More needs-led services needed for people with ADHD during the transition between childhood and adulthood
Attention Deficit Hyperactivity Disorders (ADHD) is a common neurodevelopmental disorder that may persist into adulthood in up to two-thirds of cases. However, few young adults with ADHD are in contact with clinical services. This is a concern given that ADHD has long-term health, social and economic consequences.
A new study, published in the BMC Health Services Research, conducted by Dr Eklund and colleagues at the Institute of Psychiatry, Psychology and Neurosciences, King’s College London, examined needs, clinical service use and the move between child and adult mental health services among adolescents and young adults with a childhood diagnosis of ADHD (now aged 14- 24). The study used reliable diagnostic and outcome measures to collect data on ADHD symptoms, impairments, co-morbid psychiatric difficulties, parental caregiver burden and a host of socio-demographic factors over a three year period. They found that despite continuing symptoms and needs, the factor that most strongly correlated with contact with clinical services was the young person’s age, rather than their ADHD symptoms or related needs.
“We found that the likelihood of a young person being in contact with clinical services declined with 25% for every year increase in age” said Dr Eklund. This suggests that irrespective of the severity of symptoms or needs, adolescents and young adults with ADHD are not receiving treatments due to their age. This could be partly explained by the fact that parents have less control over their child’s health behaviour during the transition to young adulthood” said Dr Eklund. “However, the most likely explanation is that there are simply not enough available services for young adults with ADHD. Once they become too old to access child and adolescent services (usually at the age of 17 or 19 years) young people with ADHD have significant difficulties accessing adult Community Mental Health Teams (CMHTs) who do not consider them ‘ill enough’ unless they also suffering from significantly impairing co-morbid mental health problems”.
In the UK, the National Institute for Health and Care Excellence (NICE) recommends that a person with ADHD receiving treatment and care from child and adolescent services should be reassessed at school leaving age to establish the need for continuing treatment into adulthood. If they continue to have significant symptoms of ADHD or other coexisting conditions that require treatment then arrangements should be made for a smooth transition to adult services. “However, in reality, adolescents and young adults with ADHD are among those least likely to make the move from child to adult mental health services”, explained Dr Eklund. We found that only 9% had made a transition to adult services and around 75% felt that they had not received enough support from health services in regards to accessing information regarding available services in adulthood or in the co-ordination of transition planning. We found that most families also felt they needed someone to talk to about their practical as well as emotional needs”, said Dr Eklund.
“Based on our results, we suggest that more investment is needed in services for young adults with ADHD”, said Dr Eklund. Given that most adult mental health disorders begin in adolescence, it is vital that young people with ADHD are able to access evidence based treatments during the transition to young adulthood. Less disruption to care could be achieved by increasing the age-threshold of child services so that young people could continue to be supported through these key transitional years or by creating specific ADHD services for all ages”.
Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry,
Psychology and Neurosciences, King’s College London, London, UK
Clinical service use as people with Attention Deficit Hyperactivity Disorder transition into adolescence and adulthood: a prospective longitudinal study.
Eklund H, Cadman T, Findon J, Hayward H, Howley D, Beecham J, Xenitidis K, Murphy D, Asherson P, Glaser K
BMC Health Serv Res. 2016 Jul 11