Transitional care to adult ADHD services in a North West England district

ADHD is the commonest neurodevelopmental disorder of children and adolescents. ADHD is no longer conceptualized as a predominantly childhood disorder but is a chronic disorder that persists into adolescence and adulthood. The paper aims to analyse the transitional care of adolescents diagnosed with ADHD in childhood into adult specialist ADHD services in a local district. The paper also seeks to review current practice and to design a multi‐disciplinary transitional care pathway to adult services for adolescents with complex health needs based on best practice and available clinical guidelines.

Adolescents diagnosed with ADHD from childhood who were eligible for transition to adult ADHD services and who reached the age of 16 years over a period of two years consecutively (July 2009 to June 2011) were studied by a retrospective analysis of their clinical records. The current transitional care pathway was reviewed and revised.

Out of 504 patients on the specialist ADHD database, 104 adolescents were eligible for transition to adult services. A total of 19 patients (18 per cent) were referred to CAMHS. A total of 68 adolescents (65 per cent) were discharged from the paediatric services following voluntary discontinuation of medications and non‐attendance at follow‐up clinics. Only 16 patients (15 per cent) were successfully referred to the specialist adult ADHD services (three of them already discharged). A multi‐disciplinary transitional care pathway to adult services for young people with complex health needs and learning difficulties and information for the carers and young people have been designed and adopted in the local city borough, agreed by all the stakeholders.

A total of 73 per cent of eligible patients were either discharged or lost to follow‐up. There must be some flexibility in the referral pathway to the adult ADHD services to allow some of the adolescents who were previously lost to follow‐up to be re‐referred by other primary or secondary care healthcare professionals if the need arises in the future.

The paper shows that there is a high rate of discontinuation of medications, loss to follow‐up and a remarkably low rate of successful transition to locally commissioned adult ADHD services among adolescents diagnosed with ADHD in childhood.