What is “attention deficit disorder with or without hyperactivity” and why is it so poorly treated in France ?

Trop de TDAH ne sont pas soignés en France

Everyone has heard of attention deficit disorder with or without hyperactivity. or ADHD, but few of us know precisely what it is. Insufficiently detected, this disorder is therefore poorly supported in France, regrets Dr Thiébaut-Noël Willig, pediatrician specializing in neurodevelopmental disorders and member of the brand new French ADHD Society.

Attention deficit disorder with or without hyperactivity is a neurodevelopmental disorder. What are the criteria for making the diagnosis ?

Dr Willig: The diagnostic criteria are precise, based on the DSM-5 (Diagnostic and Statistical Manual of Mental and Psychiatric Disorders of the American Psychiatric Association) or the ICD11 (International Classification of Mental and Psychiatric Disorders). diseases, by the World Health Organization). In essence, these criteria include symptoms that are evident and persistent in daily life, such as inattention, hyperactivity, or impulsivity. In addition, these symptoms must have a notable impact on the social, family, professional or school, and possibly medical, life of the person concerned.

What are the rules for prescribing methylphenidate today in the context of ADHD in children and adults ?

Once a precise diagnosis has been established with a significant or even severe impact, the recommendations vary depending on the country. The Anglo-Saxons tend to favor pharmacological treatment more quickly, while the French recommendations initially recommend non-drug treatment, except in cases of severe impact. Some children do not present a level of severity justifying treatment, and this must be assessed on a case-by-case basis.

What is the percentage of children on methylphenidate (Ritaline) in France ?

The crucial question is rather the percentage of children who should be on treatment and who are not! Work is underway with Health Insurance in the Occitanie region to collect this data. Internationally, the prevalence of ADHD is generally between 5 and 5.5% of an age group. However, access to prescription varies from one country to another. For example, in the United States, the prescription rate for methylphenidate is well above this percentage, while France is at around 15 to 20% of theoretical prescription needs. In other words: in our country, only one in six children who require this treatment access it. Added to this is a considerable disparity in prescriptions between departments.

Why so many disparities ?

Firstly, the lack of doctors who are aware and competent in terms of prescribing but also, on the diagnostic side, due to the absence of care channels integrating the treatment of ADHD disorder in certain regions. In addition, for those under treatment, you must find a doctor each month to renew the prescription, this being limited to 28 days. More recently, stock shortages lead to damaging processing interruptions.

The rules for prescribing methylphenidate also limit its access. In fact, it is classified as a narcotic product, which requires a secure prescription. Additionally, only three specialties can provide the very first prescription and refills each year: pediatricians, psychiatrists, and neurologists. Conversely, general practitioners trained in neurodevelopmental disorders are deprived of the possibility of this first prescription!

A group of experts at the High Authority of Health (HAS) is underway to propose new recommendations for good medical practice in childhood ADHD. This may be followed by a referral to the National Agency for the Safety of Medicines and Health Products (ANSM) to change these regulations.