Is Europe Doing a Better Job of Treating ADHD Than the U.S.?
Previously, there was a huge stigma attached to ADHD in Europe. Several advocate groups are working to give kids access to better diagnosis and treatment.
We raised a son with ADHD, from toddler to teen, in various European countries, and our American family not only observed the evolution of European attitudes about ADHD, we lived with them. We floundered in Switzerland trying to find a doctor who had experience diagnosing and treating ADHD. We had difficult conversations with school administrators and teachers who had no training and no legal obligation to provide school accommodations. In the 1990s and 2000s, knowledge about ADHD in Europe was uneven and stigma was high. Particularly painful for our family, ADHD was often dismissed as an American medical fad.
At that time, strong advocacy organizations and blockbuster books had raised awareness about ADHD in the United States. The 1990 Individuals with Disabilities Act (IDEA) required American public schools to grant equal access to students with ADHD and to provide additional school accommodations. American scientists and doctors led much of the initial research about ADHD. U.S doctors diagnosed ADHD with the broader guidelines established by the American Psychiatric Association. EU (European Union) Member States, meanwhile, used a patchwork of different national guidelines or World Health Organization guidelines. In many European countries, doctors had limited clinical experience using those guidelines.
ADHD Around the World
Attention deficit/hyperactivity disorder sounds little different depending on where you live, even though the symptoms are the same. Here’s a sample:
Trouble du déficit de l’attention avec ou sans hyperactivité (TDAH)
Das Aufmerksamkeitsdefizitsyndrom ohne Hyperaktivität (ADHS)
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Transtorno do Déficit de Atenção e Hiperatividade (TDAH)
Things Have Changed
European attitudes about ADHD are changing significantly. European institutions now estimate that at least 3.3 million children (1 in 20) in the European Union have ADHD. European institutions are quantifying the health-care, educational, and justice system costs of leaving ADHD untreated.
European doctors and scientists increasingly lead global ADHD organizations, such as the World Federation Congress. At its fifth meeting in Scotland in May 2015, several panels addressed cutting-edge research in the diagnosis and treatment of ADHD. In July 2015, the EU approved the first ADHD medicine through its centralized authorization drug approval process, Intuniv, an alternative to stimulant medication.
ADHD Europe has emerged as a Europe-wide advocacy organization. ADHD parent support and Facebook groups now exist in every one of the 28 EU Member States. As a parent in Europe, it is encouraging to point to official recognition of ADHD and to team up with other parents to share tips and strategies.
The commitment of European ADHD advocates is impressive. Hypersupers, a group of French parents and adults concerned about ADHD, have worked since 2009 to urge the French medical community to engage effectively on ADHD. In March 2015, the French Haute Autorité de Santé (HAS), an important skeptic of ADHD, finally acknowledged that inattentive ADHD is a legitimate subtype of the disorder.
Europe-wide policies to address ADHD are starting to emerge, as well. In 2007, the European Parliament adopted a statement calling on EU institutions and policy makers to devote more attention and resources to ADHD. The Interest Group on Mental Health, Welfare, and Brain Disorders is working to ensure that ADHD remains on the EU health agenda.
More to Be Done
However, Spanish parliamentarian Rosa Estaràs Ferragut believes that much more work needs to be done on awareness, the medical system, schools, and families. She says, “It is necessary and right that we address this issue that affects so many people in Europe and that we can provide solutions from EU institutions and encourage national authorities to do the same.” She is particularly concerned that ADHD leads to failure in school and, consequently, social isolation of children. She points out that EU educational systems are often at a loss about how to deal with ADHD.
Simultaneously, the Council of Europe, which represents 820 million people in 47 countries, from Ireland to Russia, is also working on ADHD. Silvia Bonet Perot, a former Health Minister of Andorra, guided a March 2015 resolution on ADHD through the Council. The Council began work in 2002 seeking to control the diagnosis and treatment of ADHD. By 2015, it wound up in a much different place: ensuring that ADHD is treated comprehensively throughout the lifespan of children and adults.
The resolution acknowledges that ADHD is likely undertreated due to inadequate training of care providers, inequalities of access to care, stigma, and misconceptions about ADHD. European governments are encouraged to use a comprehensive approach for the treatment of ADHD – behavioral management skills, academic support, psychological support, and medicine as “a measure of last resort.” The Council resolution helps to give continental coherence to formerly scattered, country-based policies on ADHD.
We parents are anxiously waiting to see how these principles will be put into practice. Estaràs Ferragut is pressing for more financial resources for schools for teacher training and to develop individualized school interventions. Bonet Perot expects concrete progress at the national level in one to two years. In future work, the Council of Europe may promote more research on alternative treatments and “put greater stress on the role of schools in creating a comprehensive support system for ADHD families,” a model she says that works in places like Sweden.
Both EU and U.S. governments urge parents to provide comprehensive treatment for their children. As a mom who has faced the exorbitant costs of counseling sessions for my child and private behavioral management training programs for me, I am interested in whether European countries will help parents piece together comprehensive treatment in an affordable way.
There are some encouraging signs. The European Parliament is proposing that more resources be provided to parents raising kids with ADHD. The United Kingdom’s National Institute for Health and Care Excellence (NICE) already includes as part of medical treatment for ADHD, behavioral management training to parents or caregivers to improve their ability to help their child with ADHD. Similarly, German authorities ensure that pediatric centers and special education centers offer specialized ADHD parent training.
The emphasis on families, and the investments that some European countries have made in families who are coping with ADHD, gives me hope that European countries are not only catching up with the United States, but, in some cases, might even go further. I look forward to watching where Europe’s ADHD policy pioneers go next.