Attention disorders, hyperactivity, impulsivity… Diagnosing children and adolescents suffering from ADHD as early as possible is essential, judges the High Health Authority which published on Monday a list of recommendations to improve their care, today uneven.
“Several teachers found that he didn’t listen to anything at school; at home, he was extremely turbulent.” Camille Therond, whose son is now 14 years old, consulted a large number of specialists – ENT, pediatrician, speech therapist, psychologist – before a psychiatrist finally put the name “ADHD” (deficit disorder attention with or without hyperactivity) on his behavioral problems.
A long journey: “We wandered from the middle section to CE2,” she sums up.
For a long time, this disorder was an “often denied reality”, explains Christine Gétin, director of the HyperSupers Association – ADHD France, who approached the HAS with the Ministry of Health to advance the subject.
“They were seen as restless and not very well-behaved children. The problem supposedly came from their upbringing with a lot of blame placed on the mothers, as if there was no scientific reality behind these disorders,” continues -She.
Classified in the category of neurodevelopmental disorders, their prevalence in children is estimated at around 5% worldwide.
“When a disorder is so common, we cannot reserve the diagnosis and treatment to a very small number of specialists,” believes Olivier Bonnot, professor of child and adolescent psychiatry at the University. Paris Saclay, who chaired the HAS working group.
In 2015, the High Authority for Health made recommendations for the first time to better identify them.
Nearly ten years later, she goes further by explaining how to make a diagnosis. According to her, this must be based on an interview with the child and his parents in order to assess the child’s development in all its dimensions (neurological, psychomotor, emotional, etc.)
It must also include a clinical examination and collection of information from those around them (family, school, etc.).
“What makes the diagnosis subtle is that many children can seem impulsive or present attention problems,” recalls Olivier Bonnot.
“This time, we finally have a clear procedure to establish a defined medical diagnosis that will be set in stone,” welcomes Christine Gétin.
The High Authority for Health goes further by issuing recommendations for treatment.
As a first intention, “non-drug” interventions are recommended, such as psychoeducation which consists of providing information on ADHD, its impacts and how to function with this disorder.
“Recognition and understanding of the difficulties presented by the child have a positive impact on their quality of life and their intra-family relationships,” she writes.
In addition, if necessary and depending on the severity of the disorder, medicinal treatment can be prescribed, recommends the HAS.
The only molecule available in France for the treatment of ADHD in children aged 6 and over and adolescents is methylphenidate, better known commercially under the name ritalin.
Currently, only pediatricians, psychiatrists and child neurologists are authorized to initiate such treatment.
In France, “professionals caring for children with ADHD are still few in number and unevenly distributed across the country”, regrets the HAS, which leads to an extension of the diagnosis and intervention time.
With the aim of expanding the provision of care, the HAS calls on the public authorities to extend these skills to other doctors (general practitioners in particular) by setting up structured and certified training.
“Today, the delays are so long to obtain an appointment with a psychologist that parents, helpless, often spend astronomical sums to carry out assessments of all kinds which are not necessarily useful,” warns Christine Gétin.
“The average time before the correct diagnosis is currently estimated between 3 and 6 years,” recalls Olivier Bonnot. But for a child, “six months is almost a school year”.
