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French Kids DO Have ADHD

And it's not all about parenting.

Three years ago, the family therapist Marilyn Wedge wrote a post for Psychology Today titled "Why French Kids Don't Have ADHD."

At last count, it has gotten 1.8 million "likes."

But it was wrong.

There's no question that French kids have attention-deficit/hyperactivity disorder, or ADHD. Kids all over the world have ADHD.

I'm not the first to question Wedge's provocative headline. In 2013, the neuropsychologist David Nowell noted that a 2011 French study estimated the French prevalence of ADHD at between 3.5 and 5.6 percent. This squares with other research that has found the global prevalence between 5.3 percent and 7.2 percent.

Wedge has touted a different statistic—citing a French diagnosis and medication rate of .5 percent (which was then widely re-reported but which I've yet to see confirmed in published research [k1]) to support her claim that "there is no scientific evidence that ADHD is a real biological disorder."

Earlier this year, France's High Health Authority officially disagreed with such assessments, encouraging doctors to recognize and diagnose childhood ADHD. (I had to translate that news from the Portuguese, as it doesn't appear to have been reported in English.)

The agency's unprecedented report mirrors growing regional concern, reflected in a resolution last March by the Parliamentary Assembly of the Council of Europe, an international human rights group, which said ADHD may still be under-treated "due to the inadequate training of care providers, inequalities in access to care as well as the stigma and misconceptions surrounding ADHD."

In other words, it's not that French kids, or Europeans, don't have ADHD, says French child psychiatrist Michel Lecendreux, but that they're clinically invisible. "It's just not very well understood, nor is it very well-diagnosed, nor well-treated." Lecendreux, a researcher at the Robert Debre Hospital in Paris who also heads the scientific commission for the French ADHD support group HyperSupers, told me that his research suggests that fewer than one-third of French children who have ADHD are being diagnosed.

As a result, he says, many French families have to manage a potentially seriously impairing disorder in isolation and without effective support. You might say they're coping with invisible ADHD. "They waste time getting therapies like psychodrama, even as their children have more risk of repeating grades, and of becoming oppositional."

All of this raises the question of why Wedge's blog has been so widely read and "liked." It seems to inspire the same sort of self-flagellating Francophilia that made best-sellers out of Mireille Guiliano's 2007 French Women Don't Get Fat, and Pamela Druckerman's 2012 Bringing up Bébé. Yet its message is potentially harmful for families already besieged by insinuations that their children's problems with distraction and impulsivity are all their fault.

Wedge attributed the disparity between France and the United States, where at last count, 11 percent of children have been diagnosed, in part to "vastly different philosophies of child-rearing" accounting for why French children "are generally better-behaved."

There is certainly some evidence that ADHD is overdiagnosed in some parts of the United States, for reasons that would take a separate blog entry to examine. But there's considerably more evidence that ADHD is a genuine neurobiological disorder that in no way is caused by poor parenting. Disturbingly, there's also evidence that those vaunted French child-rearing practices include tactics many Americans would reasonably reject. Just last March, France was scolded by the Council of Europe, an international human rights organization, for failing to clearly ban corporal punishment of children, a practice generally treated leniently by French courts and society. As the Economist noted, "there is no taboo in France today against a parent giving a child a firm slap in a public place."

As a society, modern American parents have been moving away from our ancestors' slap-happy ways for some time. It makes our jobs more challenging, as we have to use our reasoning and judgment more than force. But that, after all, is what makes us civilized, which is why we shouldn't waste time envying France's invisible ADHD.

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