The continued low recognition of adult ADHD, coupled with the severe lack of appropriate healthcare for adults with the disorder, highlights an unmet need for care of patients with ADHD transitioning into adulthood. This study aimed to review the current literature, with a focus on:
- Key issues that patients with ADHD face during the transition to adulthood in Hong Kong, Singapore, South Korea, Turkey and Africa
- Current clinical practice and country-specific approaches to ADHD management during the transition to adulthood
- Challenges facing patients and clinicians at initiation of pharmacological treatment
- Current ADHD guidelines on transition management
- Economic consequences associated with ADHD.
A MEDLINE search of the literature using a combination of the keywords “ADHD” and “transition”, from an undefined time period up to November 2014, was performed to identify relevant studies, systematic reviews, meta-analyses, editorials, local manuscripts and local guidelines appropriate for this study.
A review of the literature highlighted the following:
- Challenges of transitioning to adulthood for patients with ADHD – when transitioning from adolescence to young adulthood, the patient is faced with greater freedom/independence and increased demands in terms of decision making and long-term planning, which can have a negative impact on the patient. The provision of care during the transitioning period may, therefore, prevent future problems routinely associated with adult ADHD, such as risky behaviour, the development of substance-use disorders and inappropriate dispensation of their ADHD medication.
- Current clinical practice and country-specific approaches to ADHD management – studies investigating adult ADHD were considerably lacking in the literature. Data on the prevalence of adult ADHD were either non-existent, limited or subject to misdiagnosis. Further education and guidelines are required for healthcare providers in the Asian countries studied, Turkey and Africa.
- ADHD medication initiation: challenges faced by physicians and patients – it has been reported that treatment adherence during the initiation phase is poor; therefore, the physician should emphasise the importance of medication compliance during the first 4–8 weeks of treatment. Additionally, challenges faced by physicians and patients include barriers to accessing specialist care, long admission times and limited knowledge of ADHD in physicians, which may impede referral to specialist care.
- Current ADHD guidelines on transition management – the National Institute for Health and Care Excellence guidelines in the UK recommend that: 1) children with ADHD receiving treatment from the Child and Adolescent Mental Health Services (CAMHS) or other paediatric services should be reassessed prior to 18 years of age for continued treatment in adulthood; 2) a formal meeting between the CAMHS or paediatric service and the adult psychiatric services should be considered during the transitioning period; 3) for young people transferring between services (aged ≥16 years), the care programme approach should be utilised and should involve the young person, parent or caregiver; and 4) following transitioning, healthcare professionals should perform a comprehensive assessment of the patient.
- Economic consequences of untreated ADHD in adults – direct and indirect costs associated with adult ADHD arise from the increased frequency of healthcare utilisation compared with adults without ADHD, higher rates of psychiatric comorbidity, interaction with the judicial system, lower work productivity and fewer job prospects/lower financial income.
The limitations of this study are that it was not a systematic review and the literature search was limited in scope (only two keywords and one database were utilised). Relevant papers may have therefore been omitted from the search results.
The authors concluded that the transitioning period to adult ADHD is both under-researched and under-served. Further studies are necessary to explore the characteristics of this transitioning period, with a focus on the impact that critical differences between current operational practice and best-practice guidelines have on the transition experiences of adolescents with ADHD, their caregivers and healthcare professionals. In particular, advances in transition planning, improved case management, education, early intervention, predictors of prognosis and introduction of locally and culturally adapted clinical guidelines are required.
Treuer T, Chan KLP, Kim BN, et al. Lost in transition: a review of the unmet need of patients with attention deficit/hyperactivity disorder transitioning to adulthood. Asia Pac Psychiatry 2017; 9: e12254.