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ADHD Dilemmas – Different Approaches, complicated realities
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    A recent article shows a shocking gap between the two sides of the ocean. In the United States, more than 9 percent of school children have been diagnosed with ADHD (Attention Deficit Hyperactivity Disorder) and are under medication. In France, the prevalence of the disease is less than 0.5 percent. So how come a brain disorder is almost epidemic in one countryy, while barely existing in the other?

Attention Deficit Hyperactivity Disorder,brain chemical imbalances,biological-neurological disease,mental health,pharmaceutical companies

Apparently, the difference lies in its definition. American psychiatrists consider ADHD a biological-neurological disease, with purely biological causes requiring biological treatment. The most common treatment is medication, using stimulants like Ritalin or Adderall to treat chemical imbalances in the brain. On the other hand, French child psychiatrists have a different approach, considering ADHD to be a result of psychosocial and situational factors. The preferred approach is holistic, focusing on family counselling, behavioural therapy and sometimes dietary changes, usually looking for a cure not in the brain, but in the context. Other studies show that hyperactivity in children may be more likely to be diagnosed as a conduct disorder in the UK and ADHD in the USA, while research confirms that there is no true difference between behaviours.
    The American psychiatric system relies entirely on the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which often tends to “pathologize” behavioural aspects regarded as normal in other cultures, not considering many underlying psychosocial causes. In France, psychiatrists rely on an alternative classification system instead of the DSM – the CFTMEA, or Classification Française des Troubles Mentaux de L'Enfant et de L'Adolescent, which focuses on identifying underlying causes instead of masking symptoms with pharmaceutical quick-fixes.
Writer Pamela Druckerman gives a different explanation: French parenting philosophy offers an entirely different structure to children, one in which no means no, a far cry from the American perspective. Apparently, limits offer a sense of security and discipline, saving children from the "tyranny of their own desires". Who needs drugs when self-control is taught from an early age?


Attention Deficit Hyperactivity Disorder,brain chemical imbalances,biological-neurological disease,mental health,pharmaceutical companies

    In response to the article, adolescent psychiatrist Elias Sarkis, who lived and studied in France for years, declares in an interview that ADHD is just as common in the European country, it just simply isn’t taken as seriously as a disorder. Dr. Sarkis also notes that French society shows a strong cultural adversity to medication, and often undiagnosed and unmedicated children with ADHD continue to live with impairing consequences, often leading to substance abuse, educational issues and even prison. Structured parenting with clear, unbenadable limits often comes "at the price of the child experiencing increased anxiety and internalizing problems", Sarkis believes.
American paediatrician Dr. Nicole Brown was just completing her residency at Johns Hopkins Hospital in Baltimore when she noticed that more and more of her young patients from low-income families were being diagnosed with ADHD or ADD. Despite behavioral therapy and medication, symptoms were hard to control in these children. Brown began to wonder whether the diagnosis is a lazy label for deeper issues: “perhaps a lot of what we were seeing was more externalizing behaviour as a result of family dysfunction or other traumatic experience.” Living in violent households and neighbourhoods, these kids were constantly under stress and a cause of stress themselves for parents and teachers. However, Brown discovered they all shared one thing: trauma. Hyper-vigilance, anxiety and dissociation are often tell-tale signs of trauma and stress response, but they can easily be mistaken for impulsivity and inability to focus, the classic symptoms of the learning disorder. Now she and other researchers are trying to raise awareness on the issue, as many psychiatrists, psychologists and paediatricians often lack the knowledge or the time to tell the difference between two completely separate issues. The number of kids mistakenly diagnosed with ADHD is not clear, but a 2010 study estimated there could be nearly one million cases in the US.

Attention Deficit Hyperactivity Disorder,brain chemical imbalances,biological-neurological disease,mental health,pharmaceutical companies

    To test her hunch, Brown analysed the results of a nation-wide study on more than 65,000 children. Her findings revealed that diagnosed children often struggle with poverty, violence, substance abuse in the family and divorce. There was a strong correlation between experiencing one of these traumas and the likeliness to later be prescribed ADHD medication. Interpretation of her results is no easy task though, and one can easily end up in the chicken-or-the-egg dilemma: the difficulty of raising a child with ADHD can be the very cause behind the economic troubles and unstable family environments, especially when parents themselves may be suffering from ADHD. There is no convincing proof yet that trauma or chronic stress are causes of the development of ADHD, but there is no contradicting evidence either. Only one thing is clear: no medication focused on managing symptoms can fix any of the environmental issues that the children live with. However, about 40% of children with ADHD also have other disorders such as dyslexia or mood disorders. Stephen Hinshaw, a psychologist at the University of California, Berkeley, believes that skill-building should be the main focus.
Most American researchers dismiss “eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos” as causes of ADHD, but tend to agree that such factors can aggravate symptoms. Monnica T. Williams, a clinical psychologist and mother of a child with ADHD, argues that a genuine neurological disorder cannot be cured with discipline alone, and blaming parents for it is unjust and ineffective, but context factors like long school hours can aggravate the symptoms. She explains how moving her son to a Waldorf school in the 7th grade helped – hands-on learning may not cure the disease, but it certainly aids concentration. Williams also notes that regular schools prepare children for a success model that simply isn’t the right environment for all: “in our society more jobs require us to sit at a desk (or computer) for hours at a time. On a farm, a little ADHD might not be a problem when people have acres to roam free and hard labour to keep them busy”.
    Two decades ago, the National Institute of Mental Health in the United States invested $11 million in answering a crucial question: which is the best long-term solution for ADHD, pharmaceutical intervention, behavioural therapy, or both? Influent leaders in child psychiatry offered radical results: medication reigned supreme, surpassing the efficiency of therapy or even the combination of therapy and medication. This study became a pillar of the approach to the disorder, often used by insurance companies and school systems as an argument favouring pills. The result was a more and more popular blind belief in medication, much to the pharmaceutical industry’s delight. According to a report from prescription provider Express Scripts, the number of Americans taking ADHD medication has had a 36 percent rise in five years. Moreover, parents are often diagnosed themselves shortly after discovering their children’s disorder, since learning about their issues makes them realize they suffer from them themselves.
    However, many experts believe that the vast array of pharmaceutical treatments on the market is in itself a reason of the “epidemic”, as medical research became marketing material for companies producing these drugs. The rise in diagnoses seems to coincide with efforts to publicize the syndrome coming from pharmaceutical companies, which now seem to use similar techniques to ”sell” adult ADHD. While there is solid evidence that ADHD is a legitimate disability that impedes daily life and that medication can reduce symptoms and ease sufferers’ lives, many experts warn that corporate marketing has widely stretched its definition, often including normal behavioural issues into a pathological grey area.
For example, pharmaceutical company Shire now targets adults with the slogan “It’s Your A.D.H.D. – Own It.”, going as far as recruiting pop star Adam Levine for their marketing campaign. Other techniques employed by companies include online quizzes encouraging users to seek treatment, a worrying oversimplification of a disorder that usually requires up to six months to be diagnosed. Even the pharmaceutical executive who introduced Adderall in 1994, Roger Griggs, warns against marketing psychiatric stimulants to the general public, as addiction can lead to side effects like sleep deprivation, loss of appetite, or even extreme results like psychiatric breakdown and suicidal thoughts. A study by Dr. Gene-Jack Wang of Brookhaven National Laboratory also shows that even in correctly diagnosed patients long-term ADHD treatment can lead to dangers like mistaking a side effect for a a marker of the disease. ADHD drugs commonly target dysfunctional dopamine signalling in the brain, but long-term use can alter the density of the dopamine transporter, thus lowering its efficiency.
    Whether ADHD is an American disorder or not, its crippling effects do exist all over the world in one form or another. Either caused by neurological, chemical, social or emotional factors, the massive debates surrounding it should encourage research instead of polarization of opinions – after all, the end goal is preparing an individual for life, and no kind of medical labelling can achieve this task by itself.

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Published by Andreea Dobre


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