gordon Floyd, president and CEO of Children's Mental Health Ontario. “There's a desire for the quick fix … the idea that – ‘oh, we'll fix this with a pill' – rather than spend a few months in counselling, is pretty appealing.”

Our penchant for the pills has pegged Canada – after Iceland and the U.S. – as one of the world's top three consumers of methylphenidate, including Ritalin and similar drugs, according to the 2009 Annual Report of the UN International Narcotic Control Board, which based rankings on per capita consumption. A 2007 U.S. report on global use of ADHD drugs also singled out Canada for “higher than expected” consumption, and suggested our exposure to American advertising and “cultural norms” play a role.

ADHD is one of the most commonly diagnosed disorders of childhood, with core features that include an inability to focus, and hyper and impulsive behaviour. Increasingly, it's seen as a chronic condition that 60 per cent of kids never outgrow and one that experts estimate affects five per cent of children worldwide.

But the diagnosis rates in North America are notoriously higher. In Canada, research suggests that seven to 10 per cent of children have ADHD – most often, boys.

To some extent, the medical gender gap simply exposes the biological bias of Mother Nature: Boys' brains, perhaps due to chromosomes and hormones, are more vulnerable than girls to several neurological disorders. Boys are four times more likely to develop autism, three times more likely to suffer dyslexia, and two to three times more likely to be diagnosed with ADHD.

But some see a system of harried parents, school officials and general practitioners too ready to label rambunctious young males. While boys might be three times more likely than girls to develop ADHD, research suggests they are nine times more likely to be sent for a clinical assessment and five times more likely to be medicated for it.

IMS figures show ADHD prescriptions for males have increased 50 per cent since 2005.

The decline of male teachers in primary schools, Prof. Bradley suspects, is partly to blame for ballooning drug use – “What are we drugging? Female teachers who don't understand boys like to run and jump and shout – that's what boys do.”