ADHD Beyond Borders

This past semester I have been studying abroad in Copenhagen, Denmark. Living here has been a social experiment, immersing myself in a welfare state with progressive values. I have explored all over Europe as well, visiting thirteen countries and many more cities in my short time here. As the semester nears its end, it has come to my attention that ADHD, and many other neurological disorders, are viewed quite differently internationally than they are in the United States. A recent article by the New York Times details varying accounts of parents around the world who have experienced stigmatization and other difficulties surrounding their children’s ADHD diagnosis.

In Argentina, Olga Elizabet Abregu, mother of Santino, 8, testifies: “Here where we live no one knows about A.D.H.D., and the few people who’ve heard of it say they don’t believe in it, that it’s only rude kids without limits.”

In Georgia, stimulants are banned, so unless parents can smuggle the medications like Adderall and Ritalin from nearby Ukraine, children are left with neurologists’ prescriptions for sedatives and other drugs, typically used to treat dementia and psychosis: “They make the children dumb — I really feel sorry for them,” Nino Jakhua, mother of Nikoloz, 6, said.

In Istanbul, Sinan’s parents could not cope with the maltreatment of their son and his ADHD any longer. They moved him to a private school in Utah, paying $10,000 a year for fair treatment.

“In Germany,” one mother, Ms. Oedell, says, “it’s really not accepted to be different. Either people say ADHD. doesn’t exist, or they make it seem like some terrible moral problem.”

In Japan, the only stimulant permitted is methylphenidate, but all stimulants are treated as narcotics.

Studying abroad here in Copenhagen, however, I’ve experienced a different perception of ADHD. Maybe it’s the Scandinavian progressivity or the socialist welfare state, but Danish ADHD is not stigmatized like it is in the rest of Europe. It is however, over-diagnosed and over-medicated, according to my professor in “The Social Brain,” named Lone: “It’s so normal now. I’ve noticed in my practice as a neuropsychologist that parents come up to me and ask for advice all the time. It’s like asking about the weather.” However one of the problems she sees is Denmark’s over-acceptance of the disorder. Education is free and schools are now adopting an “inclusion” policy, whereby all kids, even those with special needs, are to be given appropriate accommodations. “Because ADHD is so common, kids with ADHD are no longer considered special because it’s too prevalent to accommodate so many children…we lose specificity and ADHD is no longer considered a real problem.” In contrast with other European countries, Denmark’s lack of stigmatization of ADHD has almost lead to trivialization.

All over the world, discrimination and misperception of ADHD threaten the well-being of patients and their families. Despite the international attitude towards ADHD, the number of diagnoses has soared in recent years. A recent meta-analysis revealed that the amount of children with ADHD worldwide hovers rather consistently around 5.29%. The authors concluded, “Our findings suggest that geographic location plays a limited role in the reasons for the large variability of ADHD prevalence estimates worldwide.” The recent rise in ADHD diagnoses worldwide is staggering. While in 2007, the international community accounted for 17% of the world’s use of Ritalin, by 2012 that number had doubled. Certain countries in particular have experienced dramatic increases. The number of prescriptions for stimulants in the UK rose by more than 50% in the same time period. Germany’s diagnosis rate rose 381% from 1989 to 2001. The international market for ADHD drugs now tallies at more than $11 billion.

Unfortunately, in most countries, higher incidence of ADHD does not mean that the disorder is becoming more accepted. As diagnoses increase, public perception, education policy, medicine and insurance policy all remain stagnant, inhibiting proper care and treatment. Nessa Childers, co-chair of the European parliament’s mental health, well being, and brain disorders interest group, insists, “We all have to go back to our member states and publicize this situation (for ADHD sufferers)”. She went on to say, “ADHD is one of the most neglected and misunderstood psychiatric conditions in Europe.” The call to action is often drowned out by more pressing political matters. Another option may be to appeal to the academic community. More scientific studies and legitimate research may sway some of the international community’s opinions and highlight the importance of acceptance and proper treatment surrounding ADHD. Given the taboo surrounding stimulant medication in many countries, psychosocial treatment is typically endorsed. Alternative treatments and therapies may find faster and more widespread traction internationally than here in America. Maybe the international community would be interested in NEURO+!