A study of three Ontario school boards in 2000, which Dr. Roberts co-authored, suggests ADHD diagnoses and drug use can vary wildly. At the East York Board of Education, the proportion of kindergarten to Grade 6 children taking drugs after an ADHD diagnosis was 13 per cent - boys nearly three times more than girls. At the Metropolitan Toronto Separate School Board it was three per cent and girls and boys had nearly equal drug use. At the more rural, eastern Ontario Hastings County Board of Education, it was 43 per cent of children with ADHD who were medicated, and boys seven times more than girls. The survey, published in the Pediatric Journal of Child Health, also found that 27 per cent of boys with ADHD were medicated for the condition compared to five per cent of girls.
Other reasons cited for the increase in ADHD medications, include their illicit use among college and university students who treat the stimulants like brain steroids to improve their studies.
Part of the drug increase is thought to reflect the fact that new and longer-lasting ADHD medications have hit the market. It may be, says Mr. Floyd at CMHO, that those who didn't tolerate the older drugs have signed up for the next generation - which are also more costly than the last. IMS statistics show spending on ADHD drugs surged 104 per cent - from $122-million in 2005, to $249-million in 2009.
Any time new medicines become available, drug companies facing more competition ramp up their marketing efforts, he says. This includes dispatching legions of drug representatives to doctors' offices to promote their use - "So their drug is top of mind for the doctor when kids come in."
Drugs to treat ADHD, with common side effects that include insomnia and headaches, have been better studied than most psychiatric medications used in children. But questions linger about their long term safety - a U.S. study last year suggested that Ritalin, or methylphenidate, could have unknown consequences on crucial brain systems. As well, Health Canada, and later, the U.S. Food and Drug Administration, warned a few years ago that the stimulant drugs may be dangerous for those with underlying heart problems - and those who do not actually have ADHD.
Mr. Floyd feels counselling stands a better chance of getting to the root of problem with children, rather than using drugs for years to dull symptoms. Research shows, he says, that talk therapy can be very successful for kids with ADHD.
But with wait times of six months or more in Ontario for behavioural therapies for children, many don't wait. "There's a desire for quick fix….the idea that "oh, we'll fix this with a pill' rather than spend a few months in counselling is pretty appealing."
As well, he notes, "the kid with ADHD is going to be bumped to the back of the line…ADHD doesn't stack up against a kid who is suicidal."
In the meantime, general practitioners with little training in the disorder will prescribe drugs for ADHD and not even make a referral for counselling, he says, because of the wait times - "So a kid might get a drug and nothing else."
In Ontario, the numbers of children coming through provincially funded mental health services and assessed as having ADHD remain fairly stable, says Mr. Floyd. But kids seeking help elsewhere seem more likely to be diagnosed and to receive drugs. "When we see a high energy youngster, we jump to put the label on. An assessment would look much deeper."
With files from Celia Donnelly