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?
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
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.
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.
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.
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.
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.
Copyright © Marilyn Wedge, Ph.D.
Marilyn Wedge is the author of Pills Are Not for Preschoolers: A Drug-Free Approach for Troubled Kids