Soignants libéraux et TDAH : enjeux et défis

Abstract

Attention deficit disorder with or without hyperactivity (ADHD) is one of the most prevalent neurodevelopmental disorders (NDD). Increased awareness of NDDs among the general population, coupled with a global surge in the need for psychiatric care since the COVID-19 crisis, has put considerable pressure on the French mental health system in recent years. This is particularly true for private practitioners, including psychiatrists, neurologists, and pediatricians, who are the only specialists in France authorized to initiate methylphenidate, the first-line treatment for adult ADHD. These professionals face a daunting challenge: 50% of French private psychiatrists are aged 60 or older, and they are tasked with meeting an ever-growing demand for psychiatric care. Additionally, there is a fast-growing demand from younger individuals seeking NDD diagnoses, often self-diagnosed online through social media. Furthermore, NDD diagnosis was not widely taught in French medical universities until recently, resulting in fewer professionals qualified to meet the demand. Due to this shortage of medical practitioners, many individuals are seeking NDD diagnoses from psychologists. However, in France, psychologists are not considered healthcare practitioners, and most are not trained in NDD diagnosis. Nevertheless, a “business of ADHD” has emerged, with an increasing number of neuropsychological tests and other “trainings” being oTered. This is unfortunate because ADHD diagnosis is primarily clinical, and in most cases, especially in adults, does not require neuropsychological testing. That said, psychologists can play a significant role in managing ADHD, particularly through psychoeducation or cognitive-behavioral therapies, and in some non-comorbid cases, pre-diagnosis. We believe that teams of psychologists and psychiatrists trained in NDDs could represent an eTective way to increase the number of patients diagnosed and treated for ADHD. Given the shortage of psychiatrists, we also recommend broader access to the authority to initiate methylphenidate. Doctors specializing in addiction medicine, if trained in NDDs and working alongside psychiatrists, should be authorized to initiate methylphenidate. Finally, training is paramount, and priority should be given to expanding the availability of training programs.