Tuesday, June 17, 2014

So the French don't think their kids have ADHD?

A friend of mine just shared this story on my Facebook timeline:
Why French Kids Don't Have ADHD: French children don't need medication to control their behavior.

Author and psychologist Marilyn Wedge notes that 9% of American children are diagnosed with ADHD and medicated, but that only .05% of French children receive the diagnosis.


Wedge explains that the French don't use the DSM (The Diagnostic and Statistical Manual of Mental Disorders) and have developed their own system of classifying psychological conditions:
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 ofPsychiatry 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.
Okay, so what she is saying is that Americans are quick to diagnose and prescribe, which could be arguable; however, what she is also saying is that ADHD has "psychosocial causes," dismissing the existence of ADHD.  If Timmy is anxious, it's not because he has ADHD, it's because of something happening at school or home.  That could be true OR Timmy could have ADHD, which in many cases is tied to anxiety.

Another bone I have to pick with Wedge is her assumption that ADHD is an American diagnosis.  According to psychiatrists Stephen Faraone, Joseph Sergeant, Christopher Gillberg, and Joseph Biederman in their comparison of 50 studies of school-aged children and adolescents worldwide, The Worldwide Prevalence of ADHD: is it an American condition?, published in World Psychology : 
The results of studies using DSM criteria suggest that the prevalence of ADHD/ADD-H is at least as high in many non-US children as in US children.  
Based on this paper, several countries simply do not recognize ADHD as a disorder and, therefore either do not treat it or treat the symptoms (or what Wedge calls the underlying social issues that are causing the child distress).

I can't help but wonder if the stats that Wedge cites for France are influenced by a.) the standards French psychologists and psychiatrists have developed as an alternative to the DSM, as well as b.) a failure to recognize ADHD as a real physiological anomaly.

When I asked my husband, a trained counseling psychologist who has been diagnosed with ADD, what he thought about Wedge's article, he suggested that the author also needs to acknowledge cultural norms.  In the US, we expect both children and adults to sit at a desk all day without many breaks and pay attention while sitting still without talking for hour-long intervals.  Perhaps this isn't the norm in France.  This leads me to think that the problem isn't over-diagnosis, but unrealistic and unhealthy expectations for American children and, for that matter, workers.

The last piece about this article that really bugged me is Wedge's unquestioning adoration of French parenting based on Pamela Druckerman's recent book, Bringing up Bébé.  Wedge writes:
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.
I don't trust generalizations.  While I'll be the first to agree that the French do many things well - brie, the Eiffel Tower, manicured gardens - but let's use some critical thought. Here's what I think about Wedge's assessment of French parenting and ADHD:  

  1. Surely, not ALL French parents raise their kids exactly the same way.
  2. Teaching children "self-control early" is not a simple matter, nor is it fail proof.
  3. Someone needs to send me and my family to France for a year to see if this French parenting method is for realz.
  4. ALL parents struggle with disciplining their children, regardless of whether the children have attention issues.  It's normal.
  5. Quit stereotyping American families as being ruled by their children.
  6. French children have ADHD.
  7. Perhaps if French psychologists addressed ADHD, children wouldn't need so much psychotherapy.  Sounds like a racket to me.
  8. American and French psychologists and psychiatrists are using similar treatments: behavioral therapy.  Sometimes this isn't enough.  Sometimes medication really helps.
  9. Why the heck do the French think that ADHD is not a neurological condition?  How many scans and studies do they need to prove it?
I like France and think that the French have many progressive ideas about medicine and wellbeing, but their refusal to treat or even recognize ADHD as a wiring issue in the frontal cortex of the brain that controls attention - makes me steaming mad!!

But hey, I let my kids run amok without self-control because I'm an American mom.  What do I know?

If you have read Druckerman's book, I'd LOVE to know your thoughts on French parenting and ADHD.