Nearly 5% of children affected: how to improve the diagnosis of attention deficit disorder in toddlers ?

TDAH : comment améliorer le diagnostic et la prise en charge des enfants ?

Nearly 5% of children are affected by attention deficit disorder with or without hyperactivity in the world. This is a fairly common disorder that remains poorly diagnosed and treated in France. However, the delay in diagnosis can aggravate the harmful effects of ADHD in the daily lives of patients.

“In France, ADHD suffers from a significant delay in diagnosis with an average age of around 9-10 years”, recalled Social Security in 2023. However, there is no lower age limit for diagnosing attention deficit hyperactivity disorder (ADHD), the symptoms of which can appear very early. The High Authority for Health (HAS) is publishing new recommendations on Monday, September 23, to better diagnose and manage this disorder.

What is ADHD ?

Attention deficit disorder with or without hyperactivity is one of the neurodevelopmental disorders, characterized by symptoms of inattention, accompanied or not by symptoms of hyperactivity and impulsivity, of an intensity inappropriate to the situation and the age of the child. “ADHD can present forms with predominant inattention or in which hyperactivity and impulsivity predominate, but the most frequent form in the clinical population is the combined form, associating the three types of symptoms in the child”, explains the HAS.

This is true in boys, twice as affected by this disorder as girls, but the latter could be largely underdiagnosed. In fact, the symptoms are more difficult to perceive in them, the inattentive form being the most frequent.

Too few trained professionals

While 5% of children and adolescents, 3% of adults, in the world suffer from ADHD, diagnosis and access to care remain complex. Diagnosis is based only on clinical examination and the collection of information from the child's relatives; no other examination is useful. Associated disorders and comorbidities make the process complex. Above all, the HAS points out, the professionals caring for children are still too few in number and poorly distributed across the territory.

A heavy impact on daily life

The impact of ADHD is nevertheless harmful on the school, social and family level and better care has been awaited for a long time by families. a worsening of the psychological, academic and social consequences of ADHD as well as associated disorders.

As a reminder, only pediatricians, psychiatrists and child neurologists are authorized to diagnose and initiate treatment. "With the aim of expanding the range of healthcare available in the country, the HAS is now calling on public authorities to extend these skills to other doctors (particularly general practitioners): the latter will then follow structured training leading to a diploma, in conjunction with the relevant National Professional Colleges", recommends the health authority.

What is the recommended care ?

ADHD is a chronic disease. There is no treatment to cure it, but to reduce its symptoms. The first-line treatment consists of non-drug interventions. Psychoeducation should be systematically offered to the child and their family: it is about knowing and understanding the difficulties of ADHD in order to choose the different intervention options and adhere to them.

5% of children are affected by attention deficit disorder with or without hyperactivity in the world. This is a fairly common disorder that remains poorly diagnosed and treated in France. However, delayed diagnosis can worsen the harmful effects of ADHD on patients' daily lives.

La HAS vient de publier ce matin de nouvelles Recommandations de bonnes pratiques : « TND / #TDAH : Diagnostic et interventions thérapeutiques auprès des enfants et des adolescents ».https://t.co/3jfPXYjnC6 pic.twitter.com/FFBAFA0MSy

— HyperSupers TDAH🎗️ (@TDAHyperSupers) September 23, 2024

Parenting skills training programs (PEHP) are also recommended. These are programs for parents to support them in therapeutic groups in their role as daily educators. The HAS advocates for the development of these groups, which are still too few in number in the territory. Behavioral, cognitive and emotional therapies can also be considered. At school, support must be systematic and an adjustment may be proposed

In addition to these actions, drug treatment may be prescribed depending on the severity of the ADHD. For these forms of severe intensity, the HAS recommends that it be possible to start treatment with methylphenidate (MPH) quickly after the implementation of psychoeducation, so as not to delay the effectiveness of the therapeutic process.

The HyperSupers TDAH France association, which had contacted the HAS, reacted after the publication of these recommendations: “For people with ADHD, this means that we now have references on the diagnostic process, so that from Lille to Marseille, via Brest and Strasbourg, your child's diagnosis is considered according to the same procedure. It will be necessary to train a large number of health professionals to meet the needs of people with ADHD and to organize the care pathway for both children and adults and to be attentive to the transition of care from child to adult.”