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ADHD · Saint‑HyacintheChildren from age 8 · Adolescents · Adults
ADHD is much more than a lack of attention
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can affect attention, organization, time management, impulse control and, in some people, activity level.
It begins in childhood, but can persist into adolescence and adulthood.
ADHD does not present the same way in everyone. A person may mainly experience attention difficulties, show more hyperactivity and impulsivity, or show a combination of these features.
Above all, being distracted, active or disorganized from time to time does not necessarily mean having ADHD.
For ADHD to be considered, the symptoms must be persistent, have a significant impact on functioning and be assessed in context.
Presentations
Three presentations are generally recognized.
The difficulties mainly involve attention, organization and the ability to sustain mental effort.
The person may, for example:
The person may, for example, show:
In adolescents or adults, hyperactivity may be much less visible than it was during childhood and may show up more as inner restlessness or as a need to be constantly busy.
Some people show significant signs of both inattention and hyperactivity or impulsivity.
The presentation of ADHD can also change over the course of life.
Children
At Clinique IPS du Palais, our ADHD assessment pathway is offered to children aged 8 and older, as well as to adolescents and adults.
In children, difficulties sometimes become more obvious as school demands increase.
For example, the following may be observed:
However, an active or distracted child does not necessarily have ADHD.
The child’s age, development, environment, sleep, school functioning, psychological state and several other factors must be considered.
Adolescents
Adolescence brings new demands: more independence, several teachers, more assignments to plan and a more complex daily organization.
Difficulties may appear, for example, in the form of:
Some adolescents have long managed to compensate for their difficulties. These then become more visible as the structure provided by parents or school decreases.
Adults
ADHD can persist into adulthood.
The signs are sometimes less obvious than in children.
They may affect, for example:
The Gouvernement du Québec points out that ADHD can affect functioning at home, at school, at work and in relationships.1
Attention
A person living with ADHD is not incapable of paying attention.
The difficulty has more to do with regulating attention.
Some people can be extremely focused when an activity is:
Conversely, a monotonous or unstimulating activity can require an enormous amount of effort.
This is why a person can spend several hours focused on an activity they are passionate about and have great difficulty completing an administrative task that takes a few minutes.
Executive functions
Executive functions allow us, among other things, to:
start a task;
plan;
organize;
set priorities;
manage our time;
maintain our attention;
resist distractions;
keep certain information in mind during a task;
control certain impulses;
switch efficiently from one task to another.
Some of these abilities may be harder to draw on for a person with ADHD.
A person may therefore know very well what they should do, but have more difficulty turning that intention into action consistently.
Questionnaires are useful.
But they are one part of the assessment, not the diagnosis on their own.
According to CADDRA, the assessment of ADHD must consider, among other things, the symptoms, their functional impact and the various medical, psychiatric, psychosocial, academic or occupational dimensions that may influence the clinical picture.2
There is therefore no single blood test, questionnaire or test that can automatically answer:
“Yes, you have ADHD” or “No, you don’t.”
Telling them apart
This is an essential question.
Difficulties with concentration, organization, memory or impulsivity can have several causes.
Depending on the situation, it may be relevant to explore, among other things:
Some of these conditions can resemble ADHD.
Others may be present at the same time as ADHD.
The Gouvernement du Québec notes, among other things, that learning disorders, anxiety and depressive disorders, and certain behavioural disorders are frequently associated with ADHD.1
This is why a good assessment does not seek only to confirm ADHD.
It first seeks to understand what explains the person’s difficulties.
Our approach
Our approach is intended for children aged 8 and older, adolescents and adults.
It is based on a step-by-step approach that considers medical, psychological, academic, family and psychosocial aspects alike.
Step 1
The process begins with an initial assessment with Marie-Claude Tessier, primary care nurse practitioner (PHCNP).
The purpose of this meeting is not to assume that it is necessarily ADHD.
Rather, we seek to answer an essential first question:
This initial assessment makes it possible to review, among other things:
Documents
This information helps us better understand how the difficulties show up in different settings.
However, not all of it is required to begin the process.
CADDRA in fact recommends an assessment that goes beyond the mere presence of symptoms and takes into account the person’s overall functioning and the various factors that can complicate or mimic ADHD.2
When available, we can also include in the assessment:
The initial assessment also makes it possible to screen for certain comorbidities, that is, conditions that may accompany ADHD.
This step is important because the treatment strategy may be different when a person has, for example, ADHD along with an anxiety disorder, a mood disorder, a learning disorder or another issue.
The goal is to avoid treating a symptom in isolation without understanding the overall picture.
Safety
When pharmacological treatment might be appropriate, the assessment also includes looking for the information needed to determine whether medication can be considered safely.
Tests or blood work may also be ordered when the clinical situation warrants it.
A blood test is therefore not automatically necessary for every ADHD assessment.
Depending on their specialty class and scope of practice, NPs carry out advanced professional activities that include, among other things, ordering diagnostic tests, determining medical treatments and prescribing medications.3
Depending on the situation, this may include, among other things:
Step 2
Following the initial assessment, the process continues with our mental health nurse practitioner (MHNP) when this care is indicated.
The MHNP has advanced training and particular expertise in mental health.
She can continue and deepen the assessment in order to integrate all the information gathered and establish a care strategy tailored to the person.
Depending on the situation, her involvement may include, among other things:
The MHNP is one of the five NP specialty classes recognized in Quebec. NPs can, among other things, diagnose diseases, order diagnostic tests, determine medical treatments and prescribe medications, within the scope of their specialty and practice.3
Step 3
Medication may be relevant for some people, but it is not automatically the only intervention offered.
Several medications can be used to treat ADHD.
They include stimulant and non-stimulant medications, among others.
The choice depends on several factors:
age;
symptoms;
their impact;
medical conditions;
associated mental health problems;
medications already being used;
response to previous treatments;
adverse effects;
the desired duration of action;
the person’s particular needs.
Two people with ADHD may therefore receive different treatments.
Follow-up
When medication is started, follow-up is important.
The medication can then be adjusted based on the clinical response.
The goal is not to change a person’s personality.
The goal is to reduce the difficulties enough to improve daily functioning while maintaining good tolerance of the treatment.
Follow-up makes it possible to monitor, among other things:
Step 4
Treating ADHD does not just mean prescribing a medication.
When it may be beneficial, complementary work can be done with our social worker.
Even when medication improves attention or impulsivity, some difficulties may remain:
Social work
The social worker can support the child, adolescent, adult or family according to the needs identified.
Her approach makes it possible to work on the concrete consequences of ADHD in everyday life.
The Gouvernement du Québec also recognizes the role of psychosocial and behavioural interventions, school accommodations and lifestyle habits in the management of ADHD.1
Her work may focus, among other things, on:
A team approach
At Clinique IPS du Palais, the pathway can therefore bring together several areas of expertise.
Comprehensive assessment with Marie-Claude Tessier, PHCNP
Understanding the difficulties, analyzing the available questionnaires and documents, looking for other possible explanations, screening for comorbidities and completing the medical assessment.
Specialized care with the MHNP
Deepening the mental health assessment, establishing or clarifying the diagnostic process and determining the appropriate treatment plan.
Support with the social worker
Working on daily functioning, strategies, relationships, the environment and the psychosocial dimensions that may influence the situation.
This collaboration makes it possible to approach the person as a whole rather than treating only a symptom.
Strategies
Depending on needs, various strategies can complement care.
Depending on the situation, some people may also benefit from strategies or accommodations that reduce the functional impact of their difficulties.
Lifestyle habits
It is therefore important to assess sleep when a person seeks care for concentration difficulties.
Physical activity, a balanced diet, stress management and assessing the use of caffeine, alcohol, cannabis or other substances can also be part of a comprehensive approach.
These measures do not replace treatment when ADHD is present, but they can contribute to overall functioning.
Insufficient or poor-quality sleep can contribute to difficulties with:
Myths and facts
Everyone can be distracted or disorganized from time to time.
In ADHD, the signs are persistent and have a significant impact on functioning.
No.
Behaviour must be assessed in light of the child’s age and development, and in different settings.
No.
Some people do well thanks to their abilities, a highly structured environment or significant compensation strategies.
School performance is only one part of the picture.
No.
Some people mainly have difficulties with attention and organization.
Not necessarily.
Questionnaires provide useful information but must be interpreted in the context of a more complete assessment.
No.
Care may include a combination of medication, psychoeducation, organizational strategies, psychosocial interventions, school or workplace accommodations and improvements to certain lifestyle habits.
Care can therefore be tailored to each person’s needs.
The right time
An assessment may be relevant when persistent difficulties with attention, organization, hyperactivity or impulsivity begin to have a significant impact on:
school;
work;
family;
relationships;
organization;
independence;
daily functioning.
The Gouvernement du Québec recommends, among other things, seeking care when symptoms cause distress, interfere with functioning or affect relationships, and have persisted for more than six months.1
Preparing for your visit
You do not need to have all these documents to begin the process.
They simply help us get a more complete picture when they are available.
If you have them, some documents can be particularly useful:
An ADHD assessment should not begin with a search for a medication.
It should begin with a question:
What explains the difficulties being experienced?
Sometimes, the picture is consistent with ADHD.
Sometimes, another condition better explains the symptoms.
And sometimes, several conditions are present at the same time.
Our approach aims to make this distinction and then build care tailored to the person.
Children aged 8 and older · Adolescents · Adults
A first meeting is an opportunity to take stock of your situation, the symptoms present and the assessments or documents already available.
The information on this page is provided for informational purposes and does not replace a consultation with a professional.
