Why is the percentage of kids diagnosed with ADHD so high in places like America, but almost 0 in places like France?
An important thing to understand about mental illness is that it’s defined in relation to the society in which the patient lives. Some cultures may regard ADHD as a personality trait, and some cultures may recognize the cluster of symptoms as being a distinct “thing”, but due to the way the society is set up it isn’t a “disorder.” For anything to qualify as a mental disorder it has to interfere significantly with your life.
I’m a good example. I sailed through high school and college without trying, earning decent grades just by paying attention to lectures and turning in reasonably good work on time. I was chronically disorganized, but thought of it as a personality trait; my thoughts are structured in a weird way and I make connections between things that others don’t see. I thought I was just weird.
Well, around 30 I entered grad school and went to a counselor because I was extremely stressed and overwhelmed, and wanted to figure out how to cope with that. Also I had some historical shit to work out. But, when I was describing my situation he suggested ADD as a possibility and referred me out for diagnosis. Sure enough, I’ve got ADD-PI, the non-hyperactive type of ADD. Although I can see it everywhere in my life up to now, it was never clearly the cause of my problems earlier on. I was able to brute force my way through school on raw intelligence and an ability to sponge up info from lectures.
That wasn’t enough for my current program, which has us taking 7 classes at once in topics ranging from “Pathology of musculoskeletal disorders” or “Clinical management of cardiopulmonary disorders” to statistical analysis & how to read an academic paper. There was one day when we started the morning learning massage techniques and ended the day with an overview of medications for diabetes. There’s no way in hell a person with undiagnosed ADD can do well without other aspects of their life going to shit.
Now, I mentioned that other societies are set up differently and the cognitive differences exhibited by an ADD-type person might have a place in that society. From what I’ve heard, France doesn’t have the expectation that everyone should get a University degree. Trade schools are an option available some time around or after High School, and are completely socially acceptable. A person with high dexterity, excellent spatial skills, but maybe little patience for things like reading and classroom lectures would be able to find a place early on where they could learn by doing, in a hands-on and active environment. In the US, though, Everyone Must Get A BA Or They’re Doomedtmso anything that stands in the way of that rises to the level of Disorder.
Also, and this is a bit of a random aside, the reason people think ADD is overdiagnosed is that the disorder has a name that sounds descriptive but is totally inaccurate. ADD isn’t a lack of attention, it’s a lack of control over attention; to complicate matters further, it’s also one of those diagnoses that has become a bucket of similar-looking issues with different root causes. Perception of time (specifically “The ability to place oneself on a timeline”), the ability to organize thoughts, the ability to remember that you decided you wanted to do something and then actually do it, any of these can be lacking for a person with ADD. There’s also a tendency towards frustration that can make a student with ADD fail a written exam, but demonstrate complete and utter mastery of the exact same material if you just have a conversation. There’s also difficulty recalling memories specifically, which combined with the poor perception of time makes self-reflection extremely difficult. There also are ADD patients for whom it’s impossible to anticipate the feeling of satisfaction you get from completing a project, which ends up looking like laziness or a lack of motivation; or it results in trying a bunch of things and putting them down when they get difficult or boring. This is only scratching the surface of the working memory deficits that, in any combination, count as ADD.
The cruelest impairment of all is that a lot of the time a person with ADD knows exactly what they’re doing wrong, and exactly what they should do differently, and nevertheless is totally incapable of implementing those changes. You know you need to stick with a schedule, for example, or keep a notebook to write everything down in, but maybe you neglect to enter something in your calendar, forget your notebook somewhere, or you ignore calendar alerts if you’re doing something else at the time (And you’re ALWAYS doing something else).
Anyway, ultimately there’s a good chance that so many people in the US are diagnosed with ADD compared to other countries because American society has begun to expect totally unrealistic levels of performance from everyone. It’s sort of a mis-application of the concept that “all men are created equal.” That simply isn’t true. It should be true under the law and with regard to rights (which I believe is an unspoken bit of context people forget about), but people are born with different strengths and weaknesses. American society, or at least the public & higher educational systems in the US, refuse to see that & truly guide students toward fields they are suited to.