French Kids Do Have ADHD, And French Psychiatry Is A Disgrace

On March 8, a family therapist named Marilyn Wedge, PhD published an ill-informed and poorly researched blog post, Why French Kids Don't Have ADHD.  

 

In the United States, 5% of school-aged children have been diagnosed with ADHD, and are taking pharmaceutical medications. In France, the percentage of kids diagnosed and medicated for ADHD is only .05%. How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France?

She argued that it was the superior, holistic approach of French psychiatry, combined with superior French parenting techniques, that accounted for the difference. In a later post, I'll tackle the claim of "superior French parenting".

I left the following comment:

Marilyn Wedge, I am appalled by your naive approval of the state of child psychiatry in France. It is dominated by the outdated theories of Freud, and the post-Freudian Lacan. The disgraced and discredited Bruno Bettleheim is a hero to the French child-psychiatry establishment.

Chantal Sicile-Kira, a native of France, fled France in 1993, for the sake of her autistic son Jeremy. She wrote, "children with autism were considered mentally ill, not developmentally disabled. They had no right to an education. Instead, they were enrolled in day programs on hospital sites, where they were treated with psychoanalysis. Parents had no right to visit the day program, nor did they receive any communication about what went on during the hours their child spent there." The psychiatrist who diagnosed Jeremy's autism blamed it on his "separation issues from breast-feeding".

The French filmmaker Sophie Robert spent years interviewing dozens of French child psychiatrists, ending up with over 60 hours of filmed interviews. She reports that the French psychiatrists she interviewed reject and despise all modern neuroscience, clinging to their theories that have no basis in science or evidence.

Her film, Le Mur, was particularly exploring autism in the context of French psychiatry. To French psychiatrists, describing autism as a neuro-developmental disorder is “a trend coming from the US”, a dangerous illusion that the French psychiatrists are proud to be fighting against.

Robert documented that all French main-stream psychiatrists share the following set of ideas:

• Maternity plunges every woman in a state of madness, which puts the baby in the same state of psychosis, being the root of severe disorders to come later on if mother and child aren’t separated by the father or anybody else, after the first month of life.
• Motherhood isn’t about bearing and loving a child. To the mother, pregnancy and motherhood is about finding a penis substitute the mother is lacking. Jacques Lacan created the idea that psychosis and other major disorders come from a fusion between mother and child. This too-close, incestuous relationship explains any mental illness. The child being alienated by his mother, in other word pushed into madness, because the child is not considered as a child by the mother, but as a penis substitute.
• Every mother is understood to be haunted by unconscious death wishes towards their children because she is supposed to be unable to overcome a wave of revenge, hatred and jealousy against men (having the penis they are lacking) and the children as penis substitute.
• Complex and biological phenomena asuch s the ability to think, to speak, and to refer to symbolism, result from a very simple mechanism of separating the child from the mother. In other words, if a child doesn’t speak, or doesn't otherwise develop normally is ultimately interpreted by a lack of separation between mother and child.

Robert went on to say "psychoanalysis is not only practiced by the psychoanalysts in their offices, but also by a majority of psychiatrists, psychologists, psychotherapists, nurses , occupational therapists, speech therapists, art therapists, right down to family mediators because many of them have also been trained in psychoanalysis. Psychoanalysis today has a stranglehold on the mental health sector in France, in particular on everything which relates to childhood."

It's no wonder, given the above, that the French thought up their own system of classification of mental disorders and conditions.

I am also surprised that you didn't know that the French wouldn't have used the Diagnostic and Statistical Manual, whatever edition. The dominant system in Europe is the International Classification of Diseases (ICD), which is produced by the World Health Organization (WHO). Presumably the French psychoanalytic establishment rejected the fact-based categorization of the ICD-9 (adopted in 1975).

You should also know that the diagnosis of any condition is not the same as its true prevalence. The fact that far fewer French children have an ADHD diagnosis says nothing about the true prevalence of ADHD in France.

In 2003, Faraone et al asked The worldwide prevalence of ADHD: is it an American condition? (World Psychiatry. 2003 June; 2(2): 104–113. PMCID: PMC1525089).

The authors concluded:

While the populations studied in the papers included in this report are not necessarily representative of all child populations worldwide, they are sufficient to demonstrate that ADHD is not purely an American disorder and that the prevalence of this behavioral disorder in many countries is in the same range as that in the USA...

Recognition of ADHD as a disorder affecting a significant percentage of children in many countries has important implications for the psychiatric care of children. Numerous studies have shown that appropriate management can significantly impact on the symptoms of ADHD and thus help children and their families overcome and live with the burden of this disorder. Management options include: educational strategies which help the child and adolescent achieve their academic potential at school and college; behavioral treatments aimed at teaching the child, their parents and teachers how to modify problem behaviors; and pharmacotherapy which has been shown to be highly effective for the long-term control of core symptoms. However, in the absence of adequate recognition of the disorder by the medical community, the teaching profession and the public in general, children with this behavioral disorder are unlikely to receive the assistance they require to achieve their full potential, at school, at home, and into adulthood.

====

That was the end of my comment. I subsequently found some other relevant peer-reviewed papers.  

In 2003, Frances et al. published Paediatric methylphenidate (Ritalin®) restrictive 
conditions of prescription in France.  They noted 

Methylphenidate (Ritalin®) is the only psychostimulant approved in France, since July 1995, for the treatment of attention deficit hyperactivity disorder (ADHD) in children aged 6 years and over. It is available only as a short-acting 10-mg tablet. Prescription and distribution conditions are restricted, with hospital-only prescription for the initial treatment and yearly consultations. Only neurologists, psychiatrists and paediatricians are allowed to prescribe methylphenidate, 

In other words, the French have very little in their pharmacological armamentarium to treat ADHD.

 

In August 2011, Faraone et al. published Prevalence of Attention Deficit Hyperactivity Disorder and Associated Features Among Children in France, in which they claimed "The prevalence of ADHD in youth has never been examined in France."  So Wedge pulled that 0.5% out of thin air.  The estimate in the paper is "The population prevalence of treatment for ADHD is 3.5%" and noted that the true prevalence could be as high as "5.6% of youth."

In February 2012, Cortese published The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): What every clinician should know.

This review, addressed mainly to clinicians, considers commonly asked questions related to the neuroimaging, neurophysiology, neurochemistry and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD). It provides answers based on the most recent meta-analyses and systematic reviews, as well as additional relevant original studies. Empirical findings from neurobiological research into ADHD reflect a shift in the conceptualisation of this disorder from simple theoretical views of a few isolated dysfunctions to more complex models integrating the heterogeneity of the clinical manifestations of ADHD. Thus, findings from structural and functional neuroimaging suggest the involvement of developmentally abnormal brain networks related to cognition, attention, emotion and sensorimotor functions. Brain functioning alterations are confirmed by neurophysiological findings, showing that individuals with ADHD have elevated theta/beta power ratios, and less pronounced responses and longer latencies of event-related potentials, compared with controls. At a molecular level, alterations in any single neurotransmitter system are unlikely to explain the complexity of ADHD; rather, the disorder has been linked to dysfunctions in several systems, including the dopaminergic, adrenergic, serotoninergic and cholinergic pathways. Genetic studies showing a heritability of 60-75% suggest that a plethora of genes, each one with a small but significant effect, interact with environmental factors to increase the susceptibility to ADHD. Currently, findings from neurobiological research do not have a direct application in daily clinical practice, but it is hoped that in the near future they will complement the diagnostic process and contribute to the long-term effective treatment of this impairing condition

 

 

Comments

[Concerned Reader]

Re French psychiatric theory:

EWWWW!!!!

[kim at allconsuming]

You know, we bitch and moan about the appalling state of mental health services and facilities and education in our own countries but to think you could be living in another developed 'civilised' society with such antiquated and just plain wrong (and perverse) ideas towards mental illness and indeed special needs/disability is just shocking. Abhorrent even.

[missmayinga]

Gott in bloody Himmel. I'd make a snide comment about France, but this sort of crosses the line from "Oh those wacky French people and their wacky chauvinism" to "That is actually completely terrible." J

[Psychiatry Woodbridge, VA]

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