Exemple d’une équipe territoriale de niveau 3 (« recours ») dans le TDAH : l’Équipe de Coordination Lyonnaise des troubles de l’Attention et de l’Hyperactivité (ECLAH)

Abstract

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) affects 6% of children and 3% of adults, representing approximately 481,600 youths and 240,800 adults in the Auvergne-Rhône-Alpes region. Despite its prevalence, the French national strategy for neurodevelopmental disorders (2023–2027) highlights the lack of dedicated healthcare pathways for ADHD and the challenges in accessing diagnosis, treatment, and psychosocial rehabilitation. In Auvergne-Rhône-Alpes, the discordance between the significant public health issue posed by ADHD and the local healthcare resources has often led to misdirection and congestion of specialized hospital teams. This situation persists despite the well-documented medical and societal complications of untreated ADHD. At the Vinatier Hospital in Lyon, several specialized teams offer expertise in ADHD for children and adults, but there was no specific team dedicated to ADHD until recently. The Lyon ADHD Coordination Team (ECLAH)Formed in November 2023 at the initiative of professionals from the Vinatier Hospital, ECLAH is a multidisciplinary team comprising psychologists, neuropsychologists, psychiatrists, child psychiatrists, addiction specialists, pharmacists, project managers, and clinical research associates. ECLAH aims to meet the national strategy's requirements for ADHD in the Auvergne-Rhône-Alpes region by coordinating care networks, providing information, training, care, and conducting research in the field of ADHD. ECLAH functions as a resource team, complementing existing structures without replacing them, and focuses on specialization and expertise in ADHD to enhance ongoing efforts. Training MissionThe team contributes to the “Inter-University Diploma in ADHD across all ages” (DIU). The training “ADHD: From Screening to Support” equips healthcare professionals with the knowledge and tools necessary for ADHD diagnosis and treatment. The “DIVA Adult 5.0: Diagnostic Goal!” training focuses on diagnostic reasoning and interviewing techniques for ADHD evaluation. These programs adhere to current scientific data and ADHD guidelines from recognized scientific societies, with a Qualiopi® certification pending for continuous medical education validation. Following training, professionals receive implementation support through multidisciplinary guidance meetings. Coordination and Information MissionECLAH is organizing a care network for ADHD in Auvergne-Rhône-Alpes, collaborating with general practitioners, health and educational institutions, medico-social establishments, penitentiary care, expert centers, and patient associations. The team provides information and guidance to institutions and professionals seeking ADHD-related resources either directly or through its developing website. The team maintains adherence to scientific data and best practice recommendations (RBPP) in the region, fostering expertise through awareness, training, tele-expertise, and multidisciplinary concertation meetings. ECLAH also coordinates with national ADHD organizations, contributing to the harmonization of practices and the development of ADHD guidelines. Care MissionECLAH offers third-line or “recourse” consultations for children and adults with complex cases requiring diagnostic or therapeutic support. These consultations, often involving differential diagnoses and comorbidity assessments, are conducted in partnership with specialized units such as the Center for the Evaluation of Language, Learning, and Attention Disorders (CETESLA) for child psychiatry and the University Addiction Service of Lyon (SUAL) for adults. ECLAH also provides psychoeducation and therapeutic education groups for individuals with complex ADHD or contraindications to medication. A support group for caregivers is planned, leveraging the “BREF” psychoeducation program. Research MissionECLAH engages in medical research, focusing on ADHD characteristics in women by hormonal status, the cessation of methylphenidate treatment in adolescents, links between asthma and ADHD, and screening for ADHD in high-level young athletes. ConclusionECLAH is a third-level territorial team supporting professionals and their ADHD patients in Auvergne-Rhône-Alpes. By coordinating the regional care network, ECLAH enhances the existing care structures, ensuring access to reliable ADHD information and treatment pathways. The team plans to introduce a psychoeducation group for families and prioritize ADHD detection in penitentiary settings for both adults and youths.