In 2019, the Quebec government, concerned about the increase in the number of diagnoses of attention deficit disorder with or without hyperactivity (ADHD), held a parliamentary commission to shed light on the situation. The results revealed were indeed staggering.
We learned, in particular, that the use of psychostimulants – medications grouped, in common parlance, under the term “Ritalin” – had doubled among young people aged 10 to 12 between 2006 and 2015. Even more surprising, these medications were three times more prescribed in Quebec than in the rest of Canada.
Are Quebec children doing worse than others? To explain this discrepancy, the Minister of Health, Christian Dubé, alleged that the training of local doctors helped them to carry out faster and more informed screenings, which would have an impact on this increase in prevalence.
For child psychiatrist Céline Lamy, this hypothesis does not hold water. In the test The drama of perfect childrenshe offers a vibrant plea against the overdiagnosis of psychiatric disorders and the overmedicalization of children.
With fifteen years of practice, first in France, then in Quebec, in the Laurentians and on the North Shore, she delivers some of her clinical observations to demonstrate all the consequences of pathologizing discourses on younger generations. “Because if we often wonder what planet we will leave them, it is also relevant to ask ourselves what children we will leave our planet,” she writes.
From intensive agriculture to permaculture
To change the situation, Dr. Lamy suggests completely reviewing our way of educating our children, which she currently compares to a system of intensive agriculture and livestock breeding.
“From birth, parents are given the injunction to raise, educate and help their children grow into good, productive little citizens. These principles of course start from a good intention, but this intention is biased by normativized social injunctions. If the child steps out of line and does not grow within the prescribed behavioral or temporal guidelines, we call on “agridoctors” to find what we can offer the little shoot so that it grows. correctly. We use stakes and fertilizers, as in intensive agriculture, in order to create calibrated and standardized products. »
To explain this overmedicalization of children, Céline Lamy points out the way in which the Diagnostic and Statistical Manual of Mental Disorders (DSM), a work which lists all psychiatric disorders, and which is widely used in Quebec. When it was published in 1952, around 60 different pathologies were listed. Each new version contains new disorders – homosexuality was also introduced in 1968, before being removed a few years later. For each disorder, a number of criteria are established that the patient must meet in order to make a diagnosis.
Access to child psychiatry is very limited in Quebec. Front-line caregivers will try to intervene differently for as long as possible, but, after months of waiting, it is sometimes necessary to put out the fire with medication.
In 1980, the third version of the manual marked a turning point, according to the essayist. “Since then, we have adopted a biomedical model, which refuses to consider the meaning of the symptom. We no longer need to enter into contact with the patient and their loved ones. We do not take note of his experience, of the environment in which he grew up, of transcultural differences. If enough symptoms are observable, a diagnosis can be made. Little by little, we added psychiatric disorders which are pathologizations of life. Too long a mourning becomes a pathological mourning. An angry child is labeled with intermittent explosive disorder. We do not take into consideration the fact that a child’s disproportionate emotions are also due to strong physiological immaturity. »
Immaturity does appear to play a role in the prevalence of the diagnosis. According to a study published in 2023 by researchers from UQAM, which the child psychiatrist cites in her essay, ADHD diagnoses amount to 20.8% among the youngest within the same class compared to 15.4%. among the oldest. The research also concludes that ADHD is often confused with “inattentive or more turbulent behaviors.”
Review the systems
According to Céline Lamy, the glaring lack of resources is a factor in overmedication and overdiagnosis. “Teachers have their hands full, and the teaching imposed on them is not adapted to the needs of young people. Result ? They pressure parents to find a solution to their child’s behavior. However, access to child psychiatry is very limited in Quebec. Front-line caregivers will try to intervene differently for as long as possible, but, after months of waiting, it is sometimes necessary to put out the fire with medication. »
For the child psychiatrist, it is essential to overturn the educational, school and parental systems, which fail to respect the temporality of childhood. “We are in the process of shortening the time of childhood to make children autonomous, resourceful, independent and mature. However, this vision is incompatible with the natural development of children, who are more unhappy and anxious than ever. We must stop trying to fit them into the mold of a capitalist, productivist and individualist system that has pushed us to the limit. As a parent, we must return to our child, look at him, go to meet him, slow down. »
To do this, she advocates a medical approach focused on the bond with the patient, and teaching that leaves aside performance to make more room for free play and in nature, which promotes learning. She also believes that parents must be made aware of the principle of secure attachment from pregnancy onwards, which allows the child to establish healthy relationships and explore their environment with confidence. “We have every interest in reconnecting with our inner child, to see the world from their point of view. »