ADHD: Proximate vs. Ultimate

Ram across this Psychology Today article in my Internet travels.  All of us, I am sure, have some connection to a kid who has behavioral issues, and who has been formally diagnosed or is thought to have ADHD.

Turns out that there seems to be a strong cultural component:

In the United States, at least 9 percent 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 percent. How has the epidemic of ADHD—firmly established in the U.S.—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 U.S. 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.

As in all things, we need to look for the ultimate cause, not the proximate cause.  In other words, my father, for example, died of congestive heart failure.  That's what his death certificate says.  But that was just the proximate cause...the ultimate cause was a lifetime of poor habits and poor choices.

I'm not a doctor, so the situation is obviously complex and multi-layered.  But it sure seems that with ADHD, drug treatments would deal only with suppressing the proximate undesirable behaviors, while ignoring the ultimate psycho-social causes.