At the end of two years of work, the High Authority of Health (HAS) has just presented its recommendations for the identification of attention deficit disorder with or without hyperactivity (ADHD), and the support of small patients and their family. These place, for the first time, primary care physicians (general practitioners or pediatricians) at the heart of the system.
“These recommendations are first and foremost a way of asserting that ADHD exists. The second message is to educate general practitioners, who have little or no training in spotting this disorder during their training. This lack of knowledge can lead to diagnostic delay and lack of care, leading over time to a worsening of the psychological, educational and social consequences for the child with the long-term risk of repercussions on the whole life. This is why we wanted to give precise benchmarks for better identify children who suffer from this disorder but also avoid overdiagnosis “ explains Dr Dr Cédric Grouchka, member of the College of the High Authority for Health.
ADHD: a complex diagnosis
Diagnosing ADHD is complex because there are no neurological or physical signs specific to the disorder. In addition, the disorder combines three symptoms, the intensity of which varies depending on the child. “ADHD is often reduced to the term ‘hyperactivity’, suggesting that they are restless or restless children. Attention deficit and impulsivity are two other symptoms to be aware of.” insists Dr Grouchka.
In addition, these symptoms may be indicative of other disorders, further complicating the diagnosis. This is for example the case of learning disorders, behavior, intellectual precocity, anxiety disorders, depression …
Hence the development of “Good practice recommendations“to help the general practitioner to establish a pre-diagnosis.
After this preliminary diagnosis, it is up to the primary care physician to inform the parents and, if necessary, refer the child to a doctor specializing in the disorder (child psychiatrist, psychiatrist, pediatrician, neuropediatrician, neurologist) who will confirm the diagnosis, recommend the HAS.
ADHD: no treatment recommendation
These HAS recommendations do not address the management methods (drug or not, depending on the importance of the disorder) but shed light on what exists for doctors.
In France, it is estimated that between 3 and 5% of school-age children suffer from ADHD. In general, signs suggestive of the disorder are observed mainly before 12 years of age and are more frequent in boys than in girls (2 to 3 boys for 1 girl). 90% of them benefit from non-drug treatment (cognitive-behavioral therapies, psycho-educational approaches, self-assertion groups, psychomotricity sessions, etc.) and 10% benefit from treatment drug (the only molecule available and indicated in France being methylphenidate, a psychostimulant marketed under the names of Ritalin, Concerta or Quasym).
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