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  1. BitterSweet
    19872.jpg In the United States, at least 9% of school-aged children have been diagnosed with ADHD, and are taking pharmaceutical medications. In France, the percentage of kids diagnosed and medicated for ADHD is less than .5%. How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France?

    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. They do not use the Diagnostic and Statistical Manual of Mental Disorders or DSM. According to Sociologist Manuel Vallee, the French Federation of Psychiatry developed an alternative classification system as a resistance to the influence of the DSM-3. This alternative 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 the best pharmacological bandaids with which to mask symptoms.

    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. 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.

    The French holistic, psychosocial approach also allows for considering nutritional causes for ADHD-type symptoms—specifically the fact that the behavior of some children is worsened after eating foods with artificial colors, certain preservatives, and/or allergens. Clinicians who work with troubled children in this country—not to mention parents of many ADHD kids—are well aware that dietary interventions can sometimes help a 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 recent book, Bringing up Bébé. I believe her 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.

    French parents, Druckerman observes, love their children just as much as American parents. They give them piano lessons, take them to sports practice, and encourage them to make the most of their talents. But French parents have a different philosophy of discipline. Consistently enforced limits, in the French view, make children feel safe and secure. Clear limits, they believe, actually make a child feel happier and safer—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 works with children, 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 grow up in families in which the rules are well-understood, and a clear family hierarchy is firmly in place. 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.

    Author: Marilyn Wedge, PsychologyToday
    Date: July 10, 2013


  1. Alien Sex Fiend
    Why French Kids Don't Have ADHD lol wut? sorry for the one liner. read the thing n u get it
  2. C.D.rose
    To be honest, to me this reads like the author condensed her grievance against pharmacological treatment of ADHD with her appreciation for the French style de vie.

    First of all, the state of the art of psychiatry in France is mediocre. If I had to choose between psychiatric treatment in any Western European country, France would probably rank last. The country's comparably high suicide rate is already a warning sign. But more generally, one of the problems I have with French psychiatry is that it apparently intentionally isolates itself from anything that has an "Anglo-saxon" touch. And unfortunately, that is probably 80% of all research that has been done in the past decades. (The 80% number is pure speculation, but if you look at how little medical research is published in languages other than English, the real number may even be higher.) So, in my opinion, French opposition to stimulant treatment for ADHD is at least partially caused by opposition to whatever trend American psychiatry has followed recently. That does not mean of course that the French are wrong in their rejection, it would just be interesting to take a closer look at their motives.

    Furthermore, I'm also not particularly impressed with French-style education and upbringing. France has a very codified society, with rituals and customs that are to be observed quite strictly, and as such it doesn't seem to me to be the best place to grow up for rebellious boys. French society is actually pretty conservative.

    So, personally, I'm not convinced that the French way of educating and raising children is a superior one. To be honest though, I'd still probably prefer it to the American way - which is by no means intended as a pun or anything, just my personal opinion.
  3. quickiB
    "ADHD" is an English acronym, so yes, they don't have "ADHD". They "have" THADA (Troubles d’HyperActivité avec Déficit de l’Attention).
  4. Insomniacsdream
    Take the UK as an example then, we have far lower incidents of ADHD. Yes there may be a price motivation that the NHS won't want to prescribe drugs to children, but I don't think that a child's brain is developed enough to tell if they are actually genuinly unable to concentrate without drugs. If you look at adults, I would bet far fewer then 9% of them take these drugs and a lot of those would have been using stimulants since an early age and would then be hooked. It is not common for an adult to need adderall to get by in every day life, there are some I'm sure, but in America there does seem to be a strong tendency to think 'oh lets throw drugs at it', and the pharmaceutical companies make a KILLING.

    I feel this is relevant:

    To me it really illustrates how massive an affect social situation has in a child's development.
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