(Evangelyn Rodriguez) Attention deficit hyperactivity disorder, known simply as ADHD, is characterized by difficulty paying attention and controlling compulsive behavior. In the U.S., ADHD is commonly diagnosed in children and is managed using medications. According to the Centers for Disease Control and Prevention, about 9.4 percent of American children ages two to 17 have ADHD — that means about 6.1 million children are being treated with drugs like stimulants and antidepressants. On the other hand, in France where ADHD is classified differently, clinicians are finding success in managing childhood symptoms through a holistic approach. Compared with the U.S., less than 0.5 percent of children in France are diagnosed with the disorder. So why the difference?
The psychosocial approach versus the pharmaceutical approach
Clinical psychiatrists in the U.S. consider ADHD a biological disorder with biological causes, so the preferred treatment is with psychostimulants. In France, however, instead of classifying ADHD as a biological dysfunction and pathologizing what is normal childhood behavior, clinicians choose to address the underlying causes of a child’s distress — not in the brain but in a social context. Hence their preferred methods of treatment are psychotherapy and family counseling.
American psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to classify childhood emotional problems, while French psychiatrists use their own system called The French Classification for Child and Adolescent Mental Disorders (abbreviated CFTMEA in French). CFTMEA focuses primarily on psychosocial causes of children’s symptoms, but DSM disregards these causes and encourages medical treatment. This leads American clinicians to give the ADHD diagnosis in a large number of cases and prescribe pharmaceutical interventions.
Aside from considering contributory factors in the environment of symptomatic children, the French holistic approach also allows clinicians to look at nutritional causes. In particular, foods that contain artificial coloring, certain preservatives, and allergens can cause ADHD-type symptoms in children. Fully aware that dietary interventions can sometimes help resolve a child’s behavioral problems, French clinicians prefer working not only with the children, but also with their parents. This minimizes the diagnosis of ADHD in French children.
Enforcing discipline can get rid of the need for medications
French children are generally better-behaved than American children, and the vastly different parenting philosophies in the U.S. and in France could account for this. French parents believe in setting rules and restrictions, and they implement them from the time their children are born. They are also stricter than American parents, especially when it comes to food. For instance, French parents don’t allow their children to eat snacks whenever they want. Instead, they teach them to wait patiently for meals and limit their mealtimes to only four specific times of the day.
According to Pamela Druckerman, an American journalist and author of the book Bringing up Bébé, French parents believe that discipline in the form of consistently enforced limits make children feel safe and secure. They also believe that these limits make a child feel happier. By saying “no” to their children and enforcing proper discipline, French parents are able to teach their children self-control. Children who learn self-control early in life don’t need medications to control their behavior. This may be another reason why a holistic approach works well on French children and why ADHD diagnosis is very scarce in France.
Some facts about ADHD
ADHD is not a disorder that’s exclusive to children. Some people manifest symptoms in their childhood that continue through adolescence and adulthood. While hyperactivity often improves as a child grows up, trouble with focusing and organizing and poor impulse control are retained.
According to the National Institute of Mental Health (NIMH), ADHD can be caused by a variety of factors:
- Smoking, alcohol use, and drug use during pregnancy
- Exposure to toxic metals like lead
- Low birth weight
- Brain injuries
To help children with ADHD and their families, mental health professionals can educate parents so they can relate to their children. Undergoing parenting skills training, learning stress management techniques, and joining a support group can also be helpful not only to patients, but also to their families, and allow them to cope with everyday problems better.