What’s Behind the Gap in ADHD Diagnoses in US and France?

Is there something uniquely American about Attention Deficit Hyperactivity Disorder? This might seem like a strange question to ask about a recognized mental illness – something that doesn’t typically know any national boundaries. At the same time, it’s hard to ignore in light of the fact that more than 9% of American children are diagnosed with ADHD while the diagnosis rate in France is closer to 0.5%.

According to Psychology Today, the answer to the discrepancy is in how the disorder is viewed by the medical establishment in both countries. Child psychologists in the US – guided by the diagnostic criteria set by the mental illness bible the Diagnostic and Statistical Manual of Mental Disorders – view ADHD as a biological disorder that has specific biological causes. French psychologists do not.

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. 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.

When symptoms that brand an American child as a sufferer of ADHD surface in France, doctors first look at how to alter the child’s social context. In addition, how ADHD is defined in France is much narrower. All this naturally leads to fewer ADHD diagnoses in kids.

According to Marilyn Wedge, this is not altogether a bad thing.

Wedge claims that broad way in which ADHD is defined in the DSM “pathologizes” behavior in children that should be considered fairly typical. Furthermore, the DSM doesn’t encourage mental health professionals to consider anything but the symptoms – with many reaching for the prescription pad rather than take the time to identify non-obvious factors that lie underneath.

And then, of course, there are the vastly different philosophies of child-rearing in the United States 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 United States.