Le TDAH est le trouble mental le plus fréquent chez les enfants d’âge scolaire. Plusieurs études récentes ont mis en lumière des écarts considérables entre les consensus scientifiques internationaux et l’information transmise au grand public. Dans cet article, nous interrogeons les représentations de l’hyperactivité dans les thèses de médecine dédiées au TDAH en France, à partir de l’analyse systématique d’un corpus de 45 thèses soutenues entre 1990 et 2018 au niveau national. Les résultats obtenus font état de distorsions majeures (94,5 %) dans les connaissances scientifiques concernant l’étiologie, le diagnostic ou les bénéfices du traitement médicamenteux. Ces résultats suggèrent qu’il existe une idéologie présidant aux représentations sociales des médecins et, potentiellement, aux pratiques dédiées aux enfants diagnostiqués TDAH et à leur famille. Ces distorsions induisent un risque de surmédication des enfants diagnostiqués hyperactifs et questionnent le format des thèses d’exercice présentées en médecine, qui semblent mésestimer l’importance du travail diagnostique et psychothérapeutique opéré par les praticiens eux-mêmes.

Attention Deficit and Hyperactivity Disorder has first been defined in the third version of the DSM published in 1980. Though it still lacks a consensual biological etiology, ADHD is the most common mental disorder among school-age children nowadays. Several recent studies have however highlighted considerable distorsions between international scientific consensus and information provided to the general public. Those distorsions always favor biomedical approaches of ADHD and support the use of psychostimulant medication. They hence overshadow the psychosocial factors contributing to the disorder and leave no room for other therapeutic approaches like psychodynamic psychotherapies. We therefore deemed it necessary to investigate the content of medical theses focusing on this particular disorder. In this article, we examine the representations of hyperactivity in medical theses dedicated to ADHD in France, based on the systematic analysis of a corpus of 45 theses defended between 1990 and 2018. Our corpus was analyzed using the following questions: 1) does the thesis support a biomedical or psychoanalytical approach to ADHD? We used the term “combined approach” when both points of view were argued; 2) for each thesis, is the biological etiology of ADHD – genetic, neurological or neurodevelopmental – mentioned and discussed?; 3) are the environmental and social factors of hyperactivity also discussed?; 4) do medical theses present the risks associated with ADHD: academic failure, delinquency, substance abuse?; 5) what treatment do medical theses recommend in the care and support of children diagnosed with hyperactivity: drug treatment, psychotherapy or a combination of both?; 6) does the use of a psychostimulant treatment protect against the risk of school failure: yes/no/both opinions?; 7) is it possible to diagnose ADHD hyperactivity by brain imaging?; 8) finally, we sought references to scientific work or experts involved in conflicts of interest with the pharmaceutical industry – references in the text body or bibliography. We also looked for critical indications for the risks of over-medication of ADHD. The results we obtained indicate major distortions (94.5 %) in scientific knowledge concerning the etiology of ADHD, the approved methods for diagnosis or the benefits of psychostimulant medication on academic performances. Indeed, though hundreds of studies using MRI imaging have failed to show any neurological lesion associated with ADHD, 91 % of our corpus supported a neurological etiology of this disorder. Similarly, 87 % of our corpus wrongly described ADHD as a genetic disorder, and more than 50 % still affirmed MRI could be used to diagnose ADHD, despite the scientific consensus claiming the opposite. Psychostimulant medication was also the most mentioned form of treatment, despite it theoretically being a « last resort » treatment. Our results suggest there might be a biomedical ideology determining physicians’ representations of ADHD. This ideology could have an impact on physicians’ care pratices with children suffering from ADHD and their families, thus possibly increasing the risk of over-medication. It could also lead future practitioners to underestimate the importance of their diagnostic skills and the therapeutic work they engage into.