By: Kalee Brown via collective-evolution.com
According to the Centers for Disease Control and Prevention (CDC), approximately 11% of American children between the ages of 4 and 17 have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) as of 2011. However, if you ask the American Psychiatric Association (APA), they maintain that even though only 5% of American children suffer from the disorder, the diagnosis is actually given to around 15% of American children. This number has been steadily rising, jumping from 7.8% in 2003 to 9.5% in 2007.
Big Pharma has played a significant role in manufacturing the ADHD epidemic in the U.S., convincing parents and doctors that ADHD is a common problem amongst children and one that should be medicated. However, many countries disagree with the American stance on ADHD, so much so that they have entirely different structures for defining, diagnosing, and treating it. For example, the percentage of children in France that have been diagnosed and medicated for ADHD is less than 0.5%. This is largely because French doctors don't consider ADHD a biological disorder with biological causes, but rather a medical condition caused by psycho-social and situational factors.
Why France Defines ADHD Differently
French child psychiatrists use a different system than American psychiatrists to classify emotional problems in childhood. Instead of using the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM), the French use an alternative classification system produced by the French Federation of Psychiatry called Classification Française des Troubles Mentaux de L'Enfant et de L'Adolescent (CFTMEA). Not only does this significantly differ from the APA's system, but it was actually created with the intention to "offer French child psychiatrists an alternative to DSM-III ” because it didn't complement French psychiatric practices. The CFTMEA encourages psychiatrists to identify the underlying issues that cause a child's symptoms and to address them using a psychopathological approach.
France defines ADHD as a sociological disorder that's caused by a set of social situations, whereas the U.S. sees ADHD as a neurological disorder whose symptoms are the result of biological disfunction or a chemical imbalance in the brain. France's definition of ADHD drastically differs from that of the U.S., which is in part because the pharmaceutical industry helped define ADHD in the U.S. (you can read more about that here). France's treatment methods, therefore, also greatly differ from those practiced in the U.S.
Treatment Methods for ADHD Used in France
Once a French psychiatrist diagnoses their patient with ADHD, they hone in on the behavioural problems by searching for the underlying causes. Psychiatrists will study the child's distress and compare it to their social situations. France views ADHD as a social context problem; therefore, ADHD is often treated with psychotherapy or even family counselling. Very rarely do French psychiatrists prescribe medications to treat ADHD, as it's usually rendered unnecessary after taking a more holistic approach.
It's important to note that French psychiatrists also consider a patient's diet when searching for the causes of behavioural symptoms associated with ADHD. Poor eating habits such as consuming foods with artificial colours or flavourings, preservatives, sugars, and/or allergens may worsen a child's behaviour. This isn't difficult to imagine; even as adults we can feel the effects certain foods have on our mood, energy levels, and thought processes.
Why There Are Fewer ADHD Cases in France Than the U.S.
A study conducted in 2011 stated that the amount of youth in France with ADHD may be as low as 3.5% a far cry from the 11 to 15% estimate in the United States. Family therapist and author of A Disease Called Childhood: Why ADHD Became an American Epidemic Dr. Marilyn Wedge suggests that this may be as a result of the cultural differences between the U.S. and France in regards to raising children. According to Wedge, French parents will often impose more structured lifestyles onto their children, such as enforcing strict meal times and using the "cry it out” method with babies and toddlers. Children are taught self-discipline at a young age, which is why Wedge feels they don't need to be medicated for behavioural issues.
Unfortunately, spanking is not considered child abuse in France, so this practice is used fairly often to encourage discipline. In March 2015, the Council of Europe, an international human rights organization, faulted France over the country's lack of legislation regarding corporal punishment of children. As The New York Times explained, "Child abuse is illegal in France and is punished with long prison sentences, but it is not uncommon for French parents to slap or spank children, or for the French courts to view such actions as acceptable under a customary 'right to discipline.' "
As Dr. Wedge points out (although neither she nor Collective Evolution support spanking or any other form of child abuse), this simply adds to the discipline they're encouraged to practice throughout their childhood (source).While Wedge makes some interesting points regarding discipline, I don't think that's the underlying reason why most French children don't need to be medicated for ADHD. Rather, because ADHD is largely a behavioural issue, it rarely requires pharmacological intervention. I believe that these treatment methods are successful in France not because of their parenting culture, but rather as a result of their holistic approach in considering diet and behavioural and social context.
I believe France does not have an issue with over-diagnosing ADHD in the same way the U.S. does because pharmaceutical companies have not targeted them as heavily. Pharmaceutical companies play a substantial role in defining ADHD and deciding treatment methods in the U.S. For example, doctors and researchers in the U.S. have been paid to overstate the dangers of ADHD and the benefits of taking their drugs and understate the negative side effects.
It's easy for people to believe this misguided information when it's affiliated with well-known universities like Harvard and Johns Hopkins. Many people don't even realize that these studies are funded by the very companies that profit from the drugs' sale because that relationship is hidden in small print (source). These drugs can have significant side effects and are actually considered to be within the same class as morphine and oxycodone due to their high risk of abuse and addiction. You can't just blame all doctors, either; many of them genuinely believe they're helping these children because of the information they've been given in these studies and by Big Pharma.
Another reason the U.S. has substantially higher rates of ADHD amongst children than France is because of the ADHD drug advertisements that run in the U.S. Big Pharma creates ads for ADHD drugs sold in the U.S. that are specifically targeted at parents, describing how these drugs can improve test scores and behaviour at home, among other false claims.
One of the most controversial ones was a 2009 ad for Intuniv, Shire's A.D.H.D. treatment, which included a child in a monster costume taking off his terrifying mask to reveal his calm, smiling self with a text reading, "There's a great kid in there.” The FDA has stepped in multiple times, sending pharmaceutical companies warning letters or even forcing them to take down their ads because they are false, misleading, and/or exaggerate the effects of their drugs (source). This type of propaganda doesn't take place in France, at least not on the same scale as the in U.S., largely because it doesn't coincide with their ADHD diagnosis framework. You can read more about this topic in another article I wrote here.
How to Use This Information to More Effectively Treat ADHD
France's CFTMEA, definition for ADHD, and holistic approach to treating this disorder provide an excellent example of how we should be addressing ADHD patients, especially children. Instead of getting to the root of these children's "attention deficits” like French psychiatrists do, American health practitioners typically assume ADHD is a medical condition that can only be fixed with medication. This is not only unethical, but also clearly damaging to a child's self esteem. Many of these kids could simply be uninterested in the subject matter, suffering from some sort of emotional trauma, or even have heightened creativity and energy! You can't just blame all doctors in the U.S., either; many of them genuinely believe they're helping these children because of the information they've been given in these studies and by Big Pharma.
However, many scientists in the U.S. have suggested alternatives to medicine to treat ADHD and many of them don't even recognize ADHD as a disorder (read our article on why ADHD may not be real here). Associate Clinical Professor of Psychiatry at Tufts University School of Medicine and Editor-in-Chief of The Carlat Psychiatry Report Daniel J. Carlat, M.D, criticized the DSM, stating, "In psychiatry, many diseases are treated equally well with medication or therapy, but the guidelines tend to be biased toward medication.”
Holistic Mental Health Practitioner Dr. Tyler Woods further explains:
The DSM tends to pathologize normal behaviors. For instance, the label "Anxiety Disorder” can be given as a result of some kinds of normal and rather healthy anxieties but the DSM will have experts view it and treat it as mental illness. In addition simple shyness can be seen and treated as "Social Phobia”, while spirited and strong willed children as "Oppositional Disorder”. Consequently, many psychotherapists, regardless of their theoretical orientations, tend to follow the DSM as instructed. (source)
Neurologist Richard Saul spent his career examining patients who struggle with short attention spans and difficulty focusing. His extensive experience has led him to believe that ADHD isn't actually a disorder, but rather an umbrella of symptoms that shouldn't be considered a disease. Thus, Saul believes it shouldn't be listed as a separate disorder in the American Psychiatric Association's Diagnostic & Statistical Manual. You can read more about his opinion in our article here.
Leading integrative pediatrician and author of ADHD without Drugs: A Guide to the Natural Care of Children with ADHD Dr. Sanford Newmark, M.D. has spent more than 15 years studying and successfully treating ADHD naturally. Some of his recommendations include improved nutrition, increased sleep, iron, zinc, and Omega-3 supplementation, family counselling, making positive social and behavioural changes, and pursing alternative modalities such as Traditional Chinese Medicine and Homeopathy. Dr. Newmark considers conventional medication a "last resort,” given the fact that ADHD drugs only work about 70% of the time and have potential negative side effects (source).
It is clear that many doctors are starting to recognize the importance of treating ADHD outside conventional methods. Misdiagnosis and over-diagnosis of ADHD is a serious issue in the U.S., one that is heavily fuelled by the pharmaceutical industry. If you or a loved one has been diagnosed with ADHD, I strongly suggest you research this subject more and explore alternatives to medication with the help of a healthcare practitioner!
"The very vocabulary of psychiatry is now defined at all levels by the pharmaceutical industry.”
- Dr. Irwin Savodnik, Assistant Clinical Professor of Psychiatry at the University of California in Los Angeles (source)