Role of education settings in transition from child to adult health services for young people with ADHD

Simon Benham-Clarke,Tamsin Ford,Siobhan B Mitchell,Anna Price,Tamsin Newlove-Delgado,Sharon Blake,Helen Eke,Darren A Moore,Abigail Emma Russell,Astrid Janssens

doi:10.1080/13632752.2021.1989844

Abstract

ABSTRACT Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition. As such most schools, Further Education colleges, vocational training and Higher Education settings will need to support affected children and young people. When young people who require ongoing treatment for ADHD are around 18 years of age, they must transition from child to adult mental health services. However, only a small proportion successfully transition. As significant educational transitions are often happening at the same time, there is a need to consider how education and health service transitions may impact on one another. This paper presents findings from a large UK qualitative study involving 144 semi-structured interviews with young people who had ADHD, parents and health professionals. Two themes were identified which support the notion that education transition can impact health transition. Firstly, transition to adult health services typically requires continued prescription of ADHD medication, yet many young people stop taking their medication due to a belief that it is only needed for education-based learning. Secondly, if a young person is continuing education post-18, a lack of joined-up planning between education and health (outside of special schools) or consistent support in Higher/Further Education can leave young people with ADHD in limbo between health services and struggling within education. Given these findings, we recommend regarding multi-agency service statutory health care transition, educational staff training and ongoing oversight of child to adult health service and adult to adult health service transition effectiveness.

Highlights

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition with a worldwide pooled prevalence of 3.4% (CI 95% 2.6–4.5) (Polanczyk et al 2015)
As part of an overarching theme which recognised that successful transition depended on how invested stakeholders were in the ongoing treatment for young adults, we identified two sub-themes which highlighted the influence of education transition on health transition (Janssens et al 2020)
While underlining the importance of access to ADHD medication for young people who can benefit from it, NICE (2020) state healthcare professionals should review medications and their discontinuation yearly including its impact on education; as shown in our findings this may perpetuate a potentially misleading belief that drug treatment is only necessary for school

Summary

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition with a worldwide pooled prevalence of 3.4% (CI 95% 2.6–4.5) (Polanczyk et al 2015) This suggests that most schools, Further Education (FE) colleges and Higher Education (HE) settings will include a significant minority of affected children and young people. Diagnosis of ADHD involves a mental health clinician interpret ing whether attention span, and activity plus impulsivity levels are within a normal range for developmental stage This dimensionality (whilst not unique to ADHD) can add to the debate regarding the existence of ADHD and whether medication is necessary, but is not confined to ADHD; for example high blood pressure and obesity are likewise normally distributed (Wedge 2015). Recent evidence suggests a dose response between the duration of medication and school performance, including academic attainment; those on medication for longer do better at the end of compulsory school (Jangmo et al 2019)

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Discussion

Conclusion