ADHD - 왜 프랑스에는 미국보다 ADHD 가 훨씬 적은가?

[하토브]

다음의 글을 흥미롭게 읽었습니다. 모두 번역하지는 못하지만 요점만 전한다면,

전하는 바에 의하면 미국인들중 9% 정도는 바로 이 ADHD 주의력 결핍증에 걸려 있다고 합니다. 반면에 프랑스에서는 겨우 0.5% 미만이 이 질환에 걸린 것으로 추산한다고 합니다.

미국에서는 ADHD를 생물학적, 신경외과적 질환으로 보고 그것을 치료한다는 것입니다. 그리하여

여러 종류의 약물들을 투약합니다.

반면에 프랑스에서는 이 질환이 어린이들의 심리 사회학적인 문제로 보고, 무엇이 그런 질환을 유발시켰는가 하는 환경분석과 원인제거 등에 집중합니다. 어린이가 어떤 음식을 먹고 알레르기 반응을 겪었는가? 어떤 인조 색소나  방부제가 섞인 음식을 먹었는가? 영양상으로 무엇이 결핍되엇는가? 등도 점검대상이며, 스포츠나 피아노 레슨 등으로 인도하기도 합니다. 프랑스인 부모들은 자신들의 자녀를 사랑하지만 필요시에는 훈육을 한다고 합니다( 매로 때리는).

제 소견으로는 이런 점들이 미국에서는 어린이가 조금만 행동발달상 이상 징후만 보여도 약물을 투입하게 한다음 그 약물에서 깨어나면 다시 이상징후를 보이기 때문에 또다른 약물을 투입하고 계속하여 약물의 노예가 되게 하는 사회 습관과 제도보다 프랑스의 관행이 낫게 보입니다.

The case against labeling and medicating children, and effective alternatives for treating them

by Marilyn Wedge, Ph.D.

Why French Kids Don't Have ADHD

French children don't need medications to control their behavior.

Published on March 8, 2012 by Marilyn Wedge, Ph.D. in Suffer the Children

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In the United States, at least 9% 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 less than .5%. How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France?

Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on whether you live in France or in the United States. In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes. The preferred treatment is also biological--psycho stimulant medications such as Ritalin and Adderall.

French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children's focusing and behavioral problems with drugs, 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. They then choose to treat the underlying social context problem with psychotherapy or family counseling. This is a very different way of seeing things from the American tendency to attribute all symptoms to a biological dysfunction such as a chemical imbalance in the child's brain.

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French 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. According to Sociologist Manuel Vallee, the French Federation of Psychiatry developed an alternative classification system as a resistance to the influence of the DSM-3. This alternative was the CFTMEA (Classification Française des Troubles Mentaux de L'Enfant et de L'Adolescent), first released in 1983, and updated in 1988 and 2000. The focus of CFTMEA is on identifying and addressing the underlying psychosocial causes of children's symptoms, not on finding the best pharmacological bandaids with which to mask symptoms.

To the extent that French clinicians are successful at finding and repairing what has gone awry in the child's social context, fewer children qualify for the ADHD diagnosis. Moreover, the definition of ADHD is not as broad as in the American system, which, in my view, tends to "pathologize" much of what is normal childhood behavior. The DSM specifically does not consider underlying causes. It thus leads clinicians to give the ADHD diagnosis to a much larger number of symptomatic children, while also encouraging them to treat those children with pharmaceuticals.

The French holistic, psychosocial approach also allows for considering nutritional causes for ADHD-type symptoms—specifically the fact that the behavior of some children is worsened after eating foods with artificial colors, certain preservatives, and/or allergens. Clinicians who work with troubled children in this country—not to mention parents of many ADHD kids—are well aware that dietary interventions can sometimes help a child's problem. In the United States, the strict focus on pharmaceutical treatment of ADHD, however, encourages clinicians to ignore the influence of dietary factors on children's behavior.

And then, of course, there are the vastly different philosophies of child-rearing in the United States and France. These divergent philosophies could account for why French children are generally better-behaved than their American counterparts. Pamela Druckerman highlights the divergent parenting styles in her recent book, Bringing up Bébé. I believe her insights are relevant to a discussion of why French children are not diagnosed with ADHD in anything like the numbers we are seeing in the United States.

From the time their children are born, French parents provide them with a firm cadre—the word means "frame" or "structure." Children are not allowed, for example, to snack whenever they want. Mealtimes are at four specific times of the day. French children learn to wait patiently for meals, rather than eating snack foods whenever they feel like it. French babies, too, are expected to conform to limits set by parents and not by their crying selves. French parents let their babies "cry it out" if they are not sleeping through the night at the age of four months.

French parents, Druckerman observes, love their children just as much as American parents. They give them piano lessons, take them to sports practice, and encourage them to make the most of their talents. But French parents have a different philosophy of discipline. Consistently enforced limits, in the French view, make children feel safe and secure. Clear limits, they believe, actually make a child feel happier and safer—something that is congruent with my own experience as both a therapist and a parent. Finally, French parents believe that hearing the word "no" rescues children from the "tyranny of their own desires." And spanking, when used judiciously, is not considered child abuse in France. (Author's note: I am not personally in favor of spanking children).

As a therapist who works with children, it makes perfect sense to me that French children don't need medications to control their behavior because they learn self-control early in their lives. The children grow up in families in which the rules are well-understood, and a clear family hierarchy is firmly in place. In French families, as Druckerman describes them, parents are firmly in charge of their kids—instead of the American family style, in which the situation is all too often vice versa.

Copyright © Marilyn Wedge, Ph.D.

Marilyn Wedge is the author of Pills Are Not for Preschoolers: A Drug-Free Approach for Troubled Kids

Website:  MarilynWedgephd.com

Twitter: marilyn Wedge

Facebook: www.facebook.com/pages/Marilyn-Wedge

Be sure to read the following responses to this post by our Bloggers:

French kids do have ADHD. An interview with Elias Sarkis M.D.

by Stephanie Sarkis, Ph.D.

As our society evolves, people with ADHD have an increasingly difficult time.

by Monnica T. Williams, Ph.D.

http://www.psychologytoday.com/blog/suffer-the-children/201203/why-french-kids-dont-have-adhd