Emerging adulthood, viewed through the lens of life course health development, has the potential to be a very positive developmental stage with postindustrial societies giving adolescents and emerging adults a greater opportunity for choice and exploration but also greater challenges with greater educational and social role requirements. The loss of supports and structures offered by schools, families, and child- and family-oriented health and social services means that the emerging adult must rely more on his/her own resources in a less structured environment. This increased agency in the context of less structure is occurring as the human brain is still developing higher-level capacities such as executive functioning. The person-context interactions during EA are many and complex, leading to multiple different pathways through emerging adulthood. Those with sufficient economic and adult supports as well as personal resources and maturity will be more likely to choose well and embark on a positive trajectory during EA. Those lacking these resources, or those with physical and mental health or intellectual disabilities, may struggle during this period and experience a negative trajectory in the spheres of education, vocation, relationships, and health status. The life course health science of EA requires more detailed and deeper analysis of the relationship between family, peers, and societal supports and personal internal resources in order to help promote successful developmental trajectories during EA.

Transferring from pediatric to adult care, experienced by more than half the sample, was associated with an increased risk of poor glycemic control at follow-up. These findings suggest that young adults need additional support when moving to adult care.

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WHAT'S KNOWN ON THIS SUBJECT:The importance of transition from pediatric to adult health care for youth with special health care needs has gained increasing attention over the past decade, but fewer than half of this population received needed transition preparation in [2005][2006]. abstract OBJECTIVE: To examine current US performance on transition from pediatric to adult health care and discuss strategies for improvement. WHAT THIS STUDY ADDS: METHODS: The 2009-2010 National Survey of Children with SpecialHealth Care Needs is a nationally representative sample with 17 114 parent respondents who have youth with special health care needs (YSHCN) ages 12 and 18. They are asked about transition to an adult provider, changing health care needs, increasing responsibility for health care needs, and maintaining insurance coverage. We analyzed the association of selected characteristics with successful transition preparation. RESULTS:Overall, 40% of YSHCN meet the national transition core outcome. Several factors are associated with transition preparation, including female gender; younger age; white race; non-Hispanic ethnicity; income $400% of poverty; little or no impact of condition on activities; having a condition other than an emotional, behavioral, or developmental condition; having a medical home; and being privately insured.CONCLUSIONS: Most YSHCN are not receiving needed transition preparation. Although most providers are encouraging YSHCN to assume responsibility for their own health, far fewer are discussing transfer to an adult provider and insurance continuity. Although changes in sample design limit trend analysis, there have been no discernible improvements since this transition outcome was measured in the 2005

The proportion of YSHCN meeting the medical-transition outcome measure is quite low, particularly for youth from ethnic minorities. Higher rates are seen for older teens and those receiving care within a medical home. Significant efforts will be required to meet the proposed goal of all YSHCN receiving the services necessary to transition to adult health care.