Post-infarction care, drug treatment for diabetes, high-risk pregnancies, etc.: the subjects on which the Haute Autorité de Santé regularly issues recommendations are diverse and varied. But those made public this morning concern a delicate, even controversial subject: attention disorder with or without hyperactivity (ADHD), often reduced to “hyperactivity”.
These recommendations are intended primarily for primary care physicians, general practitioners or paediatricians. The HAS emphasizes that it is these practitioners who play a central role in identifying the disorder, although it believes that doctors are not always well trained in ADHD. But the voices of professionals raised in the press today call into question the pragmatism of the recommendations. Not sure that doctors are better equipped after reading the HAS document than before. “The document is not bad, it is open but, after the battle on autism, it has a little Care Bear side: everything is good and everyone is right”, comments in the columns of Release Bruno Falissard, President of the World Association of Child Psychiatry.
The HAS experts are indeed very cautious. They insist above all on the fact that ADHD is not a disease but “rather a syndrome associating three symptoms, the intensity of which varies according to the person”. And among these symptoms, motor hyperactivity would not be the most important, it is attention disorders which would be much more predominant; to this is added “impulsivity”. “A hyperactive child is not the kid “in the moon” or the turbulent one who will disrupt the class. The diagnosis of this disorder is based on a set of specific symptoms that persist over time and affect the child’s life.explained in The cross Doctor Cédric Grouchka, member of the College of the High Authority for Health (HAS).
If “the diagnosis of ADHD is complex”, as the HAS admits in these recommendations, it would be, according to Dr. Patrick Landman, psychiatrist and psychoanalyst, because “ADHD does not exist scientifically”. The president of the Stop DSM association insists in Le Figaro and Release on the fact that “nothing has been discovered, neither in genetics, nor in biochemistry, nor in imaging”. He says he fears an “epidemic of hyperactivity diagnoses”.
The doctors interviewed in the national dailies, however, recognize the “openness” of the HAS as regards the care offered. All are mentioned and the emphasis is on “non-drug management”. As for drug treatment with methylphenidate (better known under the trade name Ritalin), the HAS only considers it if the other measures have proved insufficient. But Bruno Falissard warns in Release against the “danger of overconsumption”, pointing out that sales of the drug are constantly rising. “Ritaline works, but we don’t know why,” concludes the doctor.
