As soon as he entered kindergarten, Naïm “problem” : He is particularly restless, impatient and impulsive. The teacher advises Rahma Jdab, his mother, to “consult”. Initially, the pediatrician at the Maternal and Child Protection Service (PMI) assured her that Naïm was “Jealous of his little brother and seeking attention”remembers. Later, the nurse and the child psychiatrist at the medical-psychological center (CMP), who will follow Naïm for three years, assure him that he is “too fusional” with his son. “When I mentioned attention deficit disorder with or without hyperactivity [TDAH]After seeing a report on television, they said it was a fabrication”She said bitterly. The diagnosis of the disorder – defined as attention deficit and/or hyperactivity and/or impulsivity – would finally come a few months later, outside the CMP. In the meantime, the structure submitted a report (on information) to the child welfare for neglect, which was not followed up after a summons from Rahma Jdab.
The recommendations for good practices in the treatment of ADHD in children, presented on Monday 23 September by the High Authority for Health (HAS), aim to avoid these situations. “Neurodevelopmental disorders [TND] – autism spectrum disorder, “dys”, etc. – have been included in the American Reference Manual for Mental Disorders since 2013. It was time to recognize ADHD”explains Olivier Bonnot, professor of child and adolescent psychiatry at the Barthélemy Durand hospital (Essonne), who chaired the working group.
They were requested by a co-referral from the Directorate-General for Health and the HyperSupers ADHD France association in 2019: until now, in France, there were only identification recommendations for primary care physicians, already implemented by this association. From now on, the HAS defines in detail the diagnosis and the care pathway – “and above all the corresponding levels of evidence”insists Dr. Nathalie Franc, a child psychiatrist at the University Hospital of Montpellier, who participated in the work.
“There is no room for blah blah”
According to these recommendations, “Any physician trained in the diagnosis and treatment of ADHD can make the diagnosis.” Ultimately, primary care physicians (pediatricians and general practitioners) should be able to identify and diagnose a simple disorder without comorbidities or, in case of suspicion of a complex disorder, refer the patient to a physician or to a specialized structure, if necessary. They have not followed secondary training. A standard examination table is available that lists several diagnostic reference scales.
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