ADHD (attention deficit hyperactivity disorder) is a hot topic for medical professionals, teachers, parents, and anyone else who cares for children.
It seems to be a 21st-century epidemic, with thousands of American children diagnosed every year.
Increasingly, professionals and laypeople alike are starting to question why ADHD appears to be so common in the US.
Is it because doctors are too quick to diagnose children with the condition, have they simply become more proficient at identifying it, or is there another explanation?
How many French children have ADHD?
In trying to answer this question, we can look at the prevalence of ADHD in other countries. Take France as an example.
In the US, roughly 9% of children are taking medication for ADHD. However, in France, fewer than 0.5% have been diagnosed. This gap provides an intriguing opportunity to examine issues around ADHD definition and diagnosis.
What could explain the difference?
One possible explanation is that US medical and education systems assume that ADHD is a biological problem, and that the best solution is to treat it with medication.
Specifically, children are usually prescribed Ritalin, Adderall, or a similar drug that supposedly helps regulate chemical imbalances in the brain.
On the other hand, French medical professionals prefer to take a holistic view of a child’s situation. They believe that evaluating behavioral and emotional problems is more constructive than giving a child drugs.
How does parenting style, lifestyle, and the medical system affect diagnosis and treatment of ADHD?
Parenting style: As a general rule, French parents employ a stricter parenting style compared with Americans. They are more likely to impose regular schedules, to emphasize the importance of self-control, and to say “No” when doing so is in a child’s best interests.
This approach teaches children how to obey rules and regulate their impulses. It can be argued that this makes them less likely to develop ADHD-type symptoms.
Diet: Although American doctors are aware that a poor diet can encourage restless or otherwise undesirable behavior, they place less emphasis on nutritional intervention than French health professionals.
In France, doctors are more likely to work with parents to devise a nutritious diet that minimizes foods known or suspected to cause ADHD-type symptoms, such as food colorings, refined sugar, and caffeine.
System of diagnosis
In the US, medical professionals use the Diagnostic and Statistical Manual of Mental Disorders (known as “the DSM”) to diagnose mental illnesses and developmental disorders, including ADHD. The DSM underpins psychiatry in the US, and emphasizes biological and genetic causes of ADHD.
French doctors use the Classification Française des Troubles Mentaux de L’Enfant et de L’Adolescent (CFTMEA) instead. The CFTMEA takes a different approach. It was written by French health professionals who were dissatisfied with the DSM. They thought it overlooked the role of social factors and the environment.
The CFTMEA encourages doctors to tackle the underlying causes of troublesome symptoms, rather than labeling them and prescribing medication. In both France and the US, doctors look for signs of hyperactivity, impulsivity, and inattention when assessing a child for ADHD.
However, French doctors are slower to make a formal diagnosis, preferring to try drugfree interventions first. They do diagnose a small percentage of children, but for the most part, they believe that ADHD symptoms can be treated with lifestyle interventions.
What do these figures mean for children with ADHD?
French and American doctors agree that ADHD exists, and that an ADHD diagnosis is helpful for some children. However, it seems likely that many American children are improperly diagnosed. This is a controversial issue in the medical community, with researchers still uncertain whether the condition is over or under-diagnosed.
At the same time, it seems likely that the so-called ADHD epidemic is caused, at least in part, by a tendency to overlook everyday lifestyle factors. The American Pediatric Association advises that behavioral therapy plays an important role in the management of ADHD, and that drugs should not be relied upon as the sole source of treatment.
If you have ADHD, or have a child diagnosed with the condition, find a doctor who is willing to discuss the condition in both a biological and environmental context.
Ask him or her to explain how they understand ADHD, what treatment they recommend, and why.
A caring medical professional will be happy to discuss all your options and answer any questions you may have.
If you are taking medication and would rather try a different approach to managing your symptoms, remember that you must consult a doctor before reducing your dose or stopping altogether.