"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.
"They were seen as restless and not very well-behaved children."
For a long time, this disorder was a "reality often denied", explains Christine Getin, director of the HyperSupers – TDAH France association, who contacted the HAS with the Ministry of Health to move the issue forward. "They were seen as restless and poorly behaved children. The problem supposedly came from their upbringing, with a great deal of blame 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 is estimated at around 51% of children worldwide. "When a disorder is so common, we cannot restrict diagnosis and treatment to a very small number of specialists," says Olivier Bonnot, professor of child and adolescent psychiatry at Paris Saclay University, who chaired the HAS working group.
How the diagnosis is made
In 2015, the French National Health Authority first issued recommendations to better identify them. Nearly ten years later, it has gone further by explaining how to pose a diagnosisAccording to her, this must be based on an interview with the child and his or her 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 a collection of information from those around him (family, school, etc.). "What makes the diagnosis subtle is that many children may appear impulsive or have attention deficit disorders.", recalls Olivier Bonnot. "This time, we finally have a clear procedure for establishing a medical diagnosis that will be set in stone.", welcomes Christine Getin.
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No medication as first line of treatment
The High Authority for Health goes further by issuing recommendations for treatment. As a first-line treatment, interventions "non-medicinal" 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, drug treatment may be prescribed, recommends the HAS.
The only drug available in France for the treatment of ADHD in children aged six and over and adolescents is methylphenidate, better known commercially as Ritalin. Currently, only pediatricians, psychiatrists, and child neurologists are authorized to initiate such treatment.
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Few professionals
In France, “The number of professionals who care for children with ADHD is still small and unevenly distributed across the country.”, regrets the HAS, which leads to an extension of the time taken for diagnosis and intervention.
With the aim of expanding the range of healthcare available, the HAS is calling on the public authorities to extend these skills to other doctors (particularly general practitioners) by setting up structured, qualifying training.
"Today, the wait times for getting an appointment with a psychologist are so long that helpless parents often spend astronomical sums on all kinds of assessments that are not necessarily useful.", warns Christine Getin. “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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