Optimising treatment strategies for ADHD in adolescence to minimise ‘lost in transition’ to adulthood

Abstract

The persistence of attention-deficit hyperactivity disorder (ADHD) from adolescence to adulthood is not matched by continuity of care in this transition period. Many adolescents with ADHD have poor medication adherence or even stop medication treatment, and use of behavioural interventions is also suboptimal. The present commentary focuses on treatment strategies that might improve effects of ADHD medication treatment by improving adherence in adolescents with ADHD and/or optimise behavioural interventions for ADHD in adolescence. Most treatment strategies in adolescents with ADHD are merely copied from treatments offered to children. Instead however treatment should be focused on what makes adolescents special and vulnerable, such as poor insight into own functioning and poor decision making. Techniques that offer promise for adolescents are motivational interviewing, use of ecological momentary assessments and interventions, mindfulness-based training and serious games. Systematic studies into the effects of these techniques alone and in combination with medication are lacking. First published online 17 April 2017Key words: Attention-deficit hyperactivity disorder, transition, adolescence, mental health services.Attention-deficit hyperactivity disorder (ADHD) is a rather common neurodevelopmental disorder with an estimated prevalence of at least 5% in children and adolescents and 2.5% in adults (Polanczyk et al. 2007;Simon et al. 2009). Onset of the disorder is mostly during the preschool years or in childhood. From the three defining symptoms of ADHD, inattentiveness tends to be rather stable over development, whereas hyperactivity and impulsivity tend to decline more over age (Biederman et al. 2000). Despite these age-related symptomatic improvements, ADHD is a highly persistent disorder with between one third and half of ADHD children still meeting clinical threshold criteria and the majority of children with ADHD being functional impaired at adult age (Faraone et al. 2015).Despite claims of overdiagnosis and overtreatment of ADHD, survey data about treatments received for ADHD among children with special needs tell a different story (Visser et al. 2015). Of all adolescents of a national representative USA sample of 12-17 year old with ADHD, 27.9% were reported to have received both medication and behavioural interventions in the last year, 48.3% received medication only, 12.5% received behavioural interventions only and 14.3% did receive neither medication nor behavioural interventions (Visser et al. 2015). Furthermore, the persistence of the disorder over adolescence into adulthood is not matched by continuity of care in this important phase of life. For example, prescription data of ADHD medication by UK general practitioners show a significant drop from age 15 to 21 years. This discontinuation of medication treatment is much greater than the agerelated decline in symptoms, suggesting that young adults with ADHD receive insufficient treatment (McCarthy et al. 2009). This is more alarming, since adolescen...

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