Identification of neurodevelopmental disorders in children now enshrined in law
Neurodevelopmental disorders include intellectual development disorder, autism spectrum disorders, oral language disorders (comprehension and/or expression), dyspraxia (coordination disorder with motor difficulties, sometimes associated with dysgraphia), attention deficit disorder with or without hyperactivity (ADHD), learning disorders known as DYS disorders (dyslexia-dysorthography, dyscalculia) and tics, including Gilles de la Tourette syndrome. These disorders are often associated with each other, in almost two-thirds of cases.
UA little guy, barely 3 years old, running everywhere. Cannot sit at the table behind which the nurse is patient, turns around in her chair, fetches a book, throws it, a toy, throws it too. Climb, stomp, stamp. A child, what? Certainly, but a child who can’t control his attention, who doesn’t seem to stop anything and whose gaze is always attracted to something.
Here we are at the heart of the attention deficit and hyperactivity reference center unit (Credah) at the Charles-Perrens hospital in Bordeaux, in the middle of a consultation on the child coordination and guidance platform. from 0 to 6 years old. All children who show warning signs of neurodevelopmental disorders are welcomed. The figures concerning attention deficit disorder with or without hyperactivity (ADHD) are impressive: between 3 and 5% of children are affected in France, or one or two per class. And 3% of adults carry such a disorder and are underdiagnosed.
Thierry DAVID / SO
The Credah medical team (Attention deficit and hyperactivity reference center) at the Charles-Perrens hospital in Bordeaux. Seated on the left, Dr. Erica Martins, head of the department.
However, in the Charles-Perrens service, the active queue revolves around 750 cases per year for Gironde alone. Considering the number of cases he is confronted with in Gironde and in other less well-resourced departments, Professor Manuel Bouvard, child psychiatrist, head of the child and adolescent psychiatry division, leans more towards the high end of the range. .
“We have known descriptions of attention disorders in individuals since the 19the century, he relates, but science agreed to introduce this term ADHD in the 1980s. School is a place of resonance, but parents often realize this before facing children who have difficulty following educational instructions or concentrating on a simple activity. They say they don’t have the instructions. At school, children suffer punishment, can be excluded, misunderstood, which generates suffering, but suffering is also on the side of exhausted parents or insufficiently trained teachers. »
Don’t Forget Parental Burnout
Since 2016, the Charles-Perrens unit has been the first – and only in France – to be labeled a reference center. Led by Doctor Erica Martins, child psychiatrist, there is a team of nurses, speech therapists, occupational therapists and psychologists. “We receive complex cases here referred by general practitioners and pediatricians for an opinion,” explains Doctor Martins. Mainly children but also teenagers and, increasingly, adults. We are a reference center, therefore authorized to support teams in the departments and evaluate certain situations with them. We have opened platforms with several care systems which include therapeutic education groups. »
“Our tools have progressed, knowledge of the disorders has evolved significantly, we have finally moved beyond internal struggles over the origin of these neurodevelopmental disorders”
Within these “platforms”, teams work on strategies that make it possible to identify not only the difficulties faced by patients, but above all their strengths. “It is by relying on their resources that these people will be able to have adapted social responses,” continues Erica Martins. Every six months, their care plan is re-evaluated, also with self-reaffirmation sessions. »
Parents are not left out: they too participate in parenting skills training programs, the objective of which is to provide them with some tools for understanding and action. “They are also in pain,” notes the doctor, “exhausted, helpless. We need to help them regain a good opinion of themselves. They feel like a failure. »
« Former, former, former »
Professor Bouvard, for his part, recalls how alarming the health situation in terms of mental health is. Corrèze and Creuse no longer have any child psychiatrists. Some departments are helpless – “when there are school holidays in the teams, it’s catastrophic,” he laments.
Access to specialized care has become problematic given medical demographics. “Our tools have progressed, knowledge of the disorders has evolved significantly, we have finally come out of the internal struggles over the origin of these neurodevelopmental disorders,” asserts Professor Bouvard. We now know that the causes are multifactorial, both genetic and environmental. The latest recommendations from the HAS [Haute Autorité de santé, NDLR]published last September, are final. It’s about training – training teachers, training health professionals, everyone. To spot better. ADHD has finally entered health policies. »
