from Psych. Today-
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.

Related Articles
Gaslight Stories: The Mania for Monomania
Psychology's Shaky Scientific Foundations. Part 2 of Phenomics—the Phinal Phrontier
Why French Kids Don’t Have ADHD—Part 2
How the Road to Understanding Depression Runs through Bereavement
Sadness Gone Mad
Find a Therapist
Search for a mental health professional near you.
Find Local:
Acupuncturists
Chiropractors
Massage Therapists
Dentists
and more!
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.

The French 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.

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).

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.

Copyright © Marilyn Wedge, Ph.D.


Marilyn Wedge is the author of Pills Are Not for Preschoolers: A Drug-Free Approach for Troubled Kids

Interesting post.

I have a friend who has 2 children. Her daughter does not have ADHD and her son does. She tried everything before she finally put him on medications. Very structured routines, a change in diet (put him on all natural, no added colors, no preservatives, etc.) and there was no change. Both children were raised the same - had the same routine, yet are different.

It is the same with another friend. Both had daughters first and sons second. The second friend did tell me that her son had colic and cried constantly until about 6 months.

Hmmm....wish there was a solid answer but it definitely makes you wonder

If the French way of dealing with ADHD works, then why isn't that the way that everybody adopts as a tried and tested system? The American way obviously doesn't work. So it's time to ditch that method of treatment, in favour of something that works better. Not unless the pharmaceutical companies have greased palms to ensure higher profits for their products? I wouldn't be surprised if that were the case?

Big pharma big profits in America

I don't believe in some of these illnesses anyway, be it kids or adults.

Some are just an excuse to get away with certain behavior.

I know we have plenty of bums in the UK on sickness benefit when there's jack chit wrong with them but they claim to have some sort of illness so they can park their azz's firmly on the gravy train.

I took a family member to the mental health clinic a few times. I was shocked by the number of kids waiting to see their mental health doctor. Some looked no older then 12-14. My family member knew some of them and said they had depression.

How can you be that depressed at that age and most likely on meds?

The number of kids I grew up with in my neighborhood that were treated for ANY mental issue...0.

Something is wrong here.