91��Ƶ

I pick up my son most days from school. It’s about a five-minute walk back, which means that he has time to broach approximately 600 subjects. He jumps from topic to topic in the same way that he walks home, which is to say plenty of stops and starts and unexpected zig-zags.

“You know what my two favorite days of the year are, Mommy?” We’d already talked about Legos, his English schoolwork, his teacher’s birthday, and the lack of dessert in his lunch, and we were only halfway home.

“No, what are they?”

“Well, my birthday is one, of course, and then also April 2.”

Why April 2?

“Because it’s World Autism Day! Maybe I should do my presentation next year on April 2, instead of in September.” 

This was his annual presentation on autism. It was one of the highlights of his year. And mine. It was an annual reminder of how far we had come. 

When my son was 15 months old and not hitting certain developmental milestones, the pediatrician referred us to a structure for children under 3, which had resources for early intervention. When I asked about a diagnosis, I was told not to worry about it, that the important thing was to start the interventions now. We didn’t question what we were told – we were too concerned with getting him any help he needed as quickly possible. 

For the next year and half, he would receive both individual and group therapy, designed to help him gain physical and communication skills. 

“What about the autism diagnosis?”  I asked, during our last month there. “Is that something you can do here?”

“Well, yes…” the psychologist said slowly, “but the issue is that if we give him an official diagnosis, then he’s going to be labelled, and then judged by that label. So people won’t give him a chance, because once they hear the word ‘autistic’, they’ll immediately make assumptions.” 

I didn’t push the issue. I’d lived in France for nearly 10 years at that point, but this was my first child. I was unfamiliar with the school system, and completely clueless about how to proceed. 

I made an appointment with the director before the school year started, explaining that my son would be entering Petite Section, and that he’d had early intervention for a year and a half. I told her he knew all his letters, could count up to 100, and had memorized most of the Paris Metro map, but had trouble with interactions and communication. I gave her copies of the therapists’ reports and recommendations, and she told me she would give them to his teachers. It would be fine, she said. The teachers knew how to handle these sorts of situations.

It quickly became clear that it was not fine, and that the teachers had no idea how to handle these sorts of situations. 

A cafeteria worker told me that my son never ate. A playground worker told me he tried to avoid other kids. The teacher’s aide told me he spent recess time walking in circles around the yard.

I made an appointment with his teachers, and asked if they’d looked at the recommendations from his therapists. They had no idea what I was talking about. The director had never passed on the information I’d given her. 

“He should probably only go to school in the mornings,” one of them said. “Maybe just a couple hours per day.”

Cutting my son’s school attendance by 75 percent didn’t seem like a reasonable first step.

“What about support?” I asked. “On our end, we can look into more therapies, and a formal evaluation. What’s the school process when this sort of situation occurs, when it turns out kids need extra help?”

Apparently, permitting the kid come to school only 4 to 8 hours a week was the process. 

They also told me that I should send a dossier to the MDPH, the governmental department responsible for aid to people with disabilities. They would decide whether or not to grant my son an AESH, a person who provides one-on-one assistance. This dossier would take apparently 4 to 6 months to process, and mostly likely an AESH wouldn’t be available until the next year.

I scheduled an autism evaluation for my son, and more therapies. He dragged his feet in the morning when I walked him to school. One evening he burst out “School sad.”

I had another meeting with the teachers. One of them told me, “You know, the Education Nationale is going to be very difficult for him,” which at the time seemed like an offensive and premature judgment – he was only three! Now I see it more as a statement of fact. She was right. It was going to be difficult for him. The system is simply not set up for kids who diverge from their norm. 

So two months after he’d proudly put his stuffed dog into his new owl-covered backpack and found his name on the student list in his classroom, we withdrew him, and enrolled him in a private school. It was 20 to 25 minutes by metro, instead of 5 minutes on foot. It cost almost as much as our rent. 

But it was brand-new, and only had 19 kids. The teachers were kind to him, and encouraging. They asked us for advice, and communicated with us when there were problems. We saw the improvement almost immediately. He ate better; he was more relaxed. He was happy to go to school (“School not sad now!”) He could attend full-time while we sorted out the diagnosis, the MDPH dossier, and the accompaniment arrangement. 

Eventually I would learn all sorts of new terms and new acronyms. AESH. AEEH. EES. GEVASCO. I would meet some parents in similar situations, and others in situations that were exponentially more difficult. I would see how schools so often underestimated the capacity of kids with special needs. I would see how they put these kids into a system designed to make success almost impossible, and then they would blame the kids for their failure. 

And I would see what a difference it made when you found a school that worked. Public or private, it didn’t matter so much, as long as the people there operated with the assumption that every kid had the same right to be there. 

All that was later, though. The diagnosis, the paperwork, the accompaniment. For the moment, it was enough that school was not sad. 

Sweet Home Alabama Part 2 – Jennifer Hua

This is a continuation of our experience sending our daughter to the US for a school year. You can read part one here.

There were still many niggling details left to take care of before Katie left for Alabama.  We informed her orthodontist in the spring that she was leaving for a year and the doctor decided to remove her braces in July, just before she left for the US, and then put them back on when she returned.

Another issue we had to deal with was Katie’s airplane ticket.  We were advised to buy a changeable roundtrip ticket.  Because we purchased the ticket in April, the computer system was unable to program a return date for beyond March of the following year. So, I had to remember to change her return flight a year later so that she could fly back in July, and for a fee, of course.  We were then only limited in that she had to fly back within 365 days of her original flight over to the US.

We also researched temporary travel insurance for her, but it was hard to tell into which category she fell, since she wasn’t a college student, or an adult.  We really couldn’t see a suitable policy for her situation.  Luckily, one unexpected benefit of having signed over guardianship to our daughter’s host family was that she then qualified to be covered under their employer-sponsored family medical insurance, so they simply added her to their policy! 

In the spring we discovered another quirk of the guardianship issue, due to a lack of communication with Katie’s host parents.  Since I had dropped her off at the family’s in late July, I blithely claimed her as a tax dependent on our tax return for that year, thinking that she’d spent the better half of the year with us.  However, over in Alabama, her host parents were told by their accountant that since they had acquired parental rights in mid-June, they should claim her as their dependent.  Needless to say, they were a bit taken aback to receive a letter from the IRS stating that someone else was claiming her!  As it didn’t change our taxation at all, I amended our return, attaching a copy of the court papers.  And, we agreed that they would also claim her for the following year.  I feel very grateful that we had such a good relationship with this family that this could be dealt with without it turning into a big issue.  We never bothered to rescind the guardianship order, figuring that Katie would soon be turning 18 and make it a moot point. 

Katie had a fantastic year in the US.  School, as you might imagine, was a piece of cake, compared to her rigorous French ���⳦é��, even given the language issue in the beginning (her English was good, but not yet fluent.)  She played her clarinet in the marching band, and was even elected prom queen in the spring!  Her family took her camping and boating, and on trips to Civil Rights era sites, Charleston, SC, and NYC.  She learned to play the guitar, and came home with the most charming Southern drawl.

Towards the end of her stay, she began to apprehend her return to the French school system.  The anglais bilingue office at the ���⳦é�� had advised us to consider having her stay in the US for two years, so as to establish residency for Alabama’s state universities.  We thought about it, but weren’t ready to make that step yet.  Because her American cousins and many of her kayaking friends in Alabama were being schooled at home or online, Katie approached us with her idea of doing online school (CNED) after she returned to France.  She wanted more time to spend with her grandparents, do volunteer work, and enjoy life at her pace.  We discussed it and got advice from various people, but ultimately decided it was not a good idea, much to her disappointment.

The return to her French ���⳦é�� was extremely difficult.  She landed in 1ѐre S, in a class of 44 students, most of whom she didn’t know since they were a year behind her.  It took quite a few months before she felt she fit in socially.  By Terminale, she had built up a group of friends, but was still suffering academically.  She had been a stellar student up through 2nde, but forgot much of her science and math while in the US, and struggled to keep up; the long school days and uncertainty of her future studies made for one confused teenager. Luckily, her teachers worked closely with us.

A few years later, we had the great pleasure to welcome her two American host sisters during the Toussaint vacation and show them the sights in Paris and in the French countryside.  I won’t forget driving through one picturesque village in the Vexin on the way to Giverny and being asked if people actually lived there!  The three girls even bought a drawn portrait of themselves together at Place du Tertre in Montmartre– real sisters!  We feel extremely grateful that this family has become true friends of ours.

I hope this may answer any questions you may have regarding logistics involved in sending your child to live in the US.  If you choose not to go with an exchange program, for school enrollment it is likely that your only options will be to transfer guardianship, like we did, or enroll in a private school.  And, I can’t over-emphasize getting in writing the conditions for re-enrollment upon return to France; I know of families that were refused re-enrollment in their zoned school because of overcrowding, and the fact that their child had temporarily left the system.  Despite the rough times since our daughter’s return, she doesn’t regret one minute having gone for a homestay; it is still by far the best way to experience the American culture.

About Jennifer Hua

Jennifer is a stay at home mom to four wonderful children, all now young adults, two of whom were born in France. She also volunteers with 91��Ƶ on the Board of Directors – Executive Committee as our Treasurer.

ADHD in France: Getting a proper assessment and coordinating with your child’s school) – Part 2

In my last blog post, I went through the current state of ADHD knowledge and assessment in France. In this post, I will explain what is involved in an ADHD assessment, and what to expect from French schools.

The following steps are necessary for a thorough evaluation and diagnosis:
1. Interview with parents including the child’s full medical, psychiatric, social and academic history
2. Interview with the child
3. Completion of questionnaires and behavior checklists
4. Psycho-educational assessment (also called psychological or cognitive testing) is also usually advised. If you have gone to a psychiatrist, the testing will be done by a psychologist whom he/she recommends.
5. Classroom observation is also a plus, but it is not commonly allowed in French schools.

Once a diagnosis is made, the psychiatrist will discuss treatment options. Medications available in France are more limited than in the US; only methylphenidate and related molecules (Ritalin®, Concerta®, and Equasym®) are available. Since the first prescription has to be delivered by a hospital service, it is preferable to see someone affiliated with a hospital. A pediatrician, general practitioner, or private practice psychiatrist can then renew the prescription. Once a year, however, the prescription must be updated at the hospital. The psychiatrist will also, based on the information he or she has gathered, order a language evaluation by an orthophoniste (similar to a speech/language pathologist in the US), in order to determine if your child has any language learning issues, since these are often associated with ADHD. In addition, if there is any grapho-motor (handwriting) or visual-spatial problem, a referral for evaluation with a psychomotricienne or psychomotor therapist (similar to, but not exactly the same as an occupational therapist in the US) will be made. If problems are identified by the orthophoniste or psychomotricienne, therapies in these areas will be prescribed. The services of French orthophonistes are covered by French social security, but those of psychomotriciennes are not.

Some psychiatrists will recommend cognitive behavior therapy for the child, usually done with a psychologist or other counselor. They may also recommend guidance parentale or parent training. Recently, there has been increased recognition that these sorts of treatment are important.  One program, called (Programme de parentalité positive), has been translated into French and is available online. Unfortunately, while these kinds of treatments are almost systematically recommended in the US, they are still unusual in France. In addition, they are not covered by social security and so must be paid for out of pocket. Many international insurance plans pay for these services. Be aware that psychiatrists in France may still recommend classic individual play therapy despite its lack of proven efficacy.

If you are coming to France with a diagnosis of ADHD already established, keep contact, if possible, with your existing physician or psychiatrist. Since it may be difficult to get an appointment with a specialist here, and you are not yet sure of your child’s reaction to the new environment, this ensures some continuity of care. Once you get an appointment with a French psychiatrist, bring all reports, diagnostic evaluations and/or follow-up documents from your home country. While most French psychiatrists do not speak fluent English, they do comprehend written English. If your child takes medication that is available here, there should not be a problem in getting a French prescription. If the medication is not available here, you need to decide whether you want to try switching or if you will obtain refills during regular visits to your home country. If other services (language, non-verbal, psychological, etc.) are necessary or desired, your psychiatrist will probably be able to point you in the right direction. In English, contact for a list of professionals who provide services in English to children with ADHD and their families.

Now we get to the difficult situation of school. French schools, overall, are poor at dealing with children with any kind of learning differences or behavioral issues. While a full discussion of this situation is beyond the scope of this post, this issue of accommodation for special needs in French schools, or the lack of such accommodation, will be discussed in other posts on this blog. For a child with ADHD, a standard French classroom can be a challenge, where learning is often neither multimodal nor behavioral, and academic expectations are high. French education professionals often pride themselves on treating all children equally, and might therefore balk at any individualized plan or at changing the rules for one child. Therefore, strategies and accommodations routinely implemented in US classrooms such as allowing a child with ADHD to get up when needed, to manipulate special “fidget materials,” to do fewer exercises in order to show comprehension, to get special “attention” signals from the teacher, and finally, to establish an individualized reinforcement system for good behavior or good efforts to control attention or impulsivity both at school and at home, are often seen as completely out of the question in a French school. French school psychologists are overworked and not present enough in classrooms to be able to help with such plans, nor do most of them practice such an approach.

However, sometimes, such special accommodations are possible and are successfully implemented.  It depends on the individual teacher and his/her desire to innovate or cooperate with parents or therapists. While it is obviously important to indicate your involvement and willingness to help, it is generally better to let the teacher come up with solutions, perhaps assisted by your gentle suggestions, rather than “imposing” ideas upon him/her. While active cooperation and consultation between parents, professionals and teachers is the norm in the US, French teachers consider themselves the “bosses” of their classrooms and often resist direction from the outside. In my professional experience, French teachers have come up with great plans for ADHD children and have very effectively implemented them; however, some do not consider this their role. On a positive note, I have found that for a subset of children with ADHD, the increased structure, stringent rules and high expectations in a French classroom are actually very beneficial and provide them with much-needed and clear limits and boundaries. 

As I mentioned in the first post, the French organization HyperSupers-TDAH France provides a great deal of useful information about ADHD on its website. The association has published brochures to better inform others about ADHD, including one specifically for teachers, and holds an annual meeting where new research on ADHD is presented. Furthermore, this group helps in advocacy and in promoting legislation concerning education and persons with ADHD and handicaps in general. In addition, HyperSupers-TDAH France has recently begun to support independent research projects. 

Organizations mentioned in the text: 

-Mia Vieyra

About Mia Vieyra

Mia Vieyra is an American clinical psychologist, who has a large private practice in Paris, where she has practiced since 1992. She sees children, adolescents and adults. One of her areas of expertise is the assessment and treatment of ADHD. She is a longstanding 91��Ƶ member.