“A reality often denied”
“Several teachers thought he didn’t listen at school; at home, he was extremely unruly.” Camille Therond, whose son is now 14, consulted a large number of specialists – ENT, psychologist, pediatrician, speech therapist, psychologist – before a psychiatrist finally put the name “ADHD” (attention deficit hyperactivity disorder) on his behavioral problems.
A long journey: “we wandered from middle school to CE2,” she sums up.
For a long time, this disorder was an “often denied reality”, explains Christine Gétin, director of the HyperSupers – TDAH France association, who contacted the HAS with the Ministry of Health to move the subject forward.
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“They were seen as restless and poorly behaved children. The problem supposedly came from their upbringing with a lot of guilt placed on the mothers, as if there was no scientific reality behind these disorders,” she continues.
Classified in the category of neurodevelopmental disorders, their prevalence in children is estimated at around 5% worldwide.
“We wandered from middle school to CE2.”
Carry out “a structured medical diagnosis which will be set in stone”
“When a disorder is so common, we cannot reserve diagnosis and treatment to a very small number of specialists,” says Olivier Bonnot, professor of child and adolescent psychiatry at the University of 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.
“What makes the diagnosis subtle is that many children may appear impulsive or have attention deficit disorders.”
Nearly ten years later, she goes further by explaining how to make a diagnosis. According to her, this should 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 should also include a clinical examination and a collection of information from those around him (family, school, etc.).
“What makes the diagnosis subtle is that many children may seem impulsive or have attention disorders,” recalls Olivier Bonnot.
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“This time, we finally have a clear procedure for establishing a structured medical diagnosis that will be set in stone,” says Christine Gétin.
The High Authority for Health goes further by issuing recommendations for treatment.
As a first-line treatment, “non-drug” interventions are recommended, such as psychoeducation, which consists of providing information on ADHD, its impacts and how to function with this disorder.
Drug treatment and waiting times
“Recognizing and understanding the difficulties presented by the child has a positive impact on his quality of life and his intra-family relationships,” she writes.
In addition, if necessary and depending on the severity of the disorder, drug treatment may be prescribed, recommends the HAS.
“Today, the wait times to get an appointment with a psychologist are so long that parents, helpless, often spend astronomical sums to have all kinds of assessments done that are not necessarily useful.”
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 increase in the time taken for diagnosis and intervention.
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With the aim of expanding the range of care available, the HAS is calling on public authorities to extend these skills to other doctors (particularly general practitioners) by setting up structured, qualifying training.
“Today, the wait times to get an appointment with a psychologist are so long that parents, feeling helpless, often spend astronomical sums to have all kinds of assessments done that are not necessarily useful,” warns Christine Gétin.
“The average time before the correct diagnosis is currently estimated at between 3 and 6 years,” recalls Olivier Bonnot. But at the child’s level, “six months is almost a school year.”
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