The world’s most popular independent online news service, The Huffington Post, recently published two significant blogs suggesting that Western Australia and France offer lessons on how to tackle the global ADHD epidemic.
Taming the ADD Epidemic
The first co-authored by Emeritus Professor of Psychiatry at Duke University and the former chair of the DSM-IV development task force Doctor Allen Frances and myself was titled Taming the ADD Epidemic. (available at http://www.huffingtonpost.com/allen-frances/add-epidemic-_b_1293556.html)
The blog outlines the experience of Perth, Western Australia, the world’s first ADHD hotspot to see a massive downturn in child prescribing rates. It describes how the implementation of tighter prescribing accountability measures that I advocated were followed by a 60-70% fall in Western Australian child ADHD prescribing numbers[1. See http://speedupsitstill.com/rise-and-fall-of-child-adhd-in-wa for more detail.] and a 51% fall in self reporting of teenage amphetamine abuse.[2. See http://speedupsitstill.com/perth-a-case-study-in-adhd-abuse for more detail.]
Dr Frances kindly concludes, “There are two potential tools that would allow us to tame the current ADD fad: 1) narrowed and more carefully applied diagnostic criteria and 2) rigorous quality controls over stimulant prescription. DSM-5 will lead us in just the wrong direction on the first; Mr. Whitely shows us the way on the second.”
Why Bébé (French for Baby) Doesn’t Have ADHD
The second by family therapist and author Marilyn Wedge, Ph.D. offers her theory as to why in the ‘United States, approximately 5 percent of school-aged children have been diagnosed with ADHD and are taking pharmaceutical medications. [Where as] In France the percentage is a mere 0.05 percent.’ (available at http://www.huffingtonpost.com/marilyn-wedge-phd/adhd_b_1310973.html )
Doctor Wedge offers two controversial explanations:
- American psychiatrists tend to view ADHD as a ‘biological disorder with biological causes’ whereas ‘French child psychiatrists…view ADHD as a medical condition that has psycho-social and situational causes.’ Therefore, ‘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.’
- ‘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…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… As a therapist who has worked with children for more than twenty years, 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 have grown up in families in which the rules are well-understood and a clear hierarchy is firmly in place. “C’est moi qui décide” (“It’s I who decide”), asserts the French parent. In French families… parents are firmly in charge of their kids — instead of the American family style, in which the situation is all too often vice versa.
Parenting styles are individual choices and beyond the control of government or the psychiatric profession. However, the Australian psychiatric profession could choose to do what the French psychiatric profession did in the early 1980’s. ‘In part as a resistance to the influence of the DSM-III, the French Federation of Psychiatry developed an alternative classification system. This 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 symptoms that will qualify for the best pharmacological bandaids to mask them.’
Given the further disease-mongering proposed in the published draft of DSM5,[3. For more information on what the American Psychiatric Association propose for ADHD in DSM5 see http://speedupsitstill.com/dsm-5-proposal-adhd-%e2%80%93-making-lifelong-patients-healthy-people For information about the general backlash to DSM5 proposals see http://speedupsitstill.com/sign-on-line-petition-proposed-dsm5 and http://speedupsitstill.com/dr-allen-frances-lead-author-dsmiv-british-psychological-association-lead-chorus-opposition-disease-mongering-proposals-dsm5] it might be timely for the Australian and New Zealand College of Psychiatry to hire a French translator.