Original Title: Rapport en soutien - Prise en charge des jeunes de moins de 18 ans qui présentent un trouble du déficit de l’attention/hyperactivité (TDAH)

Authors' objectives: Attention deficit disorder with or without hyperactivity (ADHD) is a neurodevelopmental disorder with a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with a person's functioning or development. A worrying increase in the number of ADHD diagnoses and associated medication prescriptions has been observed over the past 20 years for youth under the age of 18. To support front-line health professionals and provide a framework for practice, the INESSS has produced a care management tool to help care for youth under 18 with ADHD. This tool includes information on assessment and diagnosis, non-pharmacological and pharmacological therapeutic approaches, follow-up and deprescription.

Authors' results and conclusions: RESULTS (#1 ASSESSMENT PROCESS): The assessment process provides an overall analysis of the youth's situation and must involve the participation of the various stakeholders in his or her life. It is at this stage that all relevant information is gathered, including information on interventions already in place. Assessment includes an evaluation of the youth's health, environment, functioning and symptoms, using questionnaires and specific interviews. (#2 DIAGNOSTIC PROCESS): The recommended diagnostic process for ADHD is largely based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The presence of mental disorders, physical health problems or difficult psychosocial situations that may explain the symptoms, should be assessed during the diagnostic process. In addition, ADHD symptoms may overlap with those of other mental disorders, and comorbidities should be considered during the diagnostic process. CONCLUSION: ADHD is a complex condition that can affect youth in many areas of their functioning. Their needs must be considered, and they should be at the center of decisions concerning treatment and follow-up. Without replacing clinical judgment, the application and implementation of the recommendations outlined in this care management tool are intended to support front-line health professionals in the assessment, diagnosis, treatment and follow-up of youth under 18 with ADHD. However, the impact of this tool will depend on its dissemination, adherence to the recommendations, and the adoption and commitment of front-line health professionals to its use.

Authors' recommendations: Based on a shared decision with the family or the youth him/herself, the recommended therapeutic process is as follows: • For children under the age of six, an approach based solely on psychosocial interventions provided as first-line treatment to reduce ADHD symptoms, i.e., parent training interventions. • For children aged 6 to 17, a multimodal approach involving psychosocial, nonpharmacological and pharmacological interventions provided to reduce ADHD symptoms. – Psychosocial interventions shown to be effective in improving ADHD symptoms include behavioural interventions and parent training interventions. – Regular physical activity is also recommended as a non-pharmacological approach. – Administration of a minimum effective and tolerable dose of a long-acting psychostimulant is recommended as a first-line treatment.

Authors' methods: A rapid review of the literature presenting information and clinical recommendations regarding the diagnosis, treatment and follow-up of youth under 18 with ADHD was conducted for the period covering 2018 to 2023, following the INESSS rapid review guidelines. An advisory committee was formed, and various stakeholders were consulted to gather background information, experiential knowledge and complementary perspectives essential to understanding the problem as a whole. Regarding psychosocial interventions, the recommendations were based on parallel INESSS work on the effectiveness of these interventions on ADHD symptoms

Project Status: Completed

URL for project: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/ServicesSociaux/INESSS_Prise_charge_TDAH_GN.pdf

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/ServicesSociaux/INESSS_Prise_charge_TDAH_GN.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)