Before I continue, I wish to express gratitude for my friends who challenge me and force me to think more carefully. Now, this author is a Ph.D. writing in Psychology Today, so I expect a higher standard of analysis and precision. But it is perfectly OK for me to make frog jokes.
Why French Kids Don't Have ADHD1. Actually, they do. The article says so.
2.She admits below that the definitions are different in the two countries, making this an invalid comparison from the get go.
How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France?
4. What is the standard for "epidemic?" This seems designed to inflame, not educate. Historical trends would help us to see if there was an epidemic, as well as the realization that definitions and diagnostics change over time.
Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on whether you live in France or in the United States.
5. Yes, because they define them differnetly, as she admits. So, not surprising in the least!
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.
6. Really? Because I found this, which I don't see as conforming to her characterization:
French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes.
7. Per the link above, so do Americans.
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.
8. Hm. One of my friends suggested this article was not anti-science, but anti-Big Pharma. But of course, the author Marilyn Wedge, Ph.D., is a family therapist. No possible motive to push therapy, right? I really dislike reflexive anti-drug thinking, just because "Big Pahrma" does certain things poorly.
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.
9. Once again, the very first thing I got on Google disputes this simplistic characterization.
10. So the basis for comparison is fundamentally different, and make the whole article suspect for that reason alone, as I suggested above.
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.
11. Once again, inflammatory, not helpful, commentary. And a false dichotomy: One can use medication in conjunction with therapy. This begins to read more an more like an attack on the use of drugs per se.
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.
12. And to what extent is that, exactly? And yet more evidence that the comparison of rates is bogus.
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.
13. Once again: The article is premised on the assertion of different rates of ADHD, yet again, we see the comparison is bogus. This is really lazy stuff here. I'll also note here that the rates of ADHD around the USA vary considerably, from about 5 to 15 percent. No attempt is made to discuss why that might be, and it also undercuts the sweeping generalizations she has and will make.
The DSM specifically does not consider underlying causes.
14. From the APA website: " Since the causes of most mental disorders are subject to ongoing scientific inquiry, DSM avoids incorporating competing theories in its diagnostic definitions. This feature has been an important element in the widespread clinical acceptance of DSM, and has allowed a wide scope of research investigation."
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.
15. Again, the APA website: " No information about treatment is included." Jesus, this really IS crap. But there is more!
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.
16. No assertion that the "American approach," which again remains undefined, doesn't do this. But a good insight, I agree.
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.
17. Does it? Bare assertion, unsupported by any citation or evidence.
And then, of course, there are the vastly different philosophies of child-rearing in the United States and France.
18. There is most certainly no such thing as an American philosophy of child-rearing, and I'm not sure there is a single "French" philosophy either. No evidence or citation or proper definition s provided.
These divergent philosophies could account for why French children are generally better-behaved than their American counterparts.
19. If it could account for it, it could also not account for it. So lazy, I'm geting mad now. And the second part, about the relative behavior, is one of those "everyone knows it is true" things, that may or not actually BE true. Again, no definition no evidence, just bare assertion. What does "generally" mean? What is "better-behaved?" Which Americans? Which French kids? This sentence alone tempts me to disregard everything else the good doctor asserts.
And, 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.
20. OK, I'd have to read the book. Except she aleady talked above why the numbers are differnt, and the arguments make no sense!I hope Pamela Druckman is smarter than our good doctor!
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.
21. I have no qualms with the idea that structure is good for kids. I'm not sure what this has to do with ADHD, but sure, structure is nice. And there are plenty of AMERICAN sources espousing this philosophy as well. I know, because I have it, and I am not (thank the baby Jesus) French*.
French parents let their babies "cry it out" if they are not sleeping through the night at the age of four months.
22.The jury is out on whether this is good practice. I find it highly irresponsible of this author to frame this as positive without qualification.
French parents, Druckerman observes, love their children just as much as American parents.
23. Idiotic. Just, idioctic. OF COURSE THEY DO, TWIT.
They give them piano lessons, take them to sports practice, and encourage them to make the most of their talents.
24. See 23 above.
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.
25. Great! What this has to do with ADHD I have no idea.
Finally, French parents believe that hearing the word "no" rescues children from the "tyranny of their own desires."
26. Don't say "finally" and then make addition points. And, perhaps it makes them subject to the tyranny of authoritarianism. Obviously you have to say "no" to your kids. Again, stupid.
And spanking, when used judiciously, is not considered child abuse in France.
27. And bathing is not considered normal*. Who the fuck cares what they define child abuse as. I guess the good doctor doesn't want us to spare the rod?
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.
28. Conclusion not supported by the evidence. This is C+ work in college, and this lady has a Ph.D.?
The children grow up in families in which the rules are well-understood, and a clear family hierarchy is firmly in place.
29. Great. What this has to do with ADHD...
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.
30. AAs you can tell, I love broad assertions unbsupported by evidence that get a pass because "we all know it is true." Horse feathers. And, for what it is worth, the Wall Steet Journal and Huffington Post publish this lady. Two pillars of journalism there.
Copyright © Marilyn Wedge, Ph.D.
*All potshots at the frogs are based on a recent experience with one particularly vile amphibian, and are not meant to be taken at face value.