Le trouble déficit de l’attention/hyperactivité à l’âge adulte : concept, tableau clinique, stratégies diagnostiques et thérapeutiques

Attention Deficit/Hyperactivity Disorder (ADHD) was considered, for a long time, as a disorder affecting children and adolescents, and was most often identified in the early development. It was less known that ADHD can be found in adults. Several arguments (clinics, neuropsychology, neuroanatomy, genetics, longitudinal studies and pharmacology) confirm that ADHD persists in adulthood for most of children and should be still treated, as long as the disorder leads to impairments. Nevertheless, ADHD in adults is considerably misdiagnosed in France. In fact, this can be explained by controverse, by its difficulty to be diagnosed, by a lack of consideration of developmental aspects… Diagnosis is based on clinical aspects, developmental and familial histories, adaptative strategies and functional alteration. Clinical interview put forward particularities in adulthood: decreasing (or change) of hyperactivity and impulsivity, persistance of attentional deficit, increasing of dysexecutive syndrome because demands in planification, social relationships and emotional management are often higher when people grow up. Several domains can be impaired: raising children, driving cars, working, taking care of themselves, daily managing… One of the most difficult issue about adult ADHD concerns criteriology. Although some authors (Wender, Hallowell and Ratey) have developped criteria based on more specific features of adulthood than those described in DSM-IV, criteria have still to be discussed: age-of-onset, number of symptoms required… Assesment scales can help clinicians to evaluate ADHD symptoms and impairments of their adult patients. Main scales are: Conners Adult ADHD Rating Scale (CAARS) and Adult ADHD Self-Report Scale (ASRS) for detection, ADHD behaviour checklist and ADHD rating scale IV for diagnosis, Wender Utah Rating Scale (WURS) for retrospective diagnosis in childhood and Brown Attention Deficit Disorder Scale for a better evaluation of executive functions. This evaluation should be completed by neuropsychological testing. The results can confirm the diagnosis and guide the treatment according to the neuropsychological profile. The more salient tasks for the diagnosis of adult ADHD seem to be: Continuous Performance Test (CPT) for selective and sustained attention, Trail making Test part B for cognitive flexibility, Stroop color/word interference test for inhibition capacity, verbal fluency and processing speed in WAIS-R. It is thus extremely important: (i) to recognize that ADHD affects also adults, at high rate (4% of general population), (ii) to keep in mind that developmental particularities make the disorder more “cognitive” than “behavioral”, (iii) to clarify the link between adult ADHD and the others psychiatric disorders, especially bipolar disorder, (iv) and to know that most of the adults with ADHD can be successfully treated by psychostimulants and psychotherapy, as in childhood. In France, only few teams evaluate ADHD in adulthood. So, one of the purpose of our article is to enable a better consideration of adult ADHD in our country.     

Attention deficit/hyperactivity disorder and video games: a comparative study of hyperactive and control children.

INTRODUCTION: This study describes and compares the behavior of hyperactive and control children playing video games. SUBJECTS AND METHODS: The sample consisted of 29 ADHD children and 21 controls aged between 6 and 16 years playing video games. We used the Child Behavior Checklist and the Problem Videogame Playing scale (PVP scale). This instrument gives objective measures of problem use, which can be considered as an indication of addictive videogame playing. We designed a questionnaire for the parents, eliciting qualitative information about their child's videogame playing. There were no significant differences concerning frequency or duration of play between ADHD children and controls but differences were observed on the PVP scale. None of the controls scored above four whereas 10 hyperactive children answered affirmatively to five or more questions. These children presented a greater intensity of the disorder than the other ADHD children. CONCLUSION: While no differences concerning video game use were found, ADHD children exhibited more problems associated with videogame playing. It seems that a subgroup of ADHD children could be vulnerable to developing dependence upon video games.     

Two consecutive episodes of intracerebral hemorrhage as the presenting feature of polyarteritis nodosa

We report a case of polyarteritis nodosa revealed by intracranial haemorrhage. A 40-year-old woman presented two episodes of cerebral haemorrhage twelve days apart, the second due to an aneurysm rupture. The diagnosis of polyarteritis nodosa (PAN) was based on the following criteria: histological aneurysm examination, angiography suggesting PAN with cerebral, renal and splenic localizations, loss of weight and cutaneous nodules. Cerebral haemorrhage in PAN is rare and exceptionally the presenting feature of the disease.     

Traitement par PRP 1 partie : les lésions cartilagineuses et musculaires

Background

The frequency and diversity of injuries affecting the musculoskeletal system have incited much research leading to the discovery of new treatment options including Platelet-Rich Plasma (PRP) therapy. To date, indications have been extended to injuries involving several types of tissues including cartilage and muscles.

Method

We searched the English and French literature for articles reporting a high level of proof on PRP therapy for cartilage or muscle injuries. We found six articles on cartilage lesions and three on muscle lesions.

Results

For cartilage lesions, PRP provides superior results compared with hyaluronic acid for early stage injuries, but the evidence is limited to a short follow-up (maximum 6 months). For muscle lesions, the PRP results are encouraging.

Conclusion

As long as a consensus has not been reached concerning the methods applied for preparing PRP, the concentrations used, the activation method, and the formulation, it will be difficult to compare studies, despite their high level of proof, and to affirm that PRP has a beneficial effect on repair of different body tissues. Use of PRP therapy for cartilage injury is now a validated option for pain relief, especially in young patients after failure of hyaluronic acid. The delay of action is long (at least 6 months). Injection formulations are easy to use, well tolerated and safe. Cost is relatively low.