Why Do French Children Never Get ADHD?

In the United States a staggering 9% of children are diagnosed with ADHD and take pharmaceutical medication, often a type of amphetamine such as Aderall. In France however, the ‘disease’ is virtually unheard of.

The 0.5% of children who do get diagnosed with an ADHD-like condition in France are treated as having a psycho-social disorder, rather than biological (as is common in the U.S.). And its this holistic approach that makes French children free of the ADHD epidemic prevalent in the U.S.

French Psychiatrists focus on fixing the underlying issue that is causing the child to suffer by looking at the child’s social context. Treatment often involves dealing with an underlying social problem and/or psychotherapy or family counseling.

Psychologytoday.com reports:

French child psychiatrists don’t use the same system of classification of childhoodemotional problems as American psychiatrists. They do not use the Diagnostic and Statistical Manual of Mental Disorders or DSM.

According to Sociologist Manuel Vallee,the French Federation of Psychiatry developed an alternative classification system as a resistance to the influence of the DSM-3.

This alternative was the CFTMEA (Classification Française des Troubles Mentaux de L’Enfant et de L’Adolescent), first released in 1983, and updated in 1988 and 2000. 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.

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, in my view, tends to “pathologize” much of what is normal childhood behavior. The DSM specifically does not consider underlying causes. 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.

The French holistic, psychosocial 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. 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 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 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 U.S.

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. French parents let their babies “cry it out” (for no more than a few minutes of course) if they are not sleeping through the night at the age of four months.

French parents, Druckerman observes, love their children just as much as 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—something that is congruent with my own experience as both a therapist and a parent. Finally, French parents believe that hearing the word “no” rescues children from the “tyranny of their own desires.” And spanking, when used judiciously, is not considered child abuse in France. (Author’s note: I am not personally in favor of spanking children).

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. 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.

  • Yeah, really!

    Of course. To have American style conditions, you need American doctors ordained by the AMA and empowered by big pharama to diagnose nonsensical disease, conditions, disorders and syndroms. The Friench haven’t gone down that path — at least not as deeply, and don’t label normal behavior as abnormal.

    The drug companies we always about sales and marketing — not treating and curing disease. Marketing 101: define a problem, provide a solution, make big money with your exlcusive solution, repeat.

  • Shannon Brault

    French kids get ADHD, it’s just not diagnosed. They treat the symptoms and pretend the condition doesn’t exist. Except behavioural modification only goes so far. There are other aspects to ADHD that behavioural modification can’t treat.

  • Elise Elyz

    French kids do have ADHD. But they don’t get helped. They or/and their parents get blamed and that’s about it.

  • Kendra Grant

    I remember presenting in France a few years ago (2008) to a group of parents who had children with learning disabilities. At the time most educators, psychologist, doctors, etc. were focused on the “why” of the problem rather than on how to support learners. Parents were very frustrated as they knew their children were struggling and suffering but until the “why” was answered no-one seemed to want to address the problem. I’d be surprised if the numbers are as low as claimed. Providing a “structure” or “frame” can help but the brain difference of people with ADHD aren’t going to be solved simply through structure. Ask anyone with adult ADHD. As a parent and teacher of a child with ADHD I was the queen of structure. Again this helped but it didn’t take the disability away.