The prescription of medications to treat attention deficit hyperactivity disorder (ADHD) is increasing in France, amidst real benefits and fears of abuse surrounding this neurodevelopmental disorder that has long been misunderstood in the country.
Known as Ritalin, methylphenidate, a psychostimulant used to regulate anxiety, saw its prescriptions jump by 1,541 points in France between 2020 and 2024, according to health insurance databases analyzed by AFP. Classified as narcotics, these drugs stimulate the central nervous system, controlling the main symptoms of this disorder: attention deficit, hyperactivity, and impulsivity.
For professor of child psychiatry Olivier Bonnot, who chaired a dedicated working group at the High Authority for Health (HAS), " They are among the most effective drugs available.“.
Increasingly better detected thanks to better recognition of neurodevelopmental disorders, ADHD affects around 61% of children under 18 and 2.5% of adults worldwide, with symptoms that can vary throughout life. It's not like a virus that you either catch or you don't, but rather like high blood pressure: when the symptoms reach a certain level, they need to be treated.", said the president of the World ADHD Federation, American professor Stephen Faraone, to AFP.
"I live very well with it."
In the United States, where ADHD diagnoses and treatments are more common, voices have been raised to criticize an overly medicalized approach. About half of diagnosed American children (3-17 years old) were receiving medication in 2022, according to a national survey on children's health, compared to 10% in France, according to the High Authority of Health.
“ There has been a confusion with the American situation that has contributed to demonizing Ritalin. Parents have been accused of drugging their children and some are still subjected to comments from pharmacists.", regrets Claudine Casavecchia, president of the HyperSupers – TDAH France association.
But in recent years, the progress of screening, the reimbursement of methylphenidate extended to adults in 2022, and the need to improve care have removed obstacles. Patients testify to the benefits of psychostimulants. Vanessa, a 51-year-old teacher diagnosed in 2021, found " It's amazing to be able to watch a series without getting up every five minutes.". But she qualifies: " it is not a miracle molecule“.
Alexandre (name changed), 26, has been taking Concerta (another methylphenidate medication) since childhood. I wasn't Bart Simpson running around, just distracted, losing my things all the time." he recalls. " The treatment helps me in my daily life. I am under the care of a psychiatrist, and I live very well with my ADHD.", confides this young engineer.
Conversely, Thibault, 33, has bad memories of Ritalin, which he took around the age of eight: " I felt like I was under a bell jar, as if sedated." . " It was war, I held the pill against my cheek so as not to swallow it. My mother watched me until I swallowed." he says.
New molecule
Loss of appetite, sleep disorders, mood swings, slight growth delay, headaches…: “ generally benign", the side effects" can be adjusted by changing the dose or medication", according to the World ADHD Federation, which is based on a consensus of international experts. The data is reassuring. In the long term, we observe a slight increase in blood pressure and heart rate, which is something to monitor.", says Sébastien Weibel, psychiatrist at the Strasbourg University Hospital.
Today, ADHD specialists are welcoming the recent marketing in France of a new molecule, lisdexamphetamine—under the name Xurta—an amphetamine already sold elsewhere in Europe. Like Ritalin, it acts on dopamine and norepinephrine, which are involved in motivation and learning, but via a different mechanism of action.
“ His arrival required educational work", underlines Hugo Prunier, psychiatrist at CH Le Vinatier, because " The word 'amphetamine' is frightening in France, with prejudices shared by both caregivers and patients.". Especially since in the United States, other amphetamine-based drugs like Adderall – banned in France – to treat ADHD, have been diverted from their therapeutic indication. In this country, students can take Ritalin or Adderall to " stay awake and study " or in a festive setting, explains Professor Faraone, president of the World ADHD Federation.
Lack of data
These products also raise concerns about potential addiction, as people with ADHD are at greater risk of developing addictive behavior. Being well treated upstream can limit this risk later, in particular by better managing the symptoms of impulsivity.", reassures Louise Carton, pharmacologist and psychiatrist-addictologist at the Lille University Hospital.
There is little data in France on the misuse or duration of ADHD drug treatments, which were long marginal and most adolescents take them for less than a year, according to an international study. Two years on average for adults" explains Sébastien Weibel, who analyzed data from the Strasbourg University Hospital.
Most of the time, patients develop parallel compensation strategies to live with this disorder, for example by avoiding setting up their desk in front of a window, a source of distraction, or by having instructions repeated to them during an examination. The range of support services is expanding and enriching " in France, rejoices Eric Acquaviva, child and adolescent psychiatrist at the Robert-Debré hospital (AP-HP), with in particular alternatives to drug treatments, such as psychoeducation.
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