Wednesday, November 13, 2013

Comparing ADHD in America and France

Is ADHD over diagnosed in American children? An American psychiatrist compared the two cultures of child-raising in Psychology Today. She wrote:

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....

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....

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. (Author's note: I am not personally in favor of spanking children).... Rest of essay

What she says is true. One can spot the American kids just by their behavior in France. Its common to see a French mother chastising her child in the middle of the sidewalk with nary a look from anyone, much less a call to DHS.

23 comments:

Anonymous said...

Why hello there, John Rosamond!

Anonymous said...

Interesting. This is one thing France has 'got right'.

Anonymous said...

If you will click on the "read the rest of the essay" you will see there are responses to the article. While I'm not advocating either position I do like to be presented both sides of the argument.

Pugnacious said...

And French youth do not enegage in head-butting contact sporting events.

The Mennonites must know something about child rearing without drugs. As a side note, though, I remember when the first Mennonites moved into Noxubee county. They "ministered" to the Choctaw orphans, raising them in their own home and teaching them in their home schools, until the USBoIA busted them for applying the biblical punishment of not "sparing the rod to spoil the child." No more Choctaws for the Mennonites!

Anonymous said...

The French style of treatment would be much more expensive in America. We give kids meds because meds are cheaper (and require less effort all around).

France has single-payer, so it's not a financial burden on a family to get therapy and counseling.

Anonymous said...

I definitely think we should give kids more structure. Kids that grow up doing their own thing while mama and daddy constantly defend them, often times get in trouble, have problems holding jobs (because they can't take orders from a supervisor), etc. Kids have to learn structure, consequences of good and bad actions, etc. They have to learn that real life is often good and often bad. In the US, we have too many kids on Ritalin and too many adults on Prozac. It is crazy. Then you have Montessori schools where kids can do what they want. As if a 3-year old is mature enough to decide when to take a nap.

Sorry Marilyn, It is still Hayward State said...

Having travelled Europe extensively for nearly 40 years I've run into plenty of misbehaved children both with, and without, behavior rigorous parents in tow.

While your anecdote is ever so vaguely supportive of the point you're trying to drive home, yet again, the French mother correcting her child in public and not giving a damn who observes remains nothing but a wholly unrelated anecdote. The French mother story doesn't rise to the level of even being correlational.

The premise that the non-MD Wedge presents via the journalist Druckerman that "French parents have a different philosophy of discipline" is merely opinion.

Wedge holds out the French as an example --

Wedge: 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.

-- but altogether avoids the conflict that they [the French] endorse corporal punishment, er, "judicious spanking" while she [Wedge] does not.

Let me know when you see Wedge write about any clinical studies that address the impact of French usage of corporal punishment as a factor in achieving self-control in children. Sounds like the result is positive but I highly doubt Wedge will write about the practice.

Anonymous said...

Is 'Sorry Marilyn' attempting to draw a correlation between corporal punishment and well-behaved children? None can be drawn. The primary problem with so called ADHD children is not that they 'misbehave', but that they cannot 'stay on task' or have no desire to. That's not behavioral, in the opinions of most clinicians, but psychological.

Anonymous said...

There are alot of problems when it comes to rasing children these days. Parenst are the number one problem. Just one example, a friend of mine would let their little children stay up till past 11pm alot of times. I asked them why they were up so late? Their answer was that they just wouldnt go to bed. I asked them what time they went to bed at that age? They said around 7pm. I asked how did your parents get you in bed at that time? Their answer was they made them. So I asked, whats your problem? Not all my friends are this way but many are. No structure in the home. Fast food every night. Rules not enforced if any given. Alowing their kids to skip school for any reason. Its not like how i grew up.

Sorry Marilyn, It is still Hayward State said...

Drawing a correlation? Absolutely not.

But in this exaltation of the French by JJ via a psychologist via a journalist -- in order to grind an axe -- the fact that the French practice corporal punishment (in their overall efforts to produce these wonderfully superior self-controlled children) demands that corporal punishment aka French "judicious spanking" must part of the discussion. If corporal punishment is some part of the French approach it can't be avoided.

As for Wedge she did everything possible to avoid the point but must have realized she'd be intellectually dishonest to have not mentioned it at all.

As for your unqualified statement "That's not behavioral, in the opinions of most clinicians, but psychological" there is certainly disagreement in the psychiatric community.

Anonymous said...

I've always thought ADHD is a made up disorder that is a result of lazy parenting.

And we don't know the long term effects of these drugs right? Will be interesting to see how the brain operates at an older age after years of meds effecting its function. Can't be good.

Anonymous said...

"I've always thought ADHD is a made up disorder that is a result of lazy parenting."

Well, I'm glad to see that stupidity in JJ commenters isn't confined to political subjects.

ADHD may be overdiagnosed, but I know plenty of teachers who have no doubt it's real. But by all means, blame someone who's lazy, or black, or preferably both.

Anonymous said...

My daughter is a teacher/school counselor. The counseling association has thousands of tales about these over-diagnosed children who are filled with drugs and pushed onto the school bus. But, their issues are 'attention span' and 'staying on task', not misbehaving or being jerks. Sorry Marilyn is being entirely too puffy, attempting to craft clever sentences to please some lofty audience at Millsaps.

Anonymous said...

How did America survive and thrive all those years without treatment for this ADHD...its shocking!!!

Anonymous said...

French children grow up and make outstanding military warriors that preserve pristine condition of their weapons. The weapons have never been fired because the hyper American children wear out their weapons protecting the Frogs.

Anonymous said...

"How did America survive and thrive all those years without treatment for this ADHD...its shocking!!!"

I know! And without polio vaccine! Penicillin! And other crutches for wimps!

Anonymous said...

3:36
Your racism is shining through. You equate lazy and black with an ease that is breathtaking. Asshole.

Anonymous said...

Adult ADHD is new dx? or maybe kids turned into addict by parents, teachers and pediatricians?

Anonymous said...

4:50; How in hell can you morph a 'discussion' about ADHD into a racial argument?

Anonymous said...

ADHD is as real as depression or anxiety, but all are over diagnosed by a pill seeking quick fix culture.

Anonymous said...



"And we don't know the long term effects of these drugs right? Will be interesting to see how the brain operates at an older age after years of meds effecting its function. Can't be good."
November 13, 2013 at 3:13 PM

Actually, you don't have to wait, to see the effects. Adam Lanza was on ADHD medication, and plenty of other school shooters were.

Anonymous said...

The mayor of Toronto is ADHD.

Anonymous said...

Most of these comments are way off. So called ADHD? Lazy parenting? Apparently you don't have a child with ADHD. I was heart broken and didn't want to accept it. My child isn't disruptive but impulsive. Taking tests for long periods of time was a nightmare. I was angry with the teacher because I thought she was lazy and couldn't handle my first grader. It was awful! Teachers aren't therapists so what do the French do while their children are in school? How do they keep students on task with ADHD? I'm not for medication but it helps. However as far as lazy parenting goes you should know most responsible, caring parents don't medicate their children on weekends or during the summer because we can deal with our children.



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