Discontinuity in the Transition from Pediatric to Adult Health Care for Patients with Attention–Deficit/Hyperactivity Disorder

Montano, C. Brendan; Young, Joel

doi:10.3810/pgm.2012.09.2591

Cited by 42 publications

(28 citation statements)

References 65 publications

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“…Treatment of ADHD declines sharply from childhood through young adulthood despite persistence of functional impairment. Primary care providers are less likely than pediatricians or psychiatrists to prescribe medications for ADHD …”

Section: Resultsmentioning

confidence: 99%

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Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

et al. 2018

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Attention-deficit/hyperactivity disorder (ADHD) is a common and challenging comorbidity affecting many children with epilepsy. A working group under the International League Against Epilepsy (ILAE) Pediatric Commission identified key questions on the identification and management of ADHD in children with epilepsy. Systematic reviews of the evidence to support approaches to these questions were collated and graded using criteria from the American Academy of Neurology Practice Parameter. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements were followed, with PROSPERO registration (CRD42018094617). No increased risk of ADHD in boys with epilepsy compared to girls with epilepsy was found (Level A). Valproate use in pregnancy is associated with inattentiveness and hyperactivity in offspring (1 class I study), and children with intellectual and developmental disabilities are at increased risk of ADHD (Level A). Impact of early seizure onset on development of ADHD was unclear (Level U), but more evident with poor seizure control (Level B). ADHD screening should be performed from 6 years of age, or at diagnosis, and repeated annually (Level U) and reevaluated after change of antiepileptic drug (AED) (Level U). Diagnosis should involve health practitioners with expert training in ADHD (Level U). Use of the Strength and Difficulties Questionnaire screening tool is supported (Level B). Formal cognitive testing is strongly recommended in children with epilepsy who are struggling at school (Level U). Behavioral problems are more likely with polytherapy than monotherapy (Level C). Valproate can exacerbate attentional issues in children with childhood absence epilepsy (Level A). Methylphenidate is tolerated and effective in children with epilepsy (Level B). Limited evidence supports that atomoxetine is tolerated (Level C). Multidisciplinary involvement in transition and adult ADHD clinics is essential (Level U). In conclusion, although recommendations could be proposed for some of the study questions, this systematic review highlighted the need for more comprehensive and targeted large-population prospective studies.

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Section: Resultsmentioning

confidence: 99%

“…Recommendations (Level U: expert opinion) include multidisciplinary involvement in transition and adult ADHD clinics. This is essential as many patients experience challenges with housing, employment, relationships, and psychosocial well‐being.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

et al. 2018

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“…The PRISMA flow chart (see Figure 1) (Moher, Liberati, Tetzlaff, & Altman, 2009) shows the eight included papers selected from 2134 initial records identified. Three further papers almost met inclusion criteria (Marcer, Finlay, & Baverstock, 2008;Montano & Young, 2012;Syverson, McCarter, He, D'Angelo, & Tuchman, 2016), however, the methodology was not clear enough to identify where qualitative research findings came from, so were excluded.…”

Section: Resultsmentioning

confidence: 99%

“…Literature specific to ADHD healthcare transition is even more limited. It includes a scoping review published in 2013 ) confirming the lack of research and a literature review that described a number of barriers to continuity of care (Montano & Young, 2012). To our knowledge no systematic review has been conducted on ADHD healthcare transitions since NICE guidelines were published in 2008.…”

Section: Introductionmentioning

confidence: 99%

Review: Experiences of healthcare transitions for young people with attention deficit hyperactivity disorder: a systematic review of qualitative research

Price

Janssens

Woodley

et al. 2018

Child Adoles Ment Health

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Background Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by hyperactivity, inattention and impulsivity. Up to two thirds of young people with ADHD may experience symptoms into adulthood, yet the limited literature available suggests that many young people with ongoing needs do not transfer from child to adult healthcare services. Although worldwide and NICE guidelines recognise the importance of supported transition, evidence suggests for ADHD that this is poorly managed and variable. Little is known about how transition is experienced by those involved. We aimed to synthesise existing peer‐reviewed literature to understand views and experiences of young people, carers and clinicians on transitioning between child and adult ADHD services. Method Five databases were searched and all articles published between 2000 and up until January 2017 considered. Four key search areas were targeted; ADHD, Transition, Age and Qualitative Research. Quality appraisal was conducted using Wallace criteria. Findings from included studies were synthesised using thematic analysis. Results Eight papers, six from the UK and one each from Hong Kong and Italy, were included. Emerging themes centred on difficulties transitioning; hurdles that had to be negotiated, limitations of adult mental health services, inadequate care and the impact of transition difficulties. Conclusions Healthcare transition for this group is difficult in the United Kingdom because of multiple challenges in service provision. In addition to recommendations in NICE guidelines, respondents identified a need for better provision of information to young people about adult services and what to expect, greater flexibility around age boundaries and the value of support from specialist adult ADHD services. More research is needed into ADHD healthcare transition experiences, especially in countries outside the United Kingdom, including accounts from carers and clinicians.

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“…Finally, another aspect that needs to be addressed by clinicians and treatment planners and researchers is the adequate health care transition for adolescents and young adults with ADHD, considering that discontinuity in the transition from pediatric to adult health care for ADHD patients has also been linked to higher rates of criminality (170). Moreover, one prominent feature of ADHD treatment is that the discontinuation of medication is common especially in adolescence and early adulthood (171,172).…”

Section: Treatment Of Adhd and Criminal Behaviorsmentioning

confidence: 98%

Attention-deficit hyperactivity disorder (ADHD), substance use disorders, and criminality: a difficult problem with complex solutions

Knecht¹,

Alvaro

Martínez-Raga³

et al. 2015

International Journal of Adolescent Medicine and Health

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The association between attention-deficit hyperactivity disorder (ADHD) and criminality has been increasingly recognized as an important societal concern. Studies conducted in different settings have revealed high rates of ADHD among adolescent offenders. The risk for criminal behavior among individuals with ADHD is increased when there is psychiatric comorbidity, particularly conduct disorder and substance use disorder. In the present report, it is aimed to systematically review the literature on the epidemiological, neurobiological, and other risk factors contributing to this association, as well as the key aspects of the assessment, diagnosis, and treatment of ADHD among offenders. A systematic literature search of electronic databases (PubMed, EMBASE, and PsycINFO) was conducted to identify potentially relevant studies published in English, in peer-reviewed journals. Studies conducted in various settings within the judicial system and in many different countries suggest that the rate of adolescent and adult inmates with ADHD far exceeds that reported in the general population; however, underdiagnosis is common. Similarly, follow-up studies of children with ADHD have revealed high rates of criminal behaviors, arrests, convictions, and imprisonment in adolescence and adulthood. Assessment of ADHD and comorbid condition requires an ongoing and careful process. When treating offenders or inmates with ADHD, who commonly present other comorbid psychiatric disorder complex, comprehensive and tailored interventions, combining pharmacological and psychosocial strategies are likely to be needed.

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Discontinuity in the Transition from Pediatric to Adult Health Care for Patients with Attention–Deficit/Hyperactivity Disorder

Abstract: If we are to adequately address the health care needs of adolescents and young adults with ADHD, we need to educate primary care providers and support additional research.

Cited by 42 publications

References 65 publications

Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

Review: Experiences of healthcare transitions for young people with attention deficit hyperactivity disorder: a systematic review of qualitative research

Attention-deficit hyperactivity disorder (ADHD), substance use disorders, and criminality: a difficult problem with complex solutions

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