'Class babies' misdiagnosed
L’étude qui montre que les « bébés de classe » – les enfants les plus jeunes de leur groupe – courent plus de risques d’hériter d’un diagnostic de TDAH a fait réagir de nombreux lecteurs. La grande majorité d’entre eux, qu’ils soient parents, enseignants ou spécialistes, déplorent la « pression du diagnostic » qui s’exerce dans le réseau scolaire. Et dans certains cas,
leurs histoires sont troublantes.
leurs histoires sont troublantes.
The study that shows that "class babies" – the youngest children in their group – are more likely to inherit an ADHD diagnosis has caused many readers to react. The vast majority of them, whether parents, teachers or specialists, deplore the "pressure of diagnosis" exerted in the school system. And in some cases, their stories are disturbing.
Karine Lafrance and her son Loïc
As soon as he entered kindergarten, Guillaume had problems. The little one, born on September 25, was clearly less mature than the other children in his class. He had trouble concentrating, complying with instructions, his fine motor skills were deficient.
Early in elementary school, teachers started talking to her parents about attention deficit hyperactivity disorder (ADHD).
At age 9, he was diagnosed by a psychologist and prescribed medication by a pediatrician. Pills he always hated taking.
Then, in CEGEP, in order to benefit from support measures, the young person ended up undergoing an assessment in neuropsychology.
The result stunned the family: Guillaume does not have ADHD.
"I felt a lot of guilt that I had been making my son swallow medicine for all these years for absolutely nothing. These substances have undesirable effects that are not trivial: cramps, loss of appetite, loss of interest, sleep disorders, lark! During all these years, I encouraged my son to take them by telling him that it was for his own good. I was in the field. In fact, we were all in the field. »
It was Guillaume's mother, Hélène Lemire, who wrote to us following our report on this major study conducted at UQAM. The study, which compiled the medical records of 800,000 Quebec children, showed that "class babies," children born in July, August and September, were much more likely to inherit an ADHD diagnosis than the oldest in their classes, born in October, November and December.
The neuropsychological assessment showed that he had only mild attentional difficulties. It was a huge surprise for us, but also for our son, who had lived all his schooling with the ADHD label. He had other difficulties, but not this one.
Hélène Lemire
Following this second diagnosis, says Boisbriand's wife, Guillaume stopped taking his medication.
He is now 27 years old and works as a stage technician.
Can't start school a year laterJulie M. is in the same situation as Hélène Lemire: she wonders if her youngest daughter, born in August, could not have avoided a diagnosis and medication if she had simply been allowed to start school a year later.
In the last year of daycare, she was a player, she always had fun with the younger kids. She was not at all interested in school-type tasks.
Julie M., about her daughter
Julie M. asked that her daughter start a year later. His request was denied. Many parents have given us the same testimony: it is now almost impossible to obtain a derogation so that a child does not start school if he is 5 years old before September 30.
Julie M. knew what was waiting for her daughter: she is herself an elementary school teacher in Montérégie. "No teacher wants to have a child born in August or September. We know it, we see it, we experience it every year: these children are often not ready to start school. That's why the mother asked us not to say her name: her school service centre does not allow teachers to speak to the media.
In fact, in her first year, her daughter was invited to go for evaluation. She was medicated. InGrade 5, a second evaluation showed that the problem was not attentional: the little girl was rather dyslexic and dysorthographic.
"I'm pretty sure that if she had had the opportunity to wait a year before starting school, she would have done better," says Julie M. "My big regret is that I didn't fight more for it."
"It didn't stick"Karine Lafrance experienced the same thing. Her son Loïc, born at the end of July, was evaluated in first grade by the school's psychologist, who quickly concluded that he had attention deficit disorder, in addition to mentioning a possible diagnosis of autism.
"We were appalled and surprised. For us, it didn't fit," saysMs. Lafrance. Parents decide to use a neuropsychological assessment... whose conclusions turn out to be quite different.
Our child did not have attention deficit, let alone autism, he was rather dyslexic. No medication can correct this learning disability. In short, if we had not questioned the diagnosis, it would have been medicated for no reason.
Karine Lafrance
Since his diagnosis of dyslexia, Loïc receives adequate services from his school and is doing well, however,emphasizes Ms. Lafrance.
Medicated backwardsThe son of Jacinthe Prévost, from Lanaudière, was also quickly spotted by his second-year teacher. "We were summoned to school, we had to have him evaluated, otherwise they did it with their own specialists," she said in an interview.
A pediatrician saw Olivier, a "class baby" born in August. Even though he did not believe the medication was necessary, he still agreed to prescribe it. "Anyway, we ended up giving it to him, but he didn't want to know anything about taking it."
His parents did not give him his dose on weekends.
One of her primary school teachers insisted during the school year to check her own Ritalin intake, in order to be sure that the child took it. "It was very controlling, unpleasant."
InSecondary 1, her son stopped taking his medication. "He told me, 'When I take this, Mom, I'm not myself.' The young person made it through high school. He did his CEGEP, then his university course. He is now an engineer.
"We were pushed to medicate him," saysMs. Prévost. I am a very sad mother to have been forced to medicate my young child against his will.»
PROPORTION OF YOUTH UNDER 24 MEDICATED FOR ADHD IN QUEBEC
The judgment of professionals "questioned"
Neuropsychologist Isabelle Fournier
"The pressure for a diagnosis is very high. If, as a professional, we judge that there is no ADHD, we will be very confronted, questioned in relation to our interpretations ... Because that's the only problem that happens with medication. A quick fix. »
The speaker has been a neuropsychologist for 12 years. Isabelle Fournier worked in schools, then in the private sector. During her years of practice, she has conducted hundreds of assessments for possible ADHD cases.
Examples of this pressure? He has sometimes done an assessment at the request of a doctor... who ended up making a prescription even though she had ruled that the child did not have ADHD. A fellow psychologist was called by her clinic director after she judged that a child did not present the clinical portrait of attention deficit. "He was asked to change his conclusion." In preparation of intervention plans for a child, she heard it said: "No, we will not give help to the child, because otherwise, the parent will refuse the medication," saysMs. Fournier in an interview.
Pediatrician Guy Parizeault, who practices in Saguenay, delivers a similar message. In his 25 years of practice, he has gone "from a time when ADHD didn't exist to a time when there's not a day you don't have a request for assessment or follow-up for ADHD."
Saguenay–Lac-Saint-Jean is one of the regions where psychostimulants are prescribed the most. A study by the Institut national d'excellence en santé et en services sociaux showed that 14.2% of young people under the age of 25 were medicated for ADHD,
twice as many as the Quebec average.
Parents and children often find themselves in the doctor's office far too quickly, he says.
There is the whole issue of parental supervision, homework, which is training for exams. I often ask young people: how much time do you put into your homework? And the answer is zero.
Dr. Guy Parizeault, pediatrician
In his notes, Dr. Parizeault's diagnostic impression is often "academic laziness."
Costly neuropsychological assessmentThe difficulty of making a diagnosis of ADHD is highlighted by many professionals who have contacted us. Only doctors (general practitioners or specialists) are allowed to prescribe the medication, but the psychological diagnosis of ADHD can be made by a psychologist or neuropsychologist. Neuropsychological tests are the most advanced. They last several hours, but are rarely offered
in the public network. They often cost more than $1000.
"I can count on the fingers of one hand the children who arrive with a neuropsychological assessment," notes Dr. Parizeault.
Physicians who prescribe medication usually do so after submitting a questionnaire to parents and the teacher. But these questionnaires, such as Conners or CADDRA, "are far from optimal," says the doctor. "I've heard school staff say, 'I know, where to tick, so the child has his diagnosis,'" says speech-language pathologist Odrée Dionne-Fournelle.
And "class babies" are often targeted, adds remedial teacher Caroline Fiset, who estimates that two-thirds of her clientele of students in difficulty are among the youngest in their classes. "They need an extra boost, they don't necessarily have a learning problem."
Karine Lafrance and her son Loïc
As soon as he entered kindergarten, Guillaume had problems. The little one, born on September 25, was clearly less mature than the other children in his class. He had trouble concentrating, complying with instructions, his fine motor skills were deficient.
Early in elementary school, teachers started talking to her parents about attention deficit hyperactivity disorder (ADHD).
At age 9, he was diagnosed by a psychologist and prescribed medication by a pediatrician. Pills he always hated taking.
Then, in CEGEP, in order to benefit from support measures, the young person ended up undergoing an assessment in neuropsychology.
The result stunned the family: Guillaume does not have ADHD.
"I felt a lot of guilt that I had been making my son swallow medicine for all these years for absolutely nothing. These substances have undesirable effects that are not trivial: cramps, loss of appetite, loss of interest, sleep disorders, lark! During all these years, I encouraged my son to take them by telling him that it was for his own good. I was in the field. In fact, we were all in the field. »
It was Guillaume's mother, Hélène Lemire, who wrote to us following our report on this major study conducted at UQAM. The study, which compiled the medical records of 800,000 Quebec children, showed that "class babies," children born in July, August and September, were much more likely to inherit an ADHD diagnosis than the oldest in their classes, born in October, November and December.
The neuropsychological assessment showed that he had only mild attentional difficulties. It was a huge surprise for us, but also for our son, who had lived all his schooling with the ADHD label. He had other difficulties, but not this one.
Hélène Lemire
Following this second diagnosis, says Boisbriand's wife, Guillaume stopped taking his medication.
He is now 27 years old and works as a stage technician.
Can't start school a year laterJulie M. is in the same situation as Hélène Lemire: she wonders if her youngest daughter, born in August, could not have avoided a diagnosis and medication if she had simply been allowed to start school a year later.
In the last year of daycare, she was a player, she always had fun with the younger kids. She was not at all interested in school-type tasks.
Julie M., about her daughter
Julie M. asked that her daughter start a year later. His request was denied. Many parents have given us the same testimony: it is now almost impossible to obtain a derogation so that a child does not start school if he is 5 years old before September 30.
Julie M. knew what was waiting for her daughter: she is herself an elementary school teacher in Montérégie. "No teacher wants to have a child born in August or September. We know it, we see it, we experience it every year: these children are often not ready to start school. That's why the mother asked us not to say her name: her school service centre does not allow teachers to speak to the media.
In fact, in her first year, her daughter was invited to go for evaluation. She was medicated. InGrade 5, a second evaluation showed that the problem was not attentional: the little girl was rather dyslexic and dysorthographic.
"I'm pretty sure that if she had had the opportunity to wait a year before starting school, she would have done better," says Julie M. "My big regret is that I didn't fight more for it."
"It didn't stick"Karine Lafrance experienced the same thing. Her son Loïc, born at the end of July, was evaluated in first grade by the school's psychologist, who quickly concluded that he had attention deficit disorder, in addition to mentioning a possible diagnosis of autism.
"We were appalled and surprised. For us, it didn't fit," saysMs. Lafrance. Parents decide to use a neuropsychological assessment... whose conclusions turn out to be quite different.
Our child did not have attention deficit, let alone autism, he was rather dyslexic. No medication can correct this learning disability. In short, if we had not questioned the diagnosis, it would have been medicated for no reason.
Karine Lafrance
Since his diagnosis of dyslexia, Loïc receives adequate services from his school and is doing well, however,emphasizes Ms. Lafrance.
Medicated backwardsThe son of Jacinthe Prévost, from Lanaudière, was also quickly spotted by his second-year teacher. "We were summoned to school, we had to have him evaluated, otherwise they did it with their own specialists," she said in an interview.
A pediatrician saw Olivier, a "class baby" born in August. Even though he did not believe the medication was necessary, he still agreed to prescribe it. "Anyway, we ended up giving it to him, but he didn't want to know anything about taking it."
His parents did not give him his dose on weekends.
One of her primary school teachers insisted during the school year to check her own Ritalin intake, in order to be sure that the child took it. "It was very controlling, unpleasant."
InSecondary 1, her son stopped taking his medication. "He told me, 'When I take this, Mom, I'm not myself.' The young person made it through high school. He did his CEGEP, then his university course. He is now an engineer.
"We were pushed to medicate him," saysMs. Prévost. I am a very sad mother to have been forced to medicate my young child against his will.»
PROPORTION OF YOUTH UNDER 24 MEDICATED FOR ADHD IN QUEBEC
- 2000 : 1,9 %
- 2010 : 4,6 %
- 2020 : 7,7 %
The judgment of professionals "questioned"
Neuropsychologist Isabelle Fournier
"The pressure for a diagnosis is very high. If, as a professional, we judge that there is no ADHD, we will be very confronted, questioned in relation to our interpretations ... Because that's the only problem that happens with medication. A quick fix. »
The speaker has been a neuropsychologist for 12 years. Isabelle Fournier worked in schools, then in the private sector. During her years of practice, she has conducted hundreds of assessments for possible ADHD cases.
Examples of this pressure? He has sometimes done an assessment at the request of a doctor... who ended up making a prescription even though she had ruled that the child did not have ADHD. A fellow psychologist was called by her clinic director after she judged that a child did not present the clinical portrait of attention deficit. "He was asked to change his conclusion." In preparation of intervention plans for a child, she heard it said: "No, we will not give help to the child, because otherwise, the parent will refuse the medication," saysMs. Fournier in an interview.
Pediatrician Guy Parizeault, who practices in Saguenay, delivers a similar message. In his 25 years of practice, he has gone "from a time when ADHD didn't exist to a time when there's not a day you don't have a request for assessment or follow-up for ADHD."
Saguenay–Lac-Saint-Jean is one of the regions where psychostimulants are prescribed the most. A study by the Institut national d'excellence en santé et en services sociaux showed that 14.2% of young people under the age of 25 were medicated for ADHD,
twice as many as the Quebec average.
Parents and children often find themselves in the doctor's office far too quickly, he says.
There is the whole issue of parental supervision, homework, which is training for exams. I often ask young people: how much time do you put into your homework? And the answer is zero.
Dr. Guy Parizeault, pediatrician
In his notes, Dr. Parizeault's diagnostic impression is often "academic laziness."
Costly neuropsychological assessmentThe difficulty of making a diagnosis of ADHD is highlighted by many professionals who have contacted us. Only doctors (general practitioners or specialists) are allowed to prescribe the medication, but the psychological diagnosis of ADHD can be made by a psychologist or neuropsychologist. Neuropsychological tests are the most advanced. They last several hours, but are rarely offered
in the public network. They often cost more than $1000.
"I can count on the fingers of one hand the children who arrive with a neuropsychological assessment," notes Dr. Parizeault.
Physicians who prescribe medication usually do so after submitting a questionnaire to parents and the teacher. But these questionnaires, such as Conners or CADDRA, "are far from optimal," says the doctor. "I've heard school staff say, 'I know, where to tick, so the child has his diagnosis,'" says speech-language pathologist Odrée Dionne-Fournelle.
And "class babies" are often targeted, adds remedial teacher Caroline Fiset, who estimates that two-thirds of her clientele of students in difficulty are among the youngest in their classes. "They need an extra boost, they don't necessarily have a learning problem."
