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Vincent Iannelli, M.D.

Why French Kids Don't Have ADHD? - Actually, They Do

By March 12, 2012

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Supposedly, kids in France don't have ADHD.

At least that is what a blogger on Psychology Today writes.

It sounds reasonable, at least on the surface. After all, didn't that book just come out about how much better the French are at parenting than we are?

Also, since ADHD is almost certainly partly genetic, couldn't they just be missing the 'ADHD genes" that seem so common in the United States?

What's most interesting about the article though, is that it seems hard to disprove. After all, how many of us know all that much about ADHD in outside the United States?

Fortunately, it isn't too hard to find out.

One report by Samuele Cortese, MD, "Delay of Attention-deficit-Hyperactivity Disorder Diagnosis in France - Reasons and Resolutions," which appeared in European Psychiatric Review, states that there are "similar rates of ADHD in North America and Europe."

The report also states that:

  • in France, the mean delay between a child's first appointment for impairing ADHD symptoms and a diagnosis of ADHD was 2.8 years
  • "psychodynamic and sociological approaches to behavioural disorders" can "promote critical attitudes towards diagnostic criteria, biological underpinnings of behaviour and medications"
  • there is a reluctance for parents to seek help and for doctors to diagnosis ADHD because of the public perception of ADHD in France
  • the initial prescription for a stimulant must be made in a hospital setting

Another article, "Predictors of diagnostic delay in a clinical sample of French children with attention-deficit/hyperactivity disorder," which appeared in European Child & Adolescent Psychiatry, also found that "diagnosis of ADHD in France is among the longest reported" and is likely accounted for by "local attitude towards ADHD and the paucity of specialized centres for the diagnosis and the treatment of ADHD," including that ADHD symptoms are often seen as a consequence of being depressed or having anxiety.

And in the article, "Prevalence of Attention Deficit Hyperactivity Disorder and Associated Features Among Children in France," the authors found that "the epidemiology of ADHD in French children is similar to the epidemiology of ADHD in other countries." The article appeared in the Journal of Attention Disorders just last year.

Most importantly, the problem with the Psychology Today article and with the underdiagnosis of children with ADHD in France is that there are negative consequences to having untreated ADHD. If your child has ADHD symptoms that are causing him or her an impairment, get him evaluated for ADHD and talk to your pediatrician about your treatment options.

Related:
What French Parents Do That Americans Don't
ADHD Symptoms
History of ADHD
Understanding ADHD

Comments
March 13, 2012 at 12:01 pm
(1) john glennon says:

Dr. Iannelli missed the point of the article: while ADHD symptoms do exist in the EU, they are addressed quite differently than in the US. In the US, we label these people as suffering from mental illness. ADHD is diagnosed typically through rating scales like the Conners or Vanderbilt all of which are subjective. Once the diagnosis has been made, the symptoms are treated with medication.

In the EU, they look for the underlying cause first. Could there be something that’s causing these symptoms? A divorce? Trouble in the family? Reading disability? They then see if changes to environment and parent training might mitigate the symptoms which often works. If behavioral and cognitive interventions don’t work, medicine becomes the last resort.

While ADHD may have a genetic component, that may account for only a minority of children diagnosed. We’ll never know because we treat them all the same way. The Europeans are on to something here; address the underlying causes first. Our health care system is broken, but we continue to think it’s the best in the world. It’s not.

March 13, 2012 at 1:34 pm
(2) Vincent Iannelli, MD says:

“while ADHD symptoms do exist in the EU, they are addressed quite differently than in the US.”

From the experts in France that I have spoken to, that is certainly true. It seems like ADHD symptoms, for the most part, are ignored. ADHD is underdiagnosed and they have a reluctance to prescribe stimulants.

I don’t see how that translates into a system that works better.

You seem to be assuming that since they aren’t being diagnosed with ADHD, then they are being diagnosed and treated with something else and doing better. I don’t see any evidence of that though.

March 22, 2012 at 8:34 pm
(3) Liz Ditz says:

Marilyn Wedge’s article has been published at HuffPo, UGH.

http://www.huffingtonpost.com/marilyn-wedge-phd/adhd_b_1310973.html

But I found a French ADHD group:

HyperSupers TDAH France
The association came to life through an internet discussion. Parents of children with ADHD who were looking for the proper diagnosis tried to benefit from their educational competence and come out of their social isolation. It became obvious that parents had to wade through endless medical examinations prior to obtaining the proper diagnosis. Our young people had already reached their teens, other parents were struggling with social services who were threatening to put their children in foster homes, since they were convinced that their parents had poor parental skills, due to inaccurate diagnosis or refusal to consider this disorder.

Faced with the lack of recognition of the French institutions, five of us were motivated to create a support system to try to ease the suffering of children and their families. We saw that our close European neighbors were better equipped than the French families to face this disorder. The French ADHD association was created to support families and to try to prevent a long and chaotic medical process, in the hope that an early diagnosis can improve the future for these children both in their academic as well as in their social and professional life, in their teenage and adult life. This would also help to reduce the social cost of ADHD in France (for example early school drop-outs, drugs, alcoholism, suicide

July 15, 2012 at 9:29 am
(4) Tim Even says:

Re: ” In the EU, they look for the underlying cause first. Could there be something thats causing these symptoms? A divorce? Trouble in the family? Reading disability? They then see if changes to environment and parent training might mitigate the symptoms which often works. If behavioral and cognitive interventions dont work, medicine becomes the last resort”.

What, then, is the “underlying cause”? Well , it seems to me that genetic and environmental conditions are intertwined in such a way that it is difficult to tease them apart and that an either or approach does a dis-service to those who have the condition. I’m afraid that in the US that children are often medicated without regard to environmental factors. To wit I’ve encountered a child who was disrupting his fourth grade class because he was off his medication. After talking to him I came away that he enjoyed the side effects of his meds enough to have sparked his behavior. At another time I encountered a child clinging desperately to a pole at the front of a bus while apparently ignoring his mothers pleas to get him to his seat. The explanation? His first dose.

May 18, 2013 at 3:00 am
(5) Tom Phillpotts says:

How about diet? The American diet is possibly the most unhealthy in the world.

June 7, 2013 at 12:34 am
(6) Paul says:

Using ADHD medications is a Band-Aid on the problem. Doctors in the US are too interested in medicating a problem or treating symptoms without adequate investigation into causes and cures. The drug companies push this mindset.

Information has come to light to indicate that chemical food additives (artificial colors, etc) can cause negative behavioral reactions in children. Dietary changes can correct this. I have seen this work in my own experiences with children. Reducing the amount of sweets (even natural sugars in juices) that American parents give their kids would help. Diet plays a huge role in this. You are what you eat. We’ve turned into a society that eats less ‘food’ and more heavily chemical-laden ‘food-like items’. Also probiotics. With the heavy use of antibiotics in treating illness, probiotics are a must for children. An unhealthy gut DOES affect behavior. Less TV and more parental interaction would help (this may take a socio-economic change that would actually allow for a stay-home parent instead of nearly forcing both to work). In the cases of troubles at home or poor parenting skills (**gasp** the devil you say), training may indeed help. There is merit to judicial and appropriate spanking as well. Many of these things could go a long way toward preventing “ADHD”-like symptoms or reversing them without a need for a cocaine-like stimulant or other drugs. These things should be tried before doping up a child.

June 12, 2013 at 8:28 am
(7) Vincent Iannelli, MD says:

“Many of these things could go a long way toward preventing “ADHD”-like symptoms or reversing them without a need for a cocaine-like stimulant or other drugs. These things should be tried before doping up a child.”

“ADHD”-like symptoms is not the same thing as a formal diagnosis of ADHD. And please post the peer-reviewed studies that show that all or any of these methods work.

August 2, 2013 at 4:27 pm
(8) Chadwick says:

I have first hand experance of ADHD treatment in France. And yes they do medicate. They might do more testing first ( this was not my experance at all) but they do medicate. And from some one how has ADHD I can tell you I am very greatful they do. Don’t get me wrong you should not be putting a five year old on Ritalin. But having tried every diet and exercise and vitamin combernation out there I am telling all you people that don’t have ADHD if you have it bad only medication will help. Diet might have an effect but it’s like putting staw in the bottom on a bucket with a hole. Not many of you really
know what you are talking about. And being a mummy with a kid that has it does not count. Sorry mummies you don’t know till you have had it.

August 6, 2013 at 4:25 pm
(9) The professor says:

To make a clarification. In order to correctly diagnose ADHD you MUST rule out every other explanation like: troubles at home, sight disorders, depression and pretty much everithing listed under those “have you not think of other explanations?” list.
When its ruled out then you can correctly make the diagnosis if the criteria is fullfilled.

Greetings

November 17, 2013 at 1:31 pm
(10) Logang says:

Sorry, but I am best friends with a doctor and he said to me,

“Too many times has he seen doctors over diagnose ADHD. Kids are over medicated.”

In the U.S. There is absolutely over diagnosis and misdiagnosis of ADHD.

I’ve been through this process.

Also, don’t tell me doctors don’t make money directly or indirectly prescribing these drugs… They do.

The U.S. diet. and environmental factors are also make a huge difference. I know when I eat certain foods my mood changes..

GMO’s are banned in Europe and not in the U.S. I’d say there is a connection there as well.

Just think if doctors prescribed ABA, meditation and other means of therapy, specific diets for children and it actually worked?
The pharmecetical companies would lose BILLIONS and so would the medical industry.

It’s almost like the U.S. has a Medical Industrial Complex. Much like the Military Industrial Complex.

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