Why French Kids Don’t Have ADHD: French children don’t need medications to control their behavior.
October 1, 2012
ADHD, it’s diagnosis and treatment protocols are contentious issues. SC&A will present varying opinions on the matter in the following days.
Why French Kids Don’t Have ADHD—Part 1
In the United States, 5% 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 DSMspecifically 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….More from part one.ADHD is a cultural construction.
I appreciate Dr. Sarkis having the interest to respond to my article Why French Kids Don’t Have ADHD. The main point of my article was that there is no scientific evidence that ADHD is a real biological disorder. Medical scientists have not isolated a biological cause for ADHD, nor is there a laboratory test for it. ADHD is a social construction by a committee of psychiatrists who author theDiagnostic and Statistical Manual of Mental Disorders (DSM). Many of the authors of the DSM-4(56% to be exact) have financial ties to pharmaceutical companies who stand to profit greatly from medicating children.
In a previous construction of the DSM, the DSM-3, the authors constructed ADD as a disorder, but in the DSM-4 ADD no longer exists. It is certainly possible that ADHD will similarly disappear from future editions of the manual. I think it is important to realize that the DSM is an artifact of culture, and that not all cultures construct human problems and suffering in the same way.
As I point out in another Psychology Today blog, ADHD: The Emperor’s New Diagnosis,”…the moniker ADHD merely describes a cluster of externally observed symptoms: the child often fidgets, makes careless mistakes in schoolwork, often loses his pencils, has difficulty waiting his turn, blurts out answers in class, and so forth. This is like defining diabetes as excessive urination, frequent thirst, lack of energy, and having sweet-smelling urine. Of course doctors do not define diabetes by these observable symptoms because diabetes has a well understood biological cause. Diabetes is a metabolic disorder of the pancreas being unable to produce sufficient insulin. But ADHD…[is] defined only by externally observable symptoms.”
Dr. Sarkis and other readers may also be interested in my article, “Does ADHD Exist: A Reflection on Humberto Maturana” which appears on September 25, 2012 as a guest post on the blog of David Allen, M.D., Professor of Psychiatry at the University of Tennessee Health Science Center and author of three respected books on psychiatry.
In my own work as a family therapist for twenty three years, I find that searching out the underlying cause of a child’s distractibility, inattentiveness, fidgetiness, etc. in the child’s social context (family, school and friends) is a safer and more effective way to help the child get over his problems than by dosing him with amphetamine drugs like Ritalin. As French psychiatrists found before me, diagnosing the child with ADHD does not help at all if one’s goal is to solve the child’s problem rather than mask his symptoms with potentially harmful drugs.
Many parents are beginning to cotton on to the situation as well. As Bronwen Hruska explains, in her New York Times article of August 18, 2012, “Raising the Ritalin Generation”, the cause for a child’s antsy, disruptive behavior in the classroom may well be due to a social context factor like having a teacher who “doesn’t know what to do with boys.” Hruska also describes her shock when she read about the possible side effects of a medication her doctor said was safe for her son’s ADHD-like symptoms…