Yes, ADHD exists. No, it is not an invention of pharmaceutical laboratories to sell drugs. In a landmark report, the High Authority for Health (HAS) has just brought rationality back into the French debate around attention disorders with or without hyperactivity. On September 23, this independent institution, responsible for promoting good medical practices and quality of care, published highly anticipated recommendations on this disability. Curling in passing all those who, in our country, denied its reality, against all the evidence. Starting with the highly publicized, and very controversial, Caroline Goldman, and beyond, with some of the actors in the field of psychology and psychiatry still under the influence of psychoanalysis.
Podcasts, interviews, radio shows, books… The daughter of the successful singer, herself a psychoanalytic psychologist, has constantly repeated it: according to her, “real ADHD” affects 0.5% of children diagnosed. A figure never documented, but it doesn’t matter: the others would be victims of “overdiagnosis”. Their agitation, their impulsiveness, their difficulty concentrating? Due to “psychoaffective reasons […]attachment disorders or educational dysfunctions”, as she writes again in her recent Guide for Today’s Parents (Flammarion). Logically, overdiagnosis would also lead to the “overprescription” of methylphenidate, better known as Ritalin, of which Caroline Goldman (who did not respond to requests from L’Express) goes so far as to use the nickname ” children’s drug” or “opium of the school population”.
“Such discourse causes a lot of damage. It invalidates the work of specialists out of hand and arouses doubts and concerns among parents, who are necessarily guilty of the misfortune of their children,” denounces Dr. Hugo Baup, psychiatrist at the Périgueux hospital center. It also leads the general public to believe that there is a scientific debate around this disorder and its treatment, which is not the case. A little music, however, still sung last year by the High Council for Family, Childhood and Age, whose president, Sylviane Giampino, also happens to be a psychoanalyst. This organization published a report denouncing, among other things, the increase in the prescription of methylphenidate. “But it was based on an incomplete reading of the available data which was still quite disturbing,” recalls Dr Hugo Peyre, child psychiatrist at Montpellier University Hospital.
“The High Health Authority is the justice of the peace”
As a result of these mistakes, ADHD still remains largely underdiagnosed in France, and our country is one of those where the prescription of Ritalin remains the lowest. Because this psychostimulant carries the image of a narcotic, “patients are still sometimes stigmatized, including in pharmacies”, regrets Hugo Baup. Misdiagnosis and delay in treatment are not rare, with sometimes dramatic results. Untreated, ADHD exposes one to academic difficulties, and later to addictive behaviors or even higher rates of suicide and suicide attempts than in the general population.
For its work, the High Authority for Health took into account all of the available scientific literature. “He is the justice of the peace. And his conclusions very clearly contradict many of the errors that have been made in recent years,” says Dr. Etienne Pot, interministerial delegate for neurodevelopmental disorders. HAS experts point out that ADHD is very common, “with an estimated prevalence of around 5% of children and adolescents, and 3% of adults”. It must be diagnosed and managed by a trained doctor. The support is based on the one hand on behavioral therapies and parental guidance (parents have nothing to do with their children’s difficulties, but learning to support them cannot be improvised and requires training), and on on the other hand on medicinal treatment depending on the severity of the disorders, if psychological care is not enough. And above all, the authors write it in full: psychoanalytic therapies “are not recommended in the specific treatment of ADHD”. For good reason: they did not find proof of their effectiveness.
While misconceptions about this disorder still remain very entrenched, including in certain childcare facilities, will this report be enough to offer all families support consistent with scientific data? It is now up to the neurodevelopmental disorders delegation to ensure this, by mobilizing the various stakeholders around this objective. Multiple actions in this direction have already been undertaken, with the creation, locally, of ADHD-labelled care sectors, so that families, but also general practitioners, know where to turn. “The regional health agencies are working on this, adapting to the particularities of their territories. In some cases, it will be enough to list the professionals, in others it will be necessary to provide catch-up training for caregivers,” summarizes Etienne Pot. A survey is also underway among medical-psychological centers and coordination and orientation platforms, to obtain a precise vision of their approach to neurodevelopmental disorders. “As the methods are still sometimes very heterogeneous, the objective is also to support them in their developments,” notes Etienne Pot.
However, all specialists are well aware that in the field of health, changes in practice can be quite slow. “We tend to work the way we were trained. Questioning these beliefs can be difficult, especially on subjects presented in the public space as ideological conflicts,” notes Hugo Payre. The HAS report should nevertheless help a lot. “In the meantime, parents faced with inadequate care now have a tool to denounce it, and to turn to caregivers who respect the recommendations,” summarizes Christine Gétin, director of the HyperSupers – ADHD France association. It was time.
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