Thursday, January 7, 2016

Why French Kids Don't Have ADHD, or, Vive La Resistance

For a number of years, I've been interested in, and concerned by, the phenomena of ADHD. In our country, we are very quick to diagnose and medicate. The virtual absence of this "disorder" in many other cultures and in previous generations is a thing worth pondering. It would do us good to chasten our tendency to view our cultural location and moment as the wisest and most progressive. But who am I to say?

A little while back, the title "Why French Kids Don't Have ADHD" caught my eye. I was even more interested to find it was written by an experienced family therapist and posted on I'm guessing "psychologytoday" is not the Johns Hopkins of the psychology/psychiatry guild, but still -- when an "expert" from within voices a challenge, it's worth taking note. I say, may her tribe increase (though she's certainly not alone, as this challenge to typical ADHD diagnostic practice shows).

Here are some excerpts from this helpful post by Marilyn Wedge (my emphasis added).
In the United States, at least 9 percent 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 percent. How has the epidemic of ADHD—firmly established in the U.S.—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 U.S. 
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. ...
Moreover, the definition of ADHD [in France] 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. ... 
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. ... 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.

Not surprisingly, her article received some push back. She responded with part 2, where she takes her kid-gloves off and swings a little harder. If you have any attention span left (poor pun intended) for this overly-long post, here you go:
... 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 the Diagnostic 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. 
...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 ... 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
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... 
Recently, I discovered another interesting fact that might throw even more light on why French children have not been plagued by the ADHD epidemic in anything like the numbers of [A]merican children afflicted by it. French children are not exposed to TV screens nearly as much as children in the United States because they are protected from it. The French government has actually banned French television programs designed for children under three-years-old. ... based on a ruling by the French High Audiovisual Council: “Television viewing hurts the development of children under 3 years old and poses a certain number of risks, encouraging passivity, slow language acquisition, over-excitability, troubles with sleep and concentration, as well as dependence on screens.” 
As mental health professionals seeking clarity in our thinking and ever new ways to help our clients, we must be aware of ourselves as living and working within a cultural context. Stepping outside of our own context to see how other cultures construct human problems helps us become more aware of what is natural and what is cultural.

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