Helping Every Child with ADHD Build on Their Strengths
Interview with Professor Isabelle Massat, Child and Adolescent Psychiatrist and Director of the Neurodevelopmental Disorders Clinic within the Department of Infant, Child, Adolescent and Young Adult Psychiatry at the Brussels University Hospital (H.U.B.)
A diagnosis is not a box in which a child is confined, but a starting point for a global, dimensional and contextual understanding
He fidgets constantly, interrupts frequently, daydreams during lessons. In primary school, concerns arise. Parents hesitate: should we seek professional advice? Should we be worried? Could it be Attention Deficit Hyperactivity Disorder (ADHD)?
At the Brussels University Hospital (H.U.B.), requests for ADHD assessments have increased significantly in recent years.
“Most of our current child psychiatry consultations involve suspected ADHD or associated disorders,” explains Professor Isabelle Massat.
ADHD seems to be suspected more frequently in children. When do concerns usually arise?
Prof. Isabelle Massat – Quite often, it is around the start of primary school, at about age 6 or 7, that adults begin to raise questions. Children are then expected to meet new demands: sitting still for long periods, concentrating, learning to read…
This key transition can reveal certain difficulties such as restlessness, inattention, or impulsivity. Teachers are usually the first to notice these signs, but parents do too—especially when they can compare with siblings.
Even though early signs may already be visible in preschool, it is usually when children enter primary school that concerns first emerge. They are faced with new requirements: maintaining attention, following instructions, engaging in core learning tasks like reading. This can bring to light challenges that were less noticeable before.
At what point can we speak of ADHD?
Not every child who fidgets or daydreams in class has ADHD. The diagnosis must be based on a thorough medical assessment. Symptoms must be present for several months, occur in multiple settings (school, home, extracurricular activities), and significantly impact the child’s daily life. Importantly, other conditions—such as anxiety, attachment difficulties or language disorders—must be ruled out.
A diagnosis can be made by a child and adolescent psychiatrist or a paediatric neurologist, who are the key reference specialists. It can also be made by a general practitioner, provided they have received appropriate training.
Neuropsychologists also play a crucial role. Often, they are the first to identify atypical cognitive functioning during an assessment requested to better understand academic difficulties. If they suspect ADHD, they can offer advice on classroom strategies for pupils with special needs and refer the family to a medical specialist for formal diagnosis.
At the H.U.B., this work is carried out in particular by Simon Baijot, head of the paediatric cognition sector within the Department of Neuropsychology and Speech Therapy. He works closely with clinical teams to refine assessments and adapt recommendations to each child's specific need
Good clinical practice is not limited to listing a child’s difficulties or disorders. It is also – and above all – about identifying their strengths: their personal resources, creativity, curiosity, sense of humour, and often remarkable ability to bounce back
How is the ADHD care pathway organised at H.U.B.?
We have established medical coordination based on several entry points, including paediatric neurology and child psychiatry. Dr Florence Christiaens, paediatric neurologist at the H.U.B., is responsible for conducting neurological assessments for children as part of the ADHD pathway and plays a central role in coordinating care, especially for children with complex clinical profiles who require in-depth neurological evaluation.
The goal is to ensure a coherent and personalised care trajectory. In theory, our hospital functions as a tertiary care structure, intervening in the most complex cases – complex diagnoses, psychiatric comorbidities, difficult family situations, or severe disorders. But in practice, due to a lack of well-organised networks and a shortage of specialists in first- and second-line outpatient care, many families contact the hospital directly. We receive them, assess the situation, carry out evaluations, and in most cases, redirect them appropriately.
What advice would you give to parents before seeking help for suspected ADHD?
Before we talk about diagnosis, we must stress the importance of prevention. A healthy lifestyle—with regular sleep, balanced nutrition, and physical activity—is fundamental.
Screens, in particular, have become a major public health concern. They can interfere with attention, sleep, and emotional regulation. Some professionals even describe excessive screen time as a public health crisis when not limited.
More importantly, I encourage parents not to label or overinterpret every challenge. Many neurotypical children are energetic, distracted or dreamy. In many cases, small adjustments at home or school can make a real difference: a structured routine, quiet time, support with organisation, physical activity, psychoeducation…
And if that is not enough, then a more intensive strategy can be considered.
But some children do experience real suffering…
Many children do suffer. What’s often difficult to see is the invisible effort some of them put into adapting, compensating, trying to appear “normal”. This takes a huge toll on them.
Despite their best efforts—and their desire to learn, fit in, and make their parents and teachers proud—they are frequently criticised throughout the day.
Eventually, they can burn out—at school, in friendships, or within the family.
Their social lives may also be affected. A very impulsive or hyperactive child may be seen as disruptive, rude, or “too much” by others, and risk being excluded from birthday parties or left alone during playtime.
Such experiences leave emotional scars: loss of self-confidence, intense frustration, sometimes depressive symptoms or oppositional behaviour.
This is why it’s essential that adults ensure these children are included—by understanding how they function, and helping them learn, connect with peers, find their place and feel supported.
In these cases, a diagnosis can help bring understanding, relief, and action to prevent marginalisation. It’s not about closing doors, but about opening them.
It’s far less stigmatising for a child to have a diagnosis that explains their behaviour than to be labelled a “difficult, disruptive troublemaker”, which unfortunately still happens far too often.
What is your guiding philosophy in care?
We reject a “labelling” approach. A diagnosis should not confine a child to a box. It should be a starting point—a global, dimensional and holistic process aimed at better understanding the child across different environments.
Good clinical practice is not just about listing problems or difficulties. It’s about identifying the child’s strengths: their personal resources, creativity, curiosity, sense of humour, and often-surprising resilience. We must shine a light on everything they are capable of—often remarkably so.
With the benefit of years of experience in this field, I’ve seen how positively these children can evolve when well supported. They have many strengths and are profoundly endearing—provided we adopt a broad, compassionate view of their abilities and support their development.
In this context, the medical approach should not stop at an inventory of impairments. It must also help the child become aware of their strengths—what works well, what they can rely on.
Many children with ADHD have extraordinary resources: vivid imagination, deep sensitivity, a great sense of humour… It is from these strengths—theirs, but also those of their parents and teachers—that we build a coherent care plan, designed for the short, medium and long term.
That is the challenge we face every day.
Our initial approach is based on guidance, psychoeducation, and environmental adaptations. If this is not sufficient, medication—carefully monitored and agreed upon with the parents—may be considered.
Links:
Le TDAH chez les jeunes : expertise et soins à l'hôpital des enfants