Do the Right Thing

Spirit, science, and health

No ADHD in France? Bien Sûr Que Oui!

It isn't surprising that ADHD is commonly diagnosed in the USA but not in France

It is not at all surprising that attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are very commonly diagnosed in the United States yet not so much in France. Here in America, many consider ADD and ADHD a biological condition that primarily needs medication for treatment. While in France, this condition, when diagnosed or considered, is seen to be driven more by psychosocial factors than by biomedical reasons. Additionally, each country has different cultural perspectives regarding what might be the cause of problematic behavior in children such as hyperactivity and inattentiveness. Again, this generally translates into biological vs psychosocial differences in perspective. Furthermore, different cultures have different expectations about what is and is not normal or appropriate behavior among children (and adults). 


This is true of many other psychiatric and behavioral diagnoses as well (e.g., childhood bipolar) and curiously certain disorders and conditions seem to increase and decrease over time based on what is the popular diagnosis du jour. Consider autism and childhood bipolar disorders for example which have been much more commonly diagnosed in recent years than decades ago. Conversion disorders were diagnosed more frequently in the past than currently. There are many reasons for particular conditions being "popular" at certain times but what is clear is that some disorders come in and out of favor over time. 

These regional differences in diagnoses well underscore the cultural component to psychiatric disorders and treatment. As a society we have certain views and perspectives (that may or may not be evidenced based by the way) on what causes problematic behavior and psychiatric conditions. While in America we perhaps too often support a biomedical basis to problem behavior such as ADD and ADHD a more appropriate, evidence based, and thoughtful approach would include a maintaining a biopsychosocial perspective. In other words, biological, psychological, as well as social, cultural, and even spiritual factors all potentially contribute to create a situation for problem behavior and psychiatric troubles to unfold in children (and in adults too). So, ADD and ADHD behavior may not only be part biologically driven but psychological, social, and cultural driven too. This somewhat common sense notion often gets lost in American culture that favors biological causes to many problems.

 

 So, it makes perfect sense that the United States has many diagnosed cases of ADD and ADHD while France does not. The lesson that should be learned from this cultural difference is that if we really do want to properly diagnose and treat children with this and other disorders we should use the best available science and practice from across the globe which tends to be more biopsychosocial than biomedical. We must be careful for our own regional and cultural bias.

So, does France diagnose children with ADHD much less than the USA?  The answer is ... Oui! 

What do you think?

 

Thomas Plante, PhD, ABPP, is the Augustin Cardinal Bea, SJ University Professor at Santa Clara University and Adjunct Clinical Professor of Psychiatry at Stanford University.

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