TRANSCRIPT:

When we consider patients with attention-deficit/hyperactivity disorder, or ADHD, we first envision a child struggling with schoolwork or an adult unable to focus on daily tasks. The reality is those individuals are likely the same, as ADHD can span the lifetime of an affected individual.

A recent national survey indicated that the prevalence of ADHD in children from 2 to 17 years of age is 9.4%. Higher rates - up to 15% - have been identified in community-based samples. In adults, prevalence rates can be up to 5%, but published rates are variable due to differing rates of proper diagnosis.

The American Pediatrics Association recommends an evaluation for children who present with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity.

In preschool-age children, hyperactive-impulse symptoms predominate, whereas during adolescence and into adulthood, patients are more inattentive.

In adults, however, those same symptoms take a different form. ADHD in adults can present as more risk-taking behaviors and higher levels of familial conflict than adults who do not have ADHD.

Consequences may include relationship problems, a harder time meeting deadlines, and greater potential for causing traffic accidents.

Thus, the symptoms of ADHD from childhood to adulthood may not change, but the impact on daily functioning shifts greatly.

To minimize the impact of ADHD on quality of life and comorbid psychiatric conditions, clinicians should work with their patients to transition ADHD care from their treatment needs in childhood to those in their adult years.

The transition of care in ADHD from childhood to adulthood is known to be poor.

A British study showed that only 20% of patients with ADHD were successfully transitioned from childhood to adulthood ADHD care. In this study, both clinicians and patients reported a suboptimal transfer process.

Understanding these gaps in care is critical to helping patients with ADHD maintain their daily functioning as adults.

Transition in care typically begins in adolescence, but major changes and life experiences present significant challenges during this phase of development.

The challenges of adolescence can affect psychological, physiologic, and social wellbeing, which can result in discontinuation of care, worsening of ADHD symptoms, and decreased overall functioning.

Successfully transitioning ADHD care requires a clinician who is comfortable treating ADHD symptoms in adults while understanding the developmental background of the patient’s condition.

Unfortunately, there are still some providers who do not see ADHD as an adult disorder.

The perception of being “rejected” by a provider or failure of the transition process may result in a patient no longer receiving care and/or believing that there is no one to help them.

How can we prevent these barriers in transition of care for adult ADHD therapy? First, it begins with understanding the patient perspective of the transition process.

Patients, parents, and clinicians must all understand that a successful transition of care requires effective communication and collaboration.

Clarity of the roles in transitioning care between the child, parents, and clinician will lead to successful outcomes.

Patients view the transition process most positively when the new clinician is prepared and informed.

Throughout the transition of care process, parents and patients should be fully involved and educated to ensure a successful transition.

Transitions should be planned in advance, with a goal of completion by 18 years of age. Because comorbidity of other psychiatric conditions with ADHD is high, assessment for other disorders is needed on an ongoing basis.

Often, treatment needs shift as patients transition into their adult lives, requiring new treatment strategies to account for longer days and more complexities in managing symptoms at home and at work.

The clinician can help adult patients set new goals for their ADHD treatment outcomes. Whereas treatment goals for children may be academically focused, in adulthood there are more avenues for defining treatment success.

One patient with ADHD may not look like others due to individual differences in the impact and course of the disorder. For instance, many female patients are undiagnosed in childhood and later struggle in adulthood due to their ADHD symptoms not being detected earlier in life.

Symptoms of hyperactivity and impulsivity can result in anxiety or self-harm behaviors as the patient moves into adulthood.

In this video we have learned the challenges patients with ADHD face when transitioning from childhood to adulthood, and what steps clinicians can take to improve the process to better optimize therapy.

Successfully transitioning ADHD care from childhood to adulthood requires detailed and open planning between providers, patients, and caregivers.