Why are there more cases of child hyperactivity in the US than in France?

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Picture from download.free-download-web.com/files/2014/09/Childrens-cartoon-illustration-vector-material-2.jpg

The daily routine of someone with Attention deficit hyperactivity disorder (ADHD) can be painful and difficult to get by. For the parents of children diagnosed with the disorder, it can be even more challenging, since they are those who have to deal with the distress of their child day after day.

These parents often ask themselves where the disorder comes from and what is the best treatment for their child. There are still no answers to that question, but the differences between the treatment in the United States and France may bring a light to the discussion.

What is ADHD?

For American pediatric psychiatrists, ADHD is considered a biological disorder with biological causes. The most common symptoms are academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity.

Doctors haven’t come to an agreement on a specific cause for ADHD. The most accepted medical theory is that it is genetically transmitted; if one of the parents has ADHD, then the child has a 50% chance of having it too. But it is also said that pregnant women who drink alcohol or smoke during pregnancy increase the chance of their child having the disorder.

But it all depends from where you are looking at the situation.

For Daniel Roy, a French psychoanalyst specialized in ADHD, “in countries such as France, where psychoanalysis is on the basis of child psychiatry, there has been a strong resistance to the diagnosis of ADHD”. “Psychiatrists in France have proposed for many years a comprehensive and long monitoring of the child to allow her to build a personal understanding of what may be happening to her and also to find her place in the world”, he says.

According to Enedina Martins, a psychoanalyst for children and adolescents, ADHD cannot be diagnosed as a disease. For her, what may be called ADHD, appears when the child is missing “the name of the father,” an expression created by Jacques Lacan to design an individual that symbolizes in a person’s mind the “figure of the law.” It means that the child doesn’t have the significant – what will give the child the elements for his constitution – that will underline his behavior.

Difference between the U.S. and France

We can see a huge difference in the number of children diagnosed with ADHD when we compare the United States and France.

In the United States, 6.4 million children have been diagnosed with ADHD in the last eight years, according to the Center for Disease Control and Prevention. This year 11% of American kids are being treated for ADHD, and half of this number are treated only with medication, such as Ritalin and Adderall, and this number continues to grow. From 2003 to 2011 the number of diagnostics has increased 42%, and it keeps rising at a rate of 5% per year.

In France, the numbers are way shyer than in America. A research made in 2010 by Dr. Michel Lecendreux, show that only 5% of French children were diagnosed with ADHD, and according to him just 0.18% of them took medications as a treatment. But these numbers are changing and getting a little higher every year, even though it still isn’t close to the American statistics.

The treatment by drugs

Adderall, a drug used in the treatment for ADHD. (Photo: Wikimedia Commons)
Adderall, a drug used in the treatment for ADHD. (Photo: Wikimedia Commons)

The US represents more than 80% of the world’s consumption of medications based on methylphenidate (where Ritalin is the most known of them). The formula of the medicine created to treat the symptoms of ADHD uses two derivatives of catecholamine out of a total of three components. Both of them are used specifically to create mental alertness and sustain concentration. These are two states of mind created by adrenaline, a natural hormone produced by the human body.

According to research done by students of the University of Stockholm, in Sweden, based on the study of Lambert, Johansson, Frankenhaeuser & Klackenberg-Larsson (1969) a higher level of this hormone was found in children who “were more lively, decided, open, curious and playful than their peers.” They also found out that “individuals with some higher levels of adrenaline tended to be relatively less anxiety-prone and less aggressive than others.”

The research results lead to the conclusion that hormones of the catecholamine family, such as adrenaline, “may play an equally important part in the regulation of behavior in children as in adults”. The positive effects of this type of hormone in kids are highly studied in modern days by physicians who work with children that are said to have any kind of attention disorder.

Here begins the wide divergence in the medical world, where it is discussed the real necessity of giving medication to children that present an attention disorder, such as ADHD. Some doctors say that the medication only masks the problem; it is not a form of healing.

There is also research about the side effects of this sort of medication. The United States Food and Drug Administration said that Ritalin and other drugs of the same family might cause visual hallucinations, suicidal thoughts and psychotic and violent behavior.

Different methods of treatment

The US was the first country to say, back in the 1960s, that the disorder was a disease, and it was also them who started to treat medically the children diagnosed. By 1990s, the practice was widely spread across America, and the treatment was made almost entirely with medication.

According to Daniel Roy, the reason for the prevalence of such numbers in the US is because the pharmaceutical industry has been putting all its attention, market strength and power of persuasion to spread the idea that the best treatment for the disorder – with or without hyperactivity –, is by giving the medication. “It is a strategy put up by this industry, and they produce researches to try to prove to the medical society that their drug is the most effective in the ‘cure’ for this type of disorder.” In America, the drug has been legalized since 1961.

On the other hand, in France, there have been regulatory policies regarding the treatment for ADHD. The drug was only approved in 1975, more than ten years after the US. Also, the government authorized fewer types of the drug – 2 against 10 in America – and many controls were put up.

In 1985, the company that produced Ritalin let their license renewal expire, and that specific brand was practically removed from the French market. But in 1995, the label came back, and some of the controls were relaxed. These changes contribute to the rise of the numbers of children treated with those types of medication.

Still, the statistics show that the treatment by psychological counseling is still preferred by French parents than the use of any medication. This is a victory for the psychoanalysts in France, and show that the “healing by the word” can be more effective than by the drug.

Sarah Bazin

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