Approche historique du trouble déficit de l’attention hyperactivité et de sa prise en charge

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder affecting 5% of children and nearly 3% of adults. This frequent disorder, often associated with comorbidities, is part of a developmental trajectory from childhood to adulthood, and can have repercussions in various areas of individual functioning. We present a non-exhaustive narrative review, focusing on the evolution of the concept of ADHD and its management in children and adolescents. On the 18th century, the first European clinical descriptions, by Melchior A. Wiekard and Cornelius A. Kloekhof and later Alexander Crichton, focus on attention deficit using the term of “attentio volubilis”. A century later, Désiré Magloire Bourneville introduced the concept of “mental instability”; he formalized his models of education and advocated the creation of “special classes” in ordinary schools. By the beginning of the 20th century, Alfred Binet writes “Le portrait de l’instable” (The portrait of the unstable) and already highlights the value of positive reinforcement in the school context. Then, Georges Still, a pediatrician, described the syndrome of “loss of moral control”, in children with no impairment of “general intelligence”, with no identifiable somatic cause; which he associated with “Minimal Brain Damage” referring to minor brain lesions. This theory is taken up in studies on Van Economo-Cruchet encephalitis, which in its hyperkinetic form is similar to ADHD as we know it today. American psychiatrist Charles Bradley publishes his first study on the administration of benzedrine sulfate. Bradley supports a multi-factorial model of behavioural disorders and insists on a global management strategy, combining a psychological and a biological dimension. In 1963, Conners and Eisenberg published the first article on the effect of methylphenidate on children's behaviour and learning. Efficacity of treatements on ADHD symptoms both attested of the neurological underpinnings of this behavioral disorder. Then, two theoretical currents evolved: a neuroanatomical and neurobiological approach on the one hand, and a psychoanalytical current on the other. Polemics about the recognition of the disorder and its causality emerged, contributing to poor identification, delayed access to diagnosis and specific care in France. Wood et al., published a preliminary study on the evolution of “Minimal Brain Dysfunction” in adulthood, representing the beginnings of the developmental perspective of ADHD. Over the last forty years, the contribution of neuroscience (cognition, imaging, electrophysiology, genetics, epigenetics, etc.) has enabled us to develop integrative theoretical models of understanding that describe the complexity of the disorder: a multi-path model was proposed by Sonuga-Barke and Fairchild in 2012. Taken together, these empirical data aim to establish a model for understanding ADHD, and neuroscientists agree that multimodal approaches and “big data” analyses that integrate genetic, imaging and phenotypic data are particularly important for advancing a comprehensive model of understanding, and also for approaching the clinical heterogeneity of this disorder. The international classifications are first clinical categorizations based on predominantly behavioral criteria – initially focusing on inattention (DSM 3), then reintegrating hyperactivity (DSM-3R) introducing the term “attention deficit hyperactivity disorder”, defining ADHD subtypes: inattentive, impulsive/hyperactive, combined (DSM 4). This neuroscientific research has enabled classifications to evolve from a categorical approach to a dimensional and neurodevelopmental approach (DSM-5 and CIM 11), positioning ADHD within a model of etiological understanding. Nowadays, ADHD is the subject of an international consensus statement. The publication of the French 2023–2027 National Strategy for Neurodevelopmental Disorders demonstrates the public authorities’ commitment to this disorder. 2024 is the founding year of the French ADHD Society. Federating scientific investigations based on big data will allow us to improve our understanding of this disorder, improve treatments, understand specific clinical features and their specific trajectories, promote early intervention. ADHD has been identified for centuries, under a variety of names, and has been the subject of theoretical and societal controversy at various times. It is definitely not a contemporary disorder; the future looks promising for the benefit of patients.