[Levels of care and training for "ADHD-Specialized Physicians" for Children and Adolescents in France in 2024]

Abstract

Objectives: This article examines international recommendations for the diagnosis and management of Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. It highlights the roles of physicians at various levels of care and introduces the 2024 recommendation from the French High Authority for Health (Haute Autorité de santé [HAS]) to create a formal certification for "ADHD-specialized physicians". These physicians would be qualified to both diagnose ADHD and initiate stimulant prescriptions. The article further outlines a proposed training framework for these specialized physicians in France, detailing the required training hours, educational objectives, and methods for evaluating competencies.

Methods: The study synthesized data from international guidelines on ADHD management collected through systematic searches conducted by the HAS between 2012 and 2023. This analysis focused on how physicians' roles are defined in different healthcare systems. In parallel, an inventory of training programs available in France in 2024 was conducted, categorizing these programs based on content and duration. Training modules were grouped into four categories: diplomas focused on ADHD, general training on neurodevelopmental disorders, introductory training for primary care physicians, and modules dedicated to therapeutic interventions for ADHD.

Results: International recommendations exhibit significant variability in the delegation of diagnostic and treatment responsibilities for ADHD. Restrictive models, such as those in the UK and Germany, reserve diagnosis and stimulant initiation for specialists (e.g., child psychiatrists, pediatricians). In contrast, pragmatic approaches, exemplified by Canada and Australia, enable trained primary care physicians to handle straightforward cases. In France, the HAS has proposed an intermediate solution: recognizing "ADHD-specialized physicians" who can operate at a secondary care level. These physicians would manage ADHD diagnoses and initiate prescriptions, addressing challenges such as regional disparities in access to care, and the overburdening of specialist services. The proposed training framework for ADHD-specialized physicians includes 10-21hours of instruction. This program aims to equip physicians with skills in ADHD diagnosis, the identification of comorbidities, interpreting neuropsychological assessments, implementing psychoeducation, prescribing and monitoring pharmacological treatments, and coordinating with educational and healthcare teams. Additionally, it emphasizes non-pharmacological interventions, such as parental training programs and behavioral therapies. An additional component of the program would be a competency-based assessment using Script Concordance Tests (SCTs) designed to measure physicians' ability to apply knowledge in clinical scenarios.

Conclusions: The creation of ADHD-specialized physicians, as proposed by the HAS, represents a pivotal step in improving ADHD care in France. By addressing the gaps in access to diagnosis and treatment, this initiative aligns with successful elements of international models while tailoring solutions to the French healthcare context. A structured training framework and standardized assessment methods will ensure that these physicians can deliver high-quality care. Expanding access to pharmacological treatments through this approach has the potential to significantly reduce delays in ADHD management and enhance multidisciplinary collaboration. This initiative underscores the importance of harmonizing training, accreditation, and care delivery to meet the growing demand for ADHD services.

Keywords: Adolescent; Attention-deficit disorder with hyperactivity; Child; Education; Enfant; Formation médicale; Health care; Medical guidelines as topic; Recommandations; Recommandations comme sujet; Soins de santé; Trouble déficit de l’attention avec hyperactivité.