In the United States, approximately 5 percent of school-aged children have been diagnosed with ADHD and are taking pharmaceutical medications. In France the percentage is a mere 0.05 percent. How come the epidemic of ADHD -- which has established itself firmly in the United States -- has almost completely passed over children in France?
First, is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on whether you live in France or in the United States. In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes. The preferred treatment is also biological -- psycho stimulant medications such as Ritalin and Adderall.
French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children's focusing and behavioral problems with drugs, French doctors prefer to look for the underlying issue that is causing the child distress -- not in the child's brain but in the child's social context. They then choose to treat the underlying social context problem with psychotherapy or family counseling. This is a very different way of seeing things from the American tendency to attribute all symptoms to a biological dysfunction such as a chemical imbalance in the child's brain.
French child psychiatrists don't use the same system of classification of childhood emotional problems as American psychiatrists: The Diagnostic and Statistical Manual of Mental Disorders. In 1983, in part as a resistance to the influence of the DSM-III, the French Federation of Psychiatry developed an alternative classification system. This was the CFTMEA (Classification Française des Troubles Mentaux de L'Enfant et de L'Adolescent), first released in 1983 and updated in 1988 and 2000. The focus of CFTMEA is on identifying and addressing the underlying psychosocial causes of children's symptoms, not on finding symptoms that will qualify for the best pharmacological bandaids to mask them.
To the extent that French clinicians are successful at finding and repairing what has gone awry in the child's social context, fewer children qualify for the ADHD diagnosis.[1] Moreover, the definition of ADHD is not as broad as in the American system, which, in my view, tends to "pathologize" much of what is normal childhood behavior. The DSM specifically does not consider underlying causes. It thus leads clinicians to give the ADHD diagnosis to a much larger number of symptomatic children, while also encouraging them to treat those children with pharmaceuticals.
Sociology professor Manuel Vallée points out another important but often-overlooked advantage of the French approach, which is more holistic and psycho-social. The French point of view allows for considering nutritional causes for ADHD-type symptoms -- specifically the fact that the behavior of some children may be worsened after eating foods with artificial colors, certain preservatives and/or allergens.[2] Clinicians who work with troubled children in this country -- not to mention the parents of many ADHD kids -- are well aware that dietary interventions could potentially help the child's problem. In the United States, the strict focus on pharmaceutical treatment of ADHD, however, encourages clinicians to ignore the influence of dietary factors on children's behavior.
And then, of course, there are the vastly different philosophies of child-rearing in the United States and France. These divergent philosophies could account for why French children are generally better-behaved than their American counterparts. Pamela Druckerman highlights the divergent parenting styles in her book, Bringing up Bébé. I believe Druckerman's insights are relevant to a discussion of why French children are not diagnosed with ADHD in anything like the numbers we are seeing in the United States.
From the time their children are born, French parents provide them with a firm cadre -- the word means "frame" or "structure." Children are not allowed, for example, to snack whenever they want. Mealtimes are at four specific times of the day. French children learn to wait patiently for meals, rather than eating snack foods whenever they feel like it. French babies, too, are expected to conform to limits set by parents and not by their crying selves. French parents let their babies cry it out if they are not sleeping through the night at the age of four months.
Consistently enforced limits, in the French view, make children feel safe and secure. Clear limits, they believe, actually make a child feel happier -- something that is congruent with my own experience as both a therapist and a parent. Finally, French parents believe that hearing the word "no" rescues children from the "tyranny of their own desires." And spanking, when used judiciously, is not considered child abuse in France.
As a therapist who has worked with children for more than twenty years, it makes perfect sense to me that French children don't need medications to control their behavior because they learn self-control early in their lives. The children have grown up in families in which the rules are well-understood and a clear hierarchy is firmly in place. "C'est moi qui décide" ("It's I who decide"), asserts the French parent. In French families, as Druckerman describes them, parents are firmly in charge of their kids -- instead of the American family style, in which the situation is all too often vice versa.
For more by Marilyn Wedge, Ph.D., click here.
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For more on ADHD, click here.
References:
[1] Vallee, Manuel. (2011) "Resisting American Psychiatry: French Opposition to DSM-III, Biological Reductionism, and the Pharmaceutical Ethos" in Advances in Medical Sociology, Volume 12, p. 97.
[2] Valle, Manuel. (2010) "Biomedicalizing Mental Illness," Understanding Emerging Epidemics: Social and Political Approaches Advances in Medical Sociology, Volume 11, pp..290-291
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HyperSupers – TDAH France
The association came to life through an internet discussion. Parents of children with ADHD who were looking for the proper diagnosis tried to benefit from their educational competence and come out of their social isolation. It became obvious that parents had to wade through endless medical examinations prior to obtaining the proper diagnosis. Our young people had already reached their teens, other parents were struggling with social services who were threatening to put their children in foster homes, since they were convinced that their parents had poor parental skills, due to inaccurate diagnosis or refusal to consider this disorder.
Faced with the lack of recognition of the French institutions, five of us were motivated to create a support system to try to ease the suffering of children and their families. We saw that our close European neighbors were better equipped than the French families to face this disorder. The French ADHD association was created to support families and to try to prevent a long and chaotic medical process, in the hope that an early diagnosis can improve the future for these children both in their academic as well as in their social and professional life, in their teenage and adult life. This would also help to reduce the social cost of ADHD in France (for example early school drop-outs, drugs, alcoholism, suicide …)
Today our association numbers 800 members and 50 volunteers.
http://www.drhallowell.com/blog/award-winning-documentary-add-and-loving-it-now-airing-on-pbs-stations/
I've seen it on PBS several times, most recently about a week ago, and it's well worth the time to watch it. Patrick McKenna is a comedian who did a documentary about living with ADD. It's very entertaining and funny. Dr. Hallowell also lives with ADD and has written about it in Prevention magazine and, of course, on his blog. I think he also wrote a book on it, but I haven't read it.
Many parents want to be their child's friend (just listen, sometime, how many parents call their children "bud" or "buddy", a synonym for friend) and many parents let the children run their family instead of the adults being in charge. Too many parents neglect to provide that "frame" or "structure" that children need. Boundaries make a child feel secure; and too many parents let the children raise themselves. We've seen the result of that in children's behavior in society and in schools. Many American children are led to believe they can do no wrong, their parents will defend whatever they say and/or do, and they are raised to think they have rights without responsibilities.
Medication can help some children, but I also think many children are misdiagnosed simply because parents think it's an easy fix since they don't have the time or interest to deal with the real causes. I think all possible other methods should be explored first, especially since we don't know the long term effects of many medications being prescribed today. I wonder how many American parents whose children are on medication tried family counseling first. I'd guess very few.
Standard protocol is to only prescribe medication when other behavioral methods have failed to control the symptoms. I don't know anybody who has an ADHD child on meds who hasn't tried other methods first. No parent wants their child to take medication. Most parents come to the decision reluctantly, with a lot of suspicion, a heavy heart, and a lot of guilt. This idea that parents medicate their children into submission because they are lazy is not only false, but its also cruel. That myth is this parenting generations, "Refrigerator Mom" blame game scapegoat, and this kind of nonsense doesn't help anybody.
Of course, this article doesn't mention how French doctors treat *autism*...now does it? (The answer to that can be found in the 1950s....)
I DO agree that it's overdiagnosed and overmedicated. It's also real.
I've sat in meeting with parents yelling at us because we refuse to write a letter to a doctor saying we've seen impulsive, unfocused behavior at school when we haven't--no matter how much we try to explain how intensity, duration, and location matter.
I've heard parents complain that we must have filled out the Conners rating scale incorrectly because it doesn't indicate ADHD behavior.
And I've actually seen doctors' prescription pads reading that a child needs an IEP because the mother told the doctor the child has ADHD, even with no evidence of it at school.
We need more science before we sell pills.
http://www.touchbriefings.com/pdf/3107/cortese.pdf
where a delay in diagnosis may stem from a belief that ADHD is not a "real" disorder and here:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525089/ where the myth that ADHD is an "American" disorder is debunked. Shame on you, Ms. Wedge and shame on you, Huffington Post for publishing such drivel.
The parents, not teachers, decide if they want to take the child to the doctor. The parents, not teachers, decide whether or not to accept the diagnosis, if there is one. The parents, not teachers, decide whether or not to have their child take medication, what kind, and what dose. The parents, not teachers, fill the prescription and give the child the medication. And parents, not teachers, decide whether or not to sign the paperwork to get a child into special ed services or have a 504 Plan.
Any parent can refuse to do any of the above. To blame teachers for wimpy parents is ridiculous. But medicated or not, ADHD or not, a child's behavior is the ultimate responsibility of the parents, not the teacher. So, if a child is misbehaving in school then the parents should take responsibility for changing the behavior and not expect teachers to do their job.
-Nicole Beurkens, PhD
Licensed Psychologist
www.HorizonsDRC.com
http://www.ncbi.nlm.nih.gov/pubmed/20679156
Another interesting article about ADHD in France: http://www.touchbriefings.com/pdf/3107/cortese.pdf
Counting on lawmakers and school employees, paid your tax dollars to be entrusted with the care and education of your child to keep them safe? Think Again! Child Protection: Direct Conflict: Politics Over 20-years Research: Modern Medicine: "Spanking should not be used as discipline, says study" Cites 20 years research findings that spanking kids can cause long-term harm.
The FBI is investigating a child porn case at a school.Elem. Schl Aide's self produced child porn videos included two taken in a school classroom, one of Brooks touching a child's genitals and an other of him spanking a naked child, the complaint says.
Search "A Violent Education" for disturbing facts including graphic descriptions of injuries to students K-12 from school paddling, Teacher Immunity Laws and No Legal Redress, U.S. Supreme Court declines to hear School Corporal Punishment Appeals!
Support Federal Bill H.R. 3027 to Abolish School Corporal Punishment in all U.S. Schools at donthitstudents.com
http://www.thedailybeast.com/newsweek/2009/04/24/the-principal-and-the-paddle.html
As a teacher, I would never want to hit one of my students. As a parent, I did spank--exactly four times, and I remember each one (my husband did it more, but certainly not frequently). We never spanked them after about the age of 4, and never with anything other than our hands on clothed bottoms, and never more than 4 swats--a rule we made before having children-- when they understood other consequences we stopped altogether. Abuse is never right, but some children need more intense consequences than others. Using extreme examples to say no child should ever be spanked is just as lopsided as saying spanking is the best consequence and should always be used.