Continuity of care during transitioning from adolescence to adulthood is not consistent for adolescents with ADHD. Non-adherence to pharmacological treatment, coupled with suboptimal behavioural intervention programmes, can both be attributed to interruptions in continuity of care for adolescents with ADHD. Treatment strategies tailored to this age group are therefore required, and the authors of this commentary aimed to highlight treatment strategies that may improve adherence to pharmacological treatments and/or optimise behavioural therapy in adolescents with ADHD.
ADHD medications (stimulants and non-stimulants) offer demonstrable improvements in ADHD symptoms as shown during placebo-controlled, randomised trials; however, studies have shown that this pharmacological effect is temporary and continued administration is required for maintenance. Although some children adhere to regular treatment use, others may discontinue, and others follow a repeating cycle of use and discontinuation. Various studies have indicated that good adherence to pharmacological treatment can be predicted based on:
- A high severity of ADHD symptoms
- The presence of additional learning and behavioural problems, and absence of comorbid oppositional defiant disorder
- A younger age at initiation of pharmacological treatment
- A functioning relationship with family and clinician
- Freedom from peer-driven stigma around use of pharmacological treatment
- Use of an extended-release stimulant formulation rather than an immediate-release formulation
- A history of symptom improvement with few adverse effects.
Behavioural interventions in adolescents with ADHD are less well studied owing to methodological limitations such as small sample sizes, and appear to offer limited treatment outcomes. This, in conjunction with the limited ability of adolescents to self-reflect and recognise inappropriate decision-making,* offers an unmet knowledge/treatment gap for adolescents with ADHD. Potential age-appropriate treatment strategies include:
- Motivational interviewing, providing a counselling style that provokes behavioural change within the patient, encouraging them to take responsibility for their own treatment
- Flexible access to clinicians outside of ‘normal’ working/school hours, and expansion of communication avenues where appropriate
- Serious games that may enhance time management, planning, organisation and co-operation skills
- Mindfulness-based training, which has been associated with improved attention and self-regulation, and aims to encourage individuals to adapt to their condition rather than simply treating the symptoms.
The author concludes that studies focusing on the aforementioned treatment strategies, both on their own and in combination with pharmacological treatment, are required to determine whether or not these approaches are effective in treating ADHD symptoms in adolescents.
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*Adolescents often display a lack of organisational and planning skills, poor time estimation and conflict-resolution management, and a desire to exercise independence from those with more life experience, e.g. parents and teachers
Buitelaar JK. Optimising treatment strategies for ADHD in adolescence to minimise ‘lost in transition’ to adulthood. Epidemiol Psychiatr Sci 2017; 26: 448-452.