ADHD: The disease may have different views and approaches in the world
Attention Deficit Hyperactivity Disorder (ADHD) is a potentially serious condition that affects children and adults around the world. A group of experts criticizes "superdiagnosis and supermedicalization" of ADHD, thus creating controversy in the medical environment.
Although ADHD has been very well described since the seventeenth century, there are still doubters of its existence. In Brazil and the world, 5-9% of children and young people have ADHD, except France, whose prevalence is much lower, 0.5-1%. Why so much difference? The main reason is certainly due to the classification system used in each country. France does not use the same classification system of mental disorders used in the United States, the DSM. In 1983, the French Federation of Psychiatry created its own classification system in opposition to the DSM, updated in 2000 and that only prioritizes the psychosocial and cultural causes underlying the symptoms and not the pharmacological ones, which for the French "mask" the symptoms. In contrast, the US prioritizes neurobiological psychiatry and drug treatment.
As French physicians can repair the social context of children, fewer children are diagnosed with ADHD. Psychiatrist Elias Sarkis of the APA said that the concept of ADHD as a serious disorder is not yet fully accepted in France and that its prevalence affects 3.5% of the French population and not 0.5% as mentioned above. For the specialist also in France it is difficult for parents to obtain evaluation and treatment for their child's ADHD, taking 8 months to get 1 specialist consultation and it may take another 8 months to get the medication.
There, the child who has " excellent parenting, good family structure and clear expectations of parents "may mitigate the behavior of the disorder, but" will pay the price for getting more anxious and internalizing the problems, "explains the specialist. For him, ADHD tends to be very harmful for children who do not receive medicine and who also do not have a structured creation. Research using similar diagnostic methods shows similar prevalences of ADHD in different cultures such as South America, Europe, India and the United States. And when not, the motive is due to the methodological inequalities of the studies.
For the expert Sergeant, ADHD should be treated as soon as possible, because "a carrier who has not developed its full potential due to lack of treatment can never reach his goals, how to enter the university. "Manuel Vallee, an anthropologist and sociologist at the University of Berkeley, California, is looking at the American and French look at ADHD. He explains that until the 1970s American psychiatrists practiced psychoanalysis and thus looked upon the symptoms of disease as signs to be understood and studied rather than as problems in themselves. In the 1980s, biological psychiatry gained power in the US and began to prioritize the treatment of symptoms. On the contrary, in France, biological psychiatry does not have this power and psychiatrists are trained in psychoanalysis, which creates fundamental differences in the concept of the disorder. Thus, in the United States ADHD is a neurobiological condition and in France a disorder of psychological effect, due to a trauma or the environment, whose treatment is psychological therapy, family counseling, group therapy, finally, a holistic look. Consequently, in the American system, the number of ADHD diagnoses increases by 5 times.
In France, ADHD is considered one of the most difficult diseases to diagnose, and this process is extensive and rigorous, with prior analysis of all options to arrive at the diagnosis and last from 8 to 24 hours, during which they choose to offer evaluation with psychotherapist, social worker and multidisciplinary team. And the French doctors never use the medicine alone.
In the United States, the average time of diagnosis in the child is 45 minutes. There, ADHD is dominated by pediatricians, who prescribe 70% of the drugs consumed by children. In general, they do not even send the child to a psychiatrist and this is complicated because there are other factors involved in ADHD. Doctors know that US law only reimburses a 45-minute consultation.
We see that the treatment of ADHD is very different in the US and France. In the US, parents who want a holistic treatment (therapy and counseling) have to pay, and this is very expensive. One of the reasons why France offers holistic treatment is because the government pays 85% of it.
Meanwhile in Brazil
In Brazil, ADHD is known to be a neurobiological disorder, in this case a dysfunction in brain circuits and neurotransmitters such as dopamine and adrenaline. It is considered potentially serious, genetic (with high heritability), evolving with symptoms throughout life in more than half of the cases.
The diagnosis is clinical and multifactorial, taking into account the detailed history of the person (including childbirth and gestation), neuropsychomotor development, family history, symptoms, social and family context, schooling, presence of comorbidity, degrees of heritability and of injury and suffering caused, and others.
There are almost 4 million of Brazilian children and adolescents suffering from ADHD and unfortunately the vast majority are underdiagnosed and under-treated. Because it is so heterogeneous, it requires, on average, personalized care and a minimum of 3 to 4 one hour consultations for the definitive diagnosis. In the presence of comorbidities, more time may be needed.
The public health system and health plan covenants are not prepared for this. The first line treatment is medicated, with the use of psychostimulant. The most effective therapy is cognitive behavioral therapy. Some cases will need treatment with professionals from other areas. Unfortunately, the cost of ADHD treatment goes far beyond the financial conditions of the vast majority of families. It is essential that the problem be more publicized and correct in society and that public policies be created in this regard.
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