24 May 2013
ADHD NEARLY ABSENT IN FRANCE
I have a very personal interest in child psychology. For five years in a suburban Philadelphia private residential school, I served as both teacher and counselor for teenagers who had been removed from their families by the courts, for reasons of neglect or physical, emotional, psychological, and/or sexual abuse at home. All my students attending regular therapy sessions, and the majority of them were on psychoactive medications.
I later spent four years as a security officer and de facto counselor at an eastern Tennessee boys' group home, where convicted juvenile felons who'd served their time were placed in a halfway house setting to prepare them for re-entry into society. None of my boys had access to therapy, but some were on meds.
Finally, I am the proud grandparent of a boy who has been diagnosed with ADHD. I recognized the potential significance of his sometimes-manic behavior when he was only two years old, long before he was formally diagnosed. Now 11 years old, he sometimes struggles to control his impulses, especially angry ones. But I'm not entirely convinced that an easy diagnosis and daily medication are the answer.
Family therapist Dr. Marilyn Wedge is an author and columnist who makes the case against labeling and medicating children, and for effective alternatives for treatment. In a recent article in Psychology Today, she compared the differences in diagnosis and treatment between the U.S. and France. Her thoughts bear consideration ~
"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 0.5%. [Why has] the epidemic of ADHD ~ which has become firmly established in the United States ~ almost completely passed over children in France?
"Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question dependds on whether you live in France or in the United States. In the U.S., child psychiatrists consider ADHD to be a biological disorder with biological causes. The preferred treatment is also biological ~ psychostimulant drugs 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.
" .... 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 tends to pathologize much of what is normal childhood behavior.
" .... 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 .... In the U.S., 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 U.S. 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 Bebe .... 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 parents, Druckerman observes, love their children just as much as do 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 .... Finally, French parents believe that hearing the word 'no' rescues children from the 'tyranny of their own desires'.
" .... 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."
Regular readers will recall that I reviewed Druckerman's book a year ago ~ very favorably. At the time, I closed with the following ~
"I was struck by the parallels between Pamela Druckerman's journey as a parent and my own. Even though I didn't have the cultural or parenting resources of Paris, I was similarly committed to finding a gentler, more nurturing alternative to America's obsession with raising boys and girls to fit into gender roles. I hoped that I could make my son's childhood as androgynous as possible, recognizing the overwhelming influence of the surrounding culture and even well-intentioned relatives and friends. The degree to which I succeeded is a story for another time. What's important is that parents (and children, and grandparents) seek out every resource they can find, in order to open up their thinking and question their assumptions. I do wish that this book had been around in 1977, when my son was born, or in 2002, when my grandson was born.
"But it is around now, and I highly recommend it to anyone wishing insight into parenting which produces calm, confident, curious, cheerful, respectful, and motivated children."