Attention deficit hyperactivity disorder (ADHD) has become an increasing commonplace childhood malady, affecting somewhere between 5 to 9 percent of American children ever year.
Back in 2012, a blog was written claiming it explained the reason “Why French Kids Don’t Have ADHD.” In the article, Dr. Marilyn Wedge made the astonishing claim that while American children suffered ADHD prevalence rates of around 9 percent, French children have a prevalence rate of “less than 0.5 percent.”
The only problem with this claim? It’s not true.
The article appeared on Psychology Today, that bastion of lowest common denominator, pop psychology content, and it remains one of their most shared articles on social media. You’d think that at some point in the intervening 6 years since it was written, somebody would’ve checked and verified the article’s claims.
It certainly would’ve been easy, as it only took a few minutes to debunk the claim with a study by Lecendreux and colleagues (2011) that examined the prevalence of attention deficit hyperactivity disorder and its associated features among children in France.
“Earlier studies point to the prevalence of attention deficit hyperactivity disorder (ADHD) to be similar around the world,” the researchers noted. “There is, however, a wide variety in estimates. The prevalence of ADHD in youth has never been examined in France.”
So they set out to conduct a systematic study of ADHD prevalence rates in France starting off with 18 million telephone numbers, randomly selecting 7,912 of them. Out of 4,186 eligible families, they successfully recruited 1,012 of them to take part in a fairly extensive and detailed telephone interview. According to the researchers, the interview “covered family living situation, school performance, symptoms of ADHD, conduct disorder (CD), and oppositional-defiant disorder (ODD), and other features of ADHD.”
How Prevalent is ADHD in French Children?
The researchers found that the prevalence of ADHD in French children was between 3.5 and 5.6 percent. This is right in line with the estimate provided by the American Psychiatric Association of 5 percent (American Psychiatric Association, 2013). It is, however, lower than the U.S. Centers for Disease Control and Prevention’s (CDC) estimate of 9.4 percent.
ADHD is much more prevalent in France than what Dr. Wedge claims. And, yes, while it may be somewhat less than the U.S. rate, it is not significantly different. As the researchers note, “The epidemiology of ADHD in French children is similar to the epidemiology of ADHD in other countries” (Lecendreux et al., 2011).
In other words, according to French researchers, ADHD prevalence rates are not significantly different than those found in other countries. The whole premise of Dr. Wedge’s article is untrue, at least according to this study.
Why the Differences in ADHD Diagnosis?
According to Dr. Wedge, the reason for the differences in prevalence of ADHD between the two countries (despite such a difference not really existing) is due to the way the two societies view the disorder. She suggests that American psychologists and psychiatrists view ADHD purely as a “biological disorder with biological causes.”
I’ve read a lot of research from clinicians who treat ADHD and talked to many of them as well. So it’s puzzling to me where Dr. Wedge has gotten this viewpoint. Because, in my experience, specialists who treat ADHD in the U.S. hardly view ADHD as a purely biological disorder. Instead, most of them seem to view it as we view most mental disorders — a complex result of a bio-psycho-social interactions that not only involves the brain and neurochemistry, but also important psychological and social factors as well. I have yet to meet an ADHD specialist who doesn’t examine parenting skills, social, and environmental factors that contribute to a child’s ADHD symptoms.
In short, Dr. Wedge sets up a strawman argument — one that very few ADHD specialists have actually made. She then answers it by noting that French clinicians emphasize social antecedents in their approach to treatment: “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.”
Americans prescribe more stimulant medications to children to treat ADHD because they are effective, inexpensive, and work in a timely manner. In short, it is one of the most efficient — and most effective (see Rajeh et al., 2017) — ways to treat the condition, with very few side effects. Good ADHD clinicians, however, actually encourage parents to try non-medication, behavioral treatments before medication because they know the research shows such treatments can be just as effective and longer-lasting.
But its dependent upon parents to be able to make that choice for their children — clinicians can’t force a parent to choose one treatment option over another, even if they believe one to be more effective.
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According to the research, ADHD seems to exist with similar prevalence rates across industrialized countries. It’s unfortunate Dr. Wedge believes otherwise, and so has, in my opinion, misinformed millions of people who’ve read her article.
It’s natural for different cultures to treat mental illness in different ways. The fact that the French may emphasize one approach to treatment over their American counterparts — or that American parents choose a different type of treatment — is to be expected. Our cultures emphasize different values. But such differences don’t play out in how often children get ADHD or are successfully treated for it.
Research shows both medication and psychosocial treatments to be equally effective in reducing ADHD symptoms (e.g., Chan et al., 2016). Would we want people to try non-medication, behavioral treatments first for the treatment of ADHD? Absolutely, because psychosocial treatments — ones that combine behavioral, cognitive behavioral, and skills-training techniques — can help teach invaluable skills to children to help manage ADHD symptoms even if they stop taking medication. Such treatments can result in improvements in academic and organizational skills, such as homework completion and planner use, as well as co-occuring emotional and behavioral symptoms. Psychosocial treatments can also help in interpersonal functioning more than medication use alone (Chan et al., 2016).
Finally, we should keep in mind what researchers Rajeh and colleagues (2017) concluded: “While short term benefits are clear, longer term ones are not [for stimulant medications]. Behavioral interventions play a key role for long-term improvement of executive functioning and organizational skills. There is a paucity of long-term randomized placebo controlled studies and the current literature is inconclusive on what is the preferred intervention.”
In short, the research suggests there are no real differences in prevalence rates of ADHD in children between France and the U.S. French kids do have ADHD. And treatment approaches reflect the natural cultural differences, but don’t actually result in one group being treated more successfully than the other.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth edition: DSM-5. Washington: American Psychiatric Association.
Centers for Disease Control and Prevention. (2016). Attention-Deficit / Hyperactivity Disorder (ADHD) Data & Statistics. Retrieved from https://www.cdc.gov/ncbddd/adhd/data.html on July 14, 2018.
Chan, Eugenia; Fogler, Jason M.; Hammerness, Paul G. (2016). Treatment of attention-deficit/hyperactivity disorder in adolescents: A systematic review. JAMA: Journal of the American Medical Association, 315(18), 1997-2008.
Lecendreux, Michel; Konofal, Eric; Faraone, Stephen V. (2011). Prevalence of attention deficit hyperactivity disorder and associated features among children in France. Journal of Attention Disorders, 15(6), 516-524.
Rajeh, Adnan; Amanullah, Shabbir; Shivakumar, K.; Cole, Julie. (2017). Interventions in ADHD: A comparative review of stimulant medications and behavioral therapies. Asian Journal of Psychiatry, 25, 131-135.
Wedge, M. (2012). Why French Kids Don’t Have ADHD. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/suffer-the-children/201203/why-french-kids-dont-have-adhd on July 14, 2018.