Why French Kids Don’t Have ADHD

“French children don’t need medications to control their behavior.”

Marilyn Wedge, PhD, Psychology Today

March 8, 2012

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 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, psycho-social 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 disciplinine. 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.

Follow Marilyn Wedge

Website:  MarilynWedgephd.com

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About Pat Donworth, D.Min.

I express myself as teacher, writer, and consciousness explorer. These driving interests have manifested in my work/service as a university and hospital chaplain; a book and magazine writer/editor, and teacher and workshop leader. I designed this blog to be a portal that points to and assists awakening souls to implement, and make practical, the changes that will usher in a new world based on unity, compassion, and collaboration.
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2 Responses to Why French Kids Don’t Have ADHD

  1. mike0v says:

    This is an interesting post, but I could debate Dr. Wedge all day long on the topic of ADHD. Her article is informing, but not in any way the final word on ADHD or how to treat the disorder.
    How do I know?
    I have ADHD. My father, both of my brothers and my son have ADHD.
    I was married for twelve years to a beautiful woman who succumbed to clinical depression and schizophrenia. Our relationship couldn’t survive, so we divorced.
    I attended NAMI meetings every month for years. I took their twelve week class “Family to Family.” I contribute regularly to NAMI. I’ve met with over 10 psychiatrists in my life in an effort to help my ex-wife while we were married.
    Ever see a loved one have a psychotic break? I have.
    I outlined a book, but never got around to writing it, about life with a spouse who is seriously ill.
    I’ve read many books on mental illness. The best ones, for me, have been by Anne Sheffield. I’ll never forget her advice, “you must become an amateur expert in order to help your loved ones.”
    And so I became one.
    Dr. Wedge’s views are simplistic and seem like an attempt to blame American society for this disorder. She holds up the French family rearing paradigm as one to be followed if you don’t want your child to behave improperly. I disagree completely.
    She says that French psychiatrists view this disorder differently than American docs, which is true, but any professional in the mental health business will tell you that the DSM is flawed and most psychiatrists must use their own experience and compassion when treating patients. Every psychiatrist in the world has a different viewpoint on brain disorders. I think Dr. Wedge should make that distinction.
    Eleven paragraphs detailing what is right with French culture and how it helps to stave off ADHD doesn’t come close to any complete understanding of this disorder.
    In my opinion, ALL mental health practitioners should be required to live with a person that is seriously ill for one year before they become qualified to treat patients.
    I did it for twelve.

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