ADHD: too much Ritalin, or too few resources?

TDAH: trop de Ritalin ou trop peu de ressources?

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Several pediatricians and researchers have sounded the alarm about the increasing use of drugs — such as Ritalin — to correct the behaviour of a child who shows signs of ADHD.

Arrested by a letter from a fifty pediatricians denouncing the over-treatment to treat the attention deficit disorder with or without hyperactivity (ADHD) in children, general practitioners defended themselves Thursday, to prescribe to any wind. They certify want to help patients who do not have access to specialists.

“It is often in front of parents in distress who want quick results. However, access to other resources is far from obvious. The fastest possible, unfortunately, currently, it remains the medication “, drops in an interview with the Duty Dr. Louis Godin, president of the Fédération des médecins omnipraticiens du Québec (FMOQ). “Why blame us for trying to help a patient ?” he insists.

In an open letter published in Le Journal de Montréal Thursday, 48 pediatricians and researchers have sounded the alarm about the increasing use of drugs — such as Ritalin — to correct the behaviour of a child who shows signs of ADHD. They have called for a “discount” collective, both on the part of prescribers as to the faculty, parents, and psychologists who assess children and to ” [turn] too easily to one pill to treat all the ailments “.

Higher prescriptions

To justify their concerns, they relied on data from the Institut national d’excellence en santé et services sociaux (INESSS), which show an increase in prescriptions of drugs for young people aged 0 to 25 years, over the period from 2006 to 2015, to treat the ADHD. These figures are much higher in Quebec than in the rest of Canada. For example, in Quebec 13,97 % of youth ages 10-12 who use psychostimulant drugs. A rate that rises to 14.5 % among 13-17 years old. In the rest of the country, it is rather 5,08 % of 10-12 years, and 4.3% of 13-17 years.

The signatories of the letter also regretted that a treatment based on the addition of psychosocial intervention to be set aside. “With insurance medicines, it is cheaper to have the Ritalin to see a psychologist, this is not normal,” laments one of the co-signers, the pediatrician Guy Falardeau.

It’s also important not to “demonise” the medication, supports Annick Vincent, a psychiatrist specializing in ADHD, which considers the pills useful if they are accompanied by a therapeutic approach appropriate. “The drugs, it’s like giving glasses to a child short-sighted who has difficulties in French. It will not correct his spelling errors, but it will help to learn faster and to write correctly “, does it by example.

14%

This is the percentage of young Quebecers aged between 10-12 years who use psychostimulant drugs. In 13-17 years, it is 14.5 %. Elsewhere in the country, we rather speak of 5 % and 4.3 %.

But for this, there should be more specialists, concedes she said, explaining refuse every day of new patients in her clinic, due to lack of time.

Same sound of bell on the side of Dr. Godin. It recognizes that the multiple approach — that combines medication and intervention specialists to monitor the patient — is still the best, it ensures that ” resources are not at the rendez-vous “. “Psychologist, pediatrician, special educator, occupational therapist, child psychiatrist : we need them to specify the diagnosis and to modulate the treatment,” he explains.

The government of François Legault has also announced the same day a program of early detection of developmental delays in children, which includes the hiring of 800 professionals in the next two years to complete these examinations.

A decision welcomed by Mr. Godin and Ms. Vincent, but that left Mr. Falardeau marble. “It is nice to add to the world, to evaluate all children, but if it is for all of them to find ADHD when they are suffering from other ailments, what is this ?” asks the pediatrician, the air in exasperation.

Errors of diagnosis

Mr. Falardeau, who accumulated 43 years of experience and whose clientele is primarily children with ADHD, consider that many of them have initially received a wrong diagnosis. “As soon as we see a restless child, who has problems at school, which is inattentive and confronting, we are told that he has ADHD, he said. But it can be from anxiety related to a situation at school or at home. It is not able as a society to distinguish between the two. “

According to his observations, the anxiety in children has exploded in the last fifteen years. But when he sends a child in a CLSC for such a problem, it comes to contradict his diagnosis and say the patient has ADHD. “It is as if it was more easy to arrive at this conclusion, rather than focusing on the emotional aspects and psycho-social can come into question. “

The psychiatrist Annick Vincent abounds in the same direction. She believes that society is now made up of people who are stressed, anxious, always glued to a screen, unable to manage their time or their emotions, and this, from childhood. “Finally, we all like ADHD, but it is rather a problem of society. “

It recognises, however, that make the difference and establish a proper diagnosis is not an easy thing when one gives to a doctor fifteen minutes to evaluate the patient.

An opinion shared by Dr. Christine Grou, president of the Ordre des psychologues du Québec. “A good evaluation takes several hours. It requires to remake the whole story : recognize the symptoms, how the problem has grown, since when, in what context, to discern if it is really ADHD. At the same time, when you have before you a child impulsive, inattentive, that has the impression of working hard but can’t do it, who has lost any confidence or esteem of him, difficult to leave without intervention “, she says.

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