ADHD in Europe, Canada and Turkey

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder that begins in childhood and can last throughout life, characterized by difficulty focusing, impulsivity and hyperactivity. However, this diagnosis is not made the same way in every country, nor is it treated the same way. Especially in countries with developed health systems such as England, Germany and Canada, the approach to ADHD is quite different from Turkey in some aspects. Let's get to know these differences more closely.

Diagnostic Process: Just Symptoms Are Not Enough, Functionality is a Must

Diagnosing ADHD in the UK involves a very comprehensive process. According to NICE guidelines, only specialist psychiatrists or trained health professionals can make a diagnosis. When diagnosing, the child's behavior is observed at home, school and social environments, and various rating scales are used. So just being "very active" is not enough for a diagnosis of ADHD; It also looks at how much these behaviors disrupt the child's functionality.

In Germany, the diagnostic process is similarly multidisciplinary. Pediatricians, psychiatrists and psychotherapists work collaboratively. International diagnostic criteria such as DSM-5 or ICD-10 are used as a basis, but when making a diagnosis, not only the child but also the family and school environment must be evaluated.

In Canada, according to CADDRA (Canadian ADHD Resource Association) guidelines, the diagnosis is made by specialist doctors, but the process is very patient-oriented. A multidimensional evaluation is made using teacher and parent evaluation forms, functional loss scales and individual interviews. The Canadian system, in particular, places great emphasis on how an individual's ADHD symptoms affect their daily life.

In Türkiye, the diagnosis process mostly proceeds through child and adolescent psychiatrists. However, due to the density in public hospitals, evaluations can be kept short. Teacher or school evaluation is not always included. Although the process is faster in private hospitals, this can create a serious financial burden for families.

Treatment Approach: Therapy or Medication First?

In the UK, the first step in ADHD treatment is usually psychoeducation and parent support programs. Drug treatment is not immediately recommended, especially for mild and moderate ADHD. For these children, it is preferred to start with cognitive behavioral therapy, social skills training and classroom arrangements. But in cases of severe loss of function, medication comes into play — though always in conjunction with therapy.

Germany follows a very similar path in this regard. Psychoeducation, individual and group therapies, family counseling and school supports come first. Germany has also implemented alternative therapies such as neurofeedback. Drug treatment comes to the fore if the therapy is insufficient or the symptoms are severe. These treatment approaches are more accessible thanks to the country's holistic healthcare system.

Canada, on the other hand, seems to be a more “drug-focused” system, but it is actually quite balanced. Medication is often offered as a first step, especially if child or adult ADHD is severe. However, this does not mean that therapy is neglected. In Canada, therapy is almost always part of the treatment plan. Methods such as parent training, social skills training, mindfulness and cognitive behavioral therapy are carried out together with medication. Individualized education plans are also common in schools.

In Türkiye, the picture is a little more limited. Medicine is usually the first choice in treatment. Access to therapy is quite limited, especially in public hospitals; Appointment systems are inadequate and session numbers are limited. Receiving private therapy can be a serious financial burden. Support programs for parents and school-based interventions are not yet systematic and are often left to the initiative of teachers.

So, Who Uses How Much Medicine?

One of the most striking differences between these countries is the approach to drug use. In Canada, drugs, especially methylphenidate and amphetamine derivatives, are frequently used but carefully monitored. Regular monitoring is done for side effects and doses are adjusted meticulously. England, on the other hand, handles drug use more cautiously; Medication is given only in severe cases and if therapy is inadequate. Similarly, Germany recommends therapy first, with medication only being used if therapy does not work.

In Türkiye, medicine generally comes first. However, a systematic therapy or side effect monitoring process following the drug cannot always be applied. This can sometimes result in an incomplete treatment process based on medication alone.

Common Points and Lessons That Türkiye Can Learn

Diagnostic criteria are similar in all countries: DSM-5 or ICD-10 is used. Stimulant drugs (methylphenidate, atomoxetine, etc.) are the common choice. Psychoeducation, family support and individual therapy are seen as effective treatment tools almost everywhere.

But the areas where Türkiye needs to improve are quite clear:

• A more comprehensive and multidimensional approach in the diagnostic process,
• Free or low-cost access to psychotherapy
• Systematic support and individualized plans in schools,
• Dissemination of parent education and awareness programs.

Final Word: Geography Makes a Difference, But Support Saves Lives

ADHD is a manageable disorder when understood properly and provided with appropriate support. Canada's holistic system, Germany's therapy-oriented structure and England's gradual approach show us that the environmental and psychosocial support that accompanies treatment is as vital as diagnosis. Every step that Turkey takes on this path will improve the quality of life not only of children, but also of families and teachers.

References

Canadian ADHD Resource Alliance (CADDRA). (2020). Canadian ADHD Practice Guidelines (4.1 ed.). Toronto, ON: CADDRA. Retrieved from https://www.caddra.ca
 → Diagnostic criteria in Canada have been used for medication and psychosocial treatment approaches.

National Institute for Health and Care Excellence (NICE). (2008). Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults (Clinical guideline 72). London, UK: NICE. Retrieved from https://www.nice.org.uk/guidance/cg72
→ Essential resource for diagnostic criteria, treatment principles and educational support in the UK.

Banaschewski, T., Döpfner, M., Grosse, K. P., & Hohmann, S. (Eds.). (2018). Attention-Deficit/Hyperactivity Disorder (ADHD) in children, adolescents and adults: Long version of the interdisciplinary evidence- and consensus-based (S3) guideline. AWMF Guideline No. 028-045. Retrieved from https://www.awmf.org
 → The multidisciplinary diagnostic process in Germany has been used for therapy prioritization and comprehensive approach.