La gamme de prévalence et les différents facteurs de risque liés au TDAH présentés dans de récentes études questionnent à bien des niveaux les professionnels de soins confrontés aux aspects individuels et psychosociaux attribués à ce syndrome. De fait, l’inquiétude qu’il génère chez les parents concernés en fait une préoccupation de santé sociale grandissante. Toutefois, malgré l’importance manifeste de l’impact psychosocial du TDAH, sa dimension relationnelle et familiale chez des enfants concernés reste relativement moins étudiée que sa dimension cognitivoacadémique.

Au moyen d’une analyse des ajustements cognitivoémotionnels familiaux, nous éclairons les données de recherche contemporaines pour tenter de mieux comprendre les processus par lesquels le TDAH influe sur l’ensemble de la dynamique familiale.

Notre analyse appuyée sur de récents travaux révèle trois niveaux de processus par lesquels le TDAH interfère avec le fonctionnement psychosocial et familial de l’enfant, à savoir : 1) des difficultés d’ajustement cognitivoémotionnel chez l’enfant TDAH liées à des perturbations des processus de rétrocontrôle des fonctions exécutives ; 2) des difficultés d’ajustement dans les interactions familiales quand les manifestations TDAH de l’enfant restent peu comprises ; 3) des effets cumulés de comorbidités multiples chez l’enfant et les parents qui compliquent les processus familiaux d’adaptation cognitivoémotionnelle au TDAH. La documentation d’effets tant directs (TDAH) qu’indirects (comorbidités) souscrit la nécessité d’approfondir l’investigation de la dynamique familiale en présence du TDAH, qui se révèle être un important facteur de risque de détérioration de la qualité de vie familiale. Cette analyse souligne la nécessité d’une approche clinique intégrant une évaluation et une prise en charge systématique des processus d’ajustements familiaux, pour améliorer l’implémentation de programmes préventifs et thérapeutiques, comme le programme multisite Européen FACE© (pour Facilitation des Ajustements Cognitivo-Emotionnels) visant à aider les enfants et leur famille devant faire face au TDAH et à ses implications.

Although ADHD’s adverse impact on children’s cognitive-academic development is widely documented, its psychosocial and family implications remain comparatively understudied. Recent research suggests potential upsetting relational effects of ADHD, calling for insights into the processes underlying these effects.

This article takes on a cognitive-emotional process analysis of the current empirical research basis, to forward the understanding of relational risk and resiliency factors when children and their families confront ADHD.

Research has so far shown evidence of three process levels through which ADHD adversely impacts on children’s psychosocial and family functioning. First, ADHD children’s cognitive-emotional adjustment difficulties appear to reflect relational correlates of functional executive control deficits underlying this disorder. Thus, ADHD tends to affect the child’s interaction regulation abilities as regards adequate contextual analysis, control over undesirable behaviour and learning from relational feedback. According to a diathesis stress model, such adjustment difficulties in ADHD children may constitute an important risk factor toward family and social interactions. Second, families tend to confront adjustment difficulties in their relational dynamics when children’s ADHD-manifestations remain insufficiently understood. Overall, studies document an increased incidence of negative family perceptions and interactions in the context of ADHD. There is a tendency of parents to adopt a coercive educational model when attempting to adjust family functioning to their child’s “disruptive” behaviour. While a spiral of negative interaction dynamics thus often reflects family members’ difficulties in adapting efficiently to the child’s behaviour, research demonstrates both direct-ADHD and indirect-comorbidity-related effects in this context. This third level of analysis allows recognition of multiple child- and parent-level comorbidities, which add transactional complexity to family dynamics. Attention-Deficit–Hyperactivity Disorder is indeed frequently associated with comorbidities, including children’s oppositional-aggressive behaviour and/or parental psychopathology such as ADHD, depression, antisocial behaviour or Bipolar Disorders. Family members’ adjustment abilities as well as overall quality of life tend to suffer from such cumulative, reciprocal risk effects or, on the opposite, may remain buffered by their absence. Although findings regarding directionalities through which multiple-entry factors operate need further clarification, research highlights differential impacts of ADHD as a function of the severity of its core manifestations and the extent and type of comorbidities in the entire family. In terms of clinical implications, discussed findings underscore the importance of sufficiently acknowledging the strain of adjustment challenges associated with ADHD on a family level. In view hereof, systematic family assessment is commendable in order to account comprehensively for “descriptive” psychopathology but also for family members’ own experiences when facing ADHD. Child and parent abilities to deal with ADHD could be enhanced by modulated therapeutic approaches that stimulate development of adequate cognitive-emotional analysis and response options, as illustrated by our current multisite European FACE© programme (for Facilitating Adjustment of Cognitions and Emotions).

The extant literature calls for closer attention to the context of family pathways through which ADHD comes to represent a significant risk factor for families’ quality of life. Our analysis underscores the need for a clinical approach that integrates systematic assessment and monitoring of families’ adjustment processes, to foster efficiency of interventions that may help children and their families face ADHD along with its potentially pervasive implications.