Trouble déficit de l’attention/hyperactivité (TDA/H) et conduites à risques chez l’enfant et l’adolescent : cas particulier des accidents et des blessures non intentionnelles

Abstract

Risk behaviors in children and adolescents are a real public health problem with disastrous short-term and long-term consequences in terms of morbidity and mortality. In this article, first we define the concept of risk behaviors and highlight their diversity and co-occurrence. According to the Center for Disease Control (CDC), risk behaviors include unintentional injuries and violence, tobacco and alcohol consumption, illicit drug use, unsafe sexual behavior, unhealthy dietary habits, and inadequate physical activity. Although these risk behaviors are distinct, they are often inter-connected to one another. Second, we define the attention deficit and hyperactivity disorder (ADHD) and review the evidence showing its association with risky behaviors such as substance use (e.g., tobacco, alcohol, and cannabis), risky sexual practices, and suicidal behaviors. Next, we illustrate the risk behaviors via specific cases of accidents and unintentional injuries (e.g., sport, car accidents) whereby the negative consequences of these behaviors are most explicit in terms of morbidity and mortality in both children and adolescents. For instance, several datasets collected from hospitalized children have indicated the significant relationship between facial trauma and ADHD. The review of these findings on risk behaviors and particularly on accidents casts light on the extent to which excess mortality is associated with ADHD. Furthermore, we point out the ambiguities that exist in the study of the links between ADHD and risky behaviors, including the importance of comorbidity (e.g., conduct disorder, oppositional defiant disorder) as well as the effect of specific symptoms such as inattention in accidents and unintentional injuries. We argue for the advantages of considering ADHD as a kind of “accident proneness”, that is, individuals with ADHD demonstrate signs of a predisposition to accidents. There are several scholars who insist on the necessity to detect the symptoms of ADHD in injured children and adolescents (e.g., during consultation or hospitalization for various trauma and injuries) and include the treatment of those symptoms in their recovery process. Finally, we reflect on the practical implication of this and review the practical implications such as the taking some preventative measures in schools, particularly the implementation of longitudinal programs based on the acquisition of skills to reduce the risks for health.