Le trouble déficitaire de l’attention avec hyperactivité : données récentes des neurosciences et de l’expérience nord-américaine

ADHD diagnosis and methylphenidate consumption in children and adolescents: A systematic analysis of health databases in France over the period 2010-2019

CONTEXT

ADHD is the most common mental disorder in school-aged children. In France, methylphenidate is the only drug authorized for ADHD. Here, we describe the pattern of ADHD diagnosis and methylphenidate prescription to children and adolescents from 2010 to 2019.

METHODS

We conducted a retrospective cohort study of all beneficiaries of the French general health insurance scheme (87% of the population, 58 million people). We extracted information for all children and adolescents aged 0-17 years who received: (1) A diagnosis of ADHD (34,153 patients). (2) At least one methylphenidate prescription (144,509 patients). We analyzed the clinical, demographic, institutional, and social parameters associated with ADHD diagnosis and methylphenidate consumption in France.

RESULTS

The ADHD diagnosis among children and adolescents increased by 96% between 2010 and 2019. ADHD diagnosis affects more boys than girls. About 50.6% of children hospitalized with a diagnosis of ADHD in 2017 also had another psychiatric diagnosis. The rate of children hospitalized with an ADHD diagnosis and treated with MPH varied between 56.4 and 60.1%. The median duration of MPH treatment for a 6-year-old ADHD child initiated in 2011 is 7.1 years. In 2018, 62% of ADHD children were receiving at least one psychotropic medication. Between 2010 and 2019, methylphenidate prescription increased by +56% for incidence and +116% for prevalence. The prevalence of methylphenidate prescription reached between 0.61 and 0.75% in 2019. Boys are predominantly medicated. The median duration of treatment among 6-year-olds in 2011 was 5.5 years. The youngest children received the longest treatment duration. Diagnoses associated with methylphenidate prescription did not always correspond to the marketing authorization. Among children receiving the first prescription of methylphenidate, 22.8% also received one or more other psychotropic drugs during the same year. A quarter of initiations and half of renewals were made outside governmental recommendations. Educational and psychotherapeutic follow-up decreased from 4.1% in 2010 to 0.8% in 2019. French children and adolescents, who were the youngest in their class were more likely to be diagnosed (55%) and prescribed methylphenidate (54%). Children from disadvantaged families had an increased risk of ADHD diagnosis (41.4% in 2019) and methylphenidate medication (25.7% in 2019).

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Hyperactivity disorder in children is the most commonly found syndrome in paedo-psychiatric clinics. Children's professionals need to have clinical data on the subject. The diagnostic process includes several components which allow care to be tailored to each child.

Is the impairment in temporal allocation of visual attention in children with ADHD related to a developmental delay or a structural cognitive deficit?

We investigated the temporal allocation of visual attention in 11-year-old children with attention-deficit/hyperactivity disorder (ADHD) by comparing their attentional blink (AB) parameters (duration, amplitude and minimum performance) with those observed in three groups of healthy control participants (8-year-olds, 11-year-olds and adults). The AB is a marker of impaired ability to detect a second target following the identification of a first target when both appear randomly within a rapid sequence of distractor items. Our results showed developmental effects; with age, the AB duration decreased and the AB minimum moved to shorter lag times. Importantly, 11-year old children with ADHD presented much the same similar AB patterns (in terms of duration and minimum position) as the healthy 8-year-old controls. Our results support the hypothesis whereby impaired allocation of temporal selective attention in children with ADHD is due to a developmental delay and not a specific cognitive deficit.

Prevalence and correlates of attention deficit hyperactivity disorder in adults from a French community sample

Validated tools are lacking in languages such as French to diagnose attention deficit hyperactivity disorder (ADHD) in adults. The Adult ADHD Symptoms Self-Report (ASRS) was filled out by 1171 parents of 900 school-aged youths in the context of the Children and Parents With ADHD and Related Disorders study. Prevalence estimates based on three scoring methods are compared (6-item screener, all 18 items, or the screener followed by the 12 remaining items). On the basis of the recommended and more conservative scoring method, the overall prevalence of ADHD symptoms is estimated to be 2.99%, without significant group differences between sexes or between younger and older adults. Potential correlates of ADHD symptoms were also examined in their relatives (children, brothers/sisters, uncles/aunts, and parents) as follows: birth order, level of education, body mass index categories, enuresis, suicide attempts, depression, and learning disabilities. Adults can be screened for ADHD symptoms using the ASRS; negative long-term outcomes should be assessed in patients' relatives too.