An audit of transitional care for adolescents with ADHD in a North West England district

Abstract

Aim ADHD is now considered to be a chronic neuro-developmental disorder that persists from childhood into adolescence and adulthood. We aimed to analyse the transition of adolescents diagnosed with ADHD in childhood into adult specialist ADHD services in a local district. Methods Patients were diagnosed with ADHD using the standard DSM-IV criteria. Adolescents who were eligible for transitional to adult ADHD services were identified from a community paediatric service database. Patients who reached the age of 16 years over a period of two years consecutively (June 2010 to May 2011) were studied by a retrospective analysis of the clinical records. Results From a total of 495 patients on the specialist ADHD database, 104 adolescents were eligible for transitional to adult services over the study period. 68 adolescents (65%) were discharged from the paediatric services, often due to voluntary discontinuation of medications and self-discharge due to non-attendance at follow-up clinics (including 2 patients who moved out of the area). 19 patients (18%) were referred to CAMHS (5 of them already discharged). Only 16 patients (15%) were successfully referred to the specialist adult ADHD services (3 of them already discharged). Only one patient still remains under the community paediatric services. Conclusion 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. A total of 73% of eligible patients were either discharged or lost to follow-up. Establishing a formal transitional process early from the age of 13 years among patients with childhood ADHD may help minimise this high rate of attrition. There must be some flexibility in the referral pathway to the adult ADHD services so that the adolescents who were previously lost to follow-up can be re-referred by other primary or secondary care healthcare professionals if the need arises in the future.