I happened to chance upon this article, “Why French Kids Have Low ADHD Rates”, which was featured in theasianparent.com (Singapore Edition). http://sg.theasianparent.com/adhd-treatments-secrets-to-low-adhd-rates-in-france/
Somewhat cynical about the claim, I clicked on the link and as I read the article, cynicism quickly turned into frustration. The article on ADHD is absolutely misleading on so many levels. It can be potentially damaging for ADHD children in schools, who as it is, are already suffering because of unsympathetic teachers, as it re-inculcates negative myths about ADHD. For parents who have children with ADHD, they may get thrown into a state of confusion again, leading them to ask, “Am I doing the right thing for my child?”, “Can ADHD really go away if I start being “cruel to be kind” to my child?” , “Are my parenting skills the cause of my child’s ADHD symptoms?”, “Should I not listen to the advice of the professionals and follow this one instead?”.
Let me explain.
The article suggests that ADHD is caused by or trigged by factors such as, poor parenting skills, unhealthy food, and lack of exercise and that when these factors are “combined”, they “can be enough to eventually lead to ADHD”.
There is vast amount of research that very strongly supports the premise that ADHD is a biological condition. ADHD is termed as a neurodevelopmental disorder, which means that the growth and development of the brain are impaired and this causes chronic developmental delays in the individual with ADHD. According to Dr. Russell Barkley, a world-renowned and leading authority, author, and researcher on ADHD and Clinical Professor of Psychiatry and Pediatrics at the Medical University of South Carolina, that developmental lag is by about 30%, when compared to peers of the same age. ADHD can also occur as a result of a brain injury, although most ADHD individuals do not show evidence of brain injury or do not have history of a brain injury.
ADHD is genetically inheritable. If someone in the family has ADHD, the risk is 25% to 35%. If a parent has ADHD, the risk of the children inheriting it is 50%. If an identical twin has ADHD, the risk increases to 78% to 92%.
The parts of the brain that have been implicated in the disorder are the frontal lobe, which allows the highest functioning behaviors to occur and it sends commands to others parts of the brain, the basal ganglia, cerebellum, the anterior cingulate cortex, which regulates emotional behaviour, corpus callosum, that allows the communication of the right and left hemispheres of the brain, and a disconnection of the visual cortex and the frontal, frontal cortex, resulting in deficit in “attentional control”, where the ADHD individual is unable to effectively prepare the brain to anticipate and respond to upcoming stimulus.
With so much data available, the suggestions of the writer by theasianparent.com are irresponsible as they put the blame of the condition at the door of the parents and at their lack of care and parenting skills. Also, as it is, there are already so many misconceptions about ADHD, this article does nothing to help raise awareness of the condition but simply adds to the propagation of these misconceptions and perpetuate a lack of understanding towards individuals suffering from ADHD.
Quote: ”Although scientists worldwide will agree that both Ritalin and Adderall are effective ways to quickly increase attention and reduce hyperactivity in children, these drugs are not long term cures and will only mask the problem.”
The statement makes the assumption that ADHD is curable and that is untrue.
As said, ADHD is a biological condition or in some cases, as a result of brain injury. Treatments for ADHD are interventions for people with the condition so that they can function in a world designed for neurotypical brains and to level the playing field for them so that they can experience success, along with their peers. Not all persons with ADHD are prescribed to take Ritalin or Adderall but if medication is prescribed, it should be accompanied by other interventions or treatments.
The writer brings into the discussion, the book, “Bringing Up Bébé” where the author, Pamela Druckerman talks about the parenting skills of French parents. Yes, we know that there are cultural parenting differences in varying parts of the world but we are talking about ADHD treatments and interventions and Pamela Druckerman in her book discusses parenting strategies without ADHD children in mind.
Included in the article is a sub-title, “Cruel to be kind” and the writer refers to children with ADHD as “young troublemakers”. Insensitive, thoughtless, and irresponsible statements like these, only serve to continue the misleading notion that children with ADHD are naughty and the symptoms that they manifest originate from an intentional desire to be mischievous and that parents, teachers, and/or caregivers need to be harsh towards these children to make them toe the line, and magically, the ADHD symptoms will disappear, and ADHD will be no more.
ADHD is not simply about the inability to “concentrate”, “being easily distracted” and, about “hyperactivity”. It is a complex and a crippling condition to those with ADHD. ADHD is an inhibitory condition. What this means is that individuals with ADHD find it very hard to regulate their behaviors and most importantly, their emotions, including, frustrations, moods, anger, hostility, annoyance, and irritability This is where they get into trouble most of the time, at home, in school, at the playground, in environments where there are social interactions, and for adults, at the workplace.
ADHD individuals react impulsively to situations and studies have revealed that ADHD individuals generally do not display their inappropriate behaviors intentionally and are unaware that their behaviors have consequences on others or that other people find their behaviors distracting or annoying.
Self-control is not a socially acquired behaviour. Self-control is “neurogenetic in origin” and ADHD is a self-regulation disorder. The way ADHD individuals manage or their inability to manage their behaviours is not as a result of how they were raised but it is “a part of who they are”. Dr. Russell Barkley, Lecture on ADHD, The Centre for ADHD/ADD Advocacy Canada
Individuals with ADHD have deficits in their various executive functions, which include, their working memory.
Individuals with ADHD do not have decreased attention. In fact, they have increased attention. They are attentive to too many things at the same time and that is why they find it hard to concentrate on one thing at a time. Individuals with ADHD also have problems:
- Keeping track of time
- Holding on to a thought, while attending to another action
- Planning and organizing steps to complete a task
- Following the steps to complete a task
- Following directions or instructions
- Seeking and verbalizing help when needed
- Changing directions during the course of a task, even when additional information is presented
- Problem solving and analyzing information
- Sustaining behaviour and motivation in order to bring themselves toward a goal
- Setting priorities
- Delaying gratification
- Internalising their speech and that is why individuals with ADHD often blurt out information and why people often perceive them as talking too much
- Responding effectively to external stimulus
- Being organized, sticking to routines, are forgetful
- Learning from past experiences
- Recalling information from working memory and being able to know how to apply the information
These are just a few examples of the vast and varying symptoms that may come with ADHD.
In addition, very few people with ADHD suffer from ADHD alone. ADHD is usually accompanied by a learning disability or disabilities (25%-40%), like, dyslexia, dyscalculia, dysgraphia, speech and language problems, developmental delays, coordination problems, sensory processing disorder. The majority of ADHD individuals will have problems performing well in school and 25%-36% of them will drop out of school.
ADHD individuals are also at higher risks of developing other disorders, for example, oppositional defiant disorder (50%), conduct or antisocial problems (25%-40%), maniac-depression or bipolar disorder (5%-10%), anxiety disorder or depression (25%).
“ADHD” according to Russell Barkley, “is the most impairing outpatient disorder we treat in adults, even compared to depression or anxiety. To make those claims or to say it’s a myth is stunningly scientifically ignorant.”
Again, I quote from the article: “France’s secret lies both in parenting strategies and ADHD treatment. A French child is far less likely to develop ADHD than any other child due to a more disciplined and structured upbringing. When a child does develop signs of ADHD, the specific treatment tackling the cause of the behavioural problem seems to be more effective than simply signing yet another month’s prescription slip.”
As I mentioned, I was rather doubtful when I read this claim about French children being “less likely to develop ADHD” as this condition is known to be non-discriminatory, which means it occurs in persons across all cultures, races, genders, and countries. So, I did a little research on my own and this is what I found out.
It appears that the writer of this article took one controversial theory, which originated from this post, “Why French Kids Don’t Have ADHD”, published on March 8th, 2012, as a basis of her article.
I wonder if the writer is also aware that since that post was published, a number of articles were written to refute that claim and I list some of them here:
“French Kids Do Have ADHD: An Interview,” 2012, Sept. 22,
“Of Course French Kids Have ADHD: Epideminological Evidence Suggests That ADHD Is Not A US Phenomenon” 2013, May 23.
“French Kids Don’t Have ADHD? Well, Mine Does.” 2013, June
“Do Children In France Have ADHD?” 2014, Jan 13.
One of the fundamental reasons why France “is far less likely to develop ADHD” is because in France, ADHD as a condition is not readily accepted or recognised. An interview with a doctor who has lived in France for 10 years confirms that ADHD does exist in France and that 3.5% to 5.5% of its population has ADHD and that percentage is generally about the same in other countries. In fact, it is highly likely that there are undiagnosed ADHD persons in France due to the unwillingness of the French to recognise ADHD as a condition.
“Dr. Sarkis said in France, there is a “strong negative cultural belief against medication” for children with psychiatric disorders. However, he said, children with ADHD continue to suffer the consequences of the disorder. Regarding the impact of undiagnosed and unmedicated ADHD in France, “the reality is that there are French kids in prison, a high rate of tobacco use, and kids dropping out of school.”
Dr. Sarkis said, that if a French child with ADHD receives “excellent parenting, high structure, and clear expectations from parents” it can mitigate behaviors. However, it is “at the price of the child experiencing increased anxiety and internalizing problems.” For those children who are not able to receive excellent parenting and high structure, ADHD behaviors can be extremely impairing.
In addition, in France, “child psychiatrists don’t use the same system of classification of childhood emotional problems as American psychiatrists. They do not use the Diagnostic and Statistical Manual of Mental Disorders or DSM.” This means that in France, children are evaluated using an entirely different diagnostic tool and not the one that is commonly used, which is, the DSM.
I think that it is irresponsible journalism to present a notion as this writer did, that all one has to do to eradicate ADHD, is to exercise, eat healthy food, and be hard on children who present symptoms of ADHD. She either did not do further research or she simply dismissed research, which shows that the ADHD child does suffer negative consequences and limited success when interventions and treatments specific to his ADHD symptoms are not met or when an undiagnosed child presents ADHD symptoms and these are not picked up for further observations by professionals.
Studies also show that when there are untreated, unmanaged or undiagnosed people with ADHD, there are direct consequences on the child and society. These children who are tormented and ridiculed by their peers because of their presenting symptoms, may either be bullied or become bullies themselves. They may also be subjected to suspensions or expulsion because of their lack of ability to conform to rules or authority. ADHD individuals are five times more likely to commit suicide than non-ADHD individuals. 20%-50% of ADHD individuals have an alcohol or drug addiction, and 25% of prisoners suffer from ADHD.
I currently have a primary 5 boy who is facing suspension because he has difficulties regulating his emotions and since the start of this year, has hit two of his peers. Both times, his teachers reacted with threats. J became increasingly resentful since he entered primary school. His mother informed the principal when J was diagnosed with ADHD and would inform his teachers each new school year. However, not one teacher has made any modification or accommodation for J. Even after the information of J’s diagnosis was furnished to the school, the teachers have responded to J’s behaviour, with threats of caning and scoldings. He has been sent to the principal’s office and even disallowed from going for recess. The school principal and J’s teachers have not reached out to J’s mother to include her in any plans to help J. J’s mother has, on the other hand, approached the school to offer them help in terms of ADHD-related resources and training at her cost, so that the teachers can learn more about ADHD. The offers have all been declined.
R was diagnosed with ADHD and dyslexia in January of this year. R also entered primary one this year. As with J, the school and his teachers were informed of the diagnosis of both the conditions. As with J, nothing was done to assist R in any way. He was still made to learn words for spelling tests, two tests each week, one for English and one for Mandarin. R started off loving school. He now hates it. R started off doing well in his work. He now gets only one or two words right. He gets ridiculed by his friends for doing badly and yelled at by his mom when he goes home with the results of his tests. Just last week, he told me that his teacher hit him on his palm with a “really long ruler”. I asked him why. “Because the teacher said don’t say out loud the answer and I did.” After only 3 months in formal schooling, R is showing signs of high levels of distress, frustration, and anxiety, and a very decreased self-esteem. He thinks he is stupid and he is so turned off learning. It has only been 3 months since R started primary school and he is only in primary one. He has another 9 years and about 9 more months of formal school to go.
While there is some level of awareness about ADHD in Singapore, rarely do educators put in the effort to make accommodations for these children in school and ADHD children continue to suffer the consequences. Children manifesting symptoms of ADHD are overlooked. They are not brought to the attention of the parents and advised that they bring their child to a professional to be screened for a possible diagnosis. These children are still punished when they display symptoms of ADHD and their symptoms are interpreted as being “mischievous”, “naughty”, “defiant”, “lazy”, “slow”, even when these children have been diagnosed! Even when there is so much information readily available on the internet, our children continue to suffer because of “willing” ignorance.
One of the reasons for these happening, is because of the media like, theasianparent.com and this writer, who perpetuates the idea that if a child is showing symptoms of ADHD, be harder on him and the symptoms will go away. People with ADHD can become easily overwhelmed and being harder on a child with ADHD will only overwhelm and stress him even more and any educator worth any grain of salt will tell you that an overwhelmed or stressed brain cannot learn or develop optimally. According to this asianparent.com writer, there is no need to bring the ADHD child to a professional, have a DIY treatment instead. Here’s a book on parenting and a good diet to follow and be gone, ADHD!
I am not implying that good nutrition and exercise are not important or that putting in place, structures, routines, boundaries, if age-appropriate, will not help the ADHD child. Of course, they are important and they would help but please do not make it so that, that is all one has to do to. Every ADHD individual will present a different set of symptoms, with varying degrees, with possible different learning disability or disabilities, and/or comorbid disorder/s. You see, how complex a condition ADHD is?
The ADHD child also needs empathy and understanding and a host of other interventions and treatments specific to his symptoms, to be determined by the people who are treating him. Then modifications need to be put in place and accommodations be given so that the child with the neuroatypical brain is able to function in a world designed for neurotypical brains.
If we have more writers like this who are going to write misleading articles about ADHD, we are going to have more misunderstood ADHD children and adults and less much needed help that is so critical for ADHD children and adults.
In the article, “Living Your ADHD Courageous Life”, there is this paragraph that speaks of what many ADHD sufferers go through.
“I wake up knowing that my performance WILL be inconsistent today, tomorrow, and next week. It can feel as if one shoe is dropping, even with all of the great systems, routines, and visual cues I’ve developed over time, my ADHD isn’t cured… and never will be. Sometime soon, I will be apologizing for a mistake, mis-step, or snaful. Sometime soon, I will ask for forgiveness from someone I just met, or someone I love dearly.”
ADHD sufferers go through life with one consistent, and that is, nothing is consistent because of their condition. People with ADHD find themselves constantly apologising to a world that still cannot understand this condition. Despite all the breakthrough research that shows that ADHD is a real condition, there are people in society, educators included, who would rather deny that the condition exists than to ensure that every ADHD individual gets a fair shake in life. That ADHD individual is not stupid. He has the same potential as the non-ADHD child but the ADHD child needs us to ensure he gets the needed treatment and intervention. He needs us to make accommodations so that he has the same degree of chance to succeed as his peers.
So, I cannot say this enough. It was utterly irresponsible for theasianparent.com to have allowed an article like this to be published. This online resource has over 60,000 email subscribers and 96,075 followers on Facebook. It should be raising awareness of and educating members about the facts of ADHD, and helping to correct the misconceptions about the condition and not add to and perpetuate myths that might hinder whatever help, accommodations, and understanding, that our children could get from their teachers, parents, and any environments that these children might find themselves in.
I read the profile of Miss Marican, the writer of the article in question and it describes her as a “creative writer, tutor, and full time babysitter” and that she picked up writing as an undergraduate while in University. May I suggest that in the future, theasianparent.com choose writers who are proficient in the subject that they are writing about, and not choose a “creative writer” who creates damaging assumptions that ADHD is curable, that one has to be “cruel to be kind” to a person with ADHD, and that it is better to eat healthily and exercise than to consume medication that may be effective for the ADHD individual. Please leave intervention strategies to the specialists, especially when we are talking about a serious condition here with very serious ramifications for the ADHD individual, now and in the future, and perhaps, Miss Marican can write about creative tutoring or creative babysitting.
ADHD and The Brain
Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder Fact Sheet
Bringing Up Bébé: One American Mother Discovers the Wisdom of French Parenting
Bringing the ADHD Debate Into Sharper Focus: Part 1
Bringing the ADHD Debate Into Sharper Focus: Part 2
Do Children in France Have ADHD?
Executive Functions in ADD/ADHD Adults
Following Directions. How Hard Can That Be?
French Kids Do Have ADHD: An Interview
French Kids Don’t Have ADHD? Well, Mine Does.
Functional Disconnection Identified Between Key Brain Areas in Children with ADHD
How ADHD Affects Learning
Living Your ADHD Courageous Life
Of Course French Kids Have ADHD: Epidemiological evidence suggests that ADHD is not a US phenomenon
The Grown-Up Guide to ADHD
Understanding Attention Deficit: The New ADHD
What Is Executive Function?
Why French Kids Don’t Have ADHD
Why French kids have low ADHD rates