Abstract:A mutual lack of understanding of services and structures together with restrictive eligibility criteria exacerbated by perceived lack of resources can impact negatively on the transition between CAMHS and AMHS, disrupting continuity of care for young people.
“…All studies explored experiences of ADHD‐specific mental health populations, except Belling et al. (). The aims of two studies (Belling et al., ; Wong et al., ) differed from those of this review, so only relevant aspects were extracted.…”
Section: Resultsmentioning
confidence: 99%
“…Several respondents discussed negative impacts of not knowing what to expect,A bit vague what's available. (Nurse, CAMHS) (Belling et al., )When she gets to 18 is there gonna be somebody there that can talk to us and talk to her? … We just don't know.…”
Section: Resultsmentioning
confidence: 99%
“…Trusts recognised a need to develop skills and confidence in ADHD diagnosis and treatment in adult mental health professionals (Belling et al., ). Encountering negative attitudes sometimes led to severe emotional distress and functional impairment in patients (Matheson et al., ).…”
Section: Resultsmentioning
confidence: 99%
“…Problems of high demand combined with restrictive or nonexistent funding emerged across most studies.…commissioners do not commission services for adults, so that is another fall off point (Clinician) (Wong et al., )We have … between 350 and 400 cases of ADHD and with that population 50% of them will have had ADHD after the age of 16 … it would be good if there was a service to be provided. (Psychiatrist, CAMHS) (Belling et al., )…”
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.
“…All studies explored experiences of ADHD‐specific mental health populations, except Belling et al. (). The aims of two studies (Belling et al., ; Wong et al., ) differed from those of this review, so only relevant aspects were extracted.…”
Section: Resultsmentioning
confidence: 99%
“…Several respondents discussed negative impacts of not knowing what to expect,A bit vague what's available. (Nurse, CAMHS) (Belling et al., )When she gets to 18 is there gonna be somebody there that can talk to us and talk to her? … We just don't know.…”
Section: Resultsmentioning
confidence: 99%
“…Trusts recognised a need to develop skills and confidence in ADHD diagnosis and treatment in adult mental health professionals (Belling et al., ). Encountering negative attitudes sometimes led to severe emotional distress and functional impairment in patients (Matheson et al., ).…”
Section: Resultsmentioning
confidence: 99%
“…Problems of high demand combined with restrictive or nonexistent funding emerged across most studies.…commissioners do not commission services for adults, so that is another fall off point (Clinician) (Wong et al., )We have … between 350 and 400 cases of ADHD and with that population 50% of them will have had ADHD after the age of 16 … it would be good if there was a service to be provided. (Psychiatrist, CAMHS) (Belling et al., )…”
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.
“…However, there is now a shift towards CAMHS continuing to provide care for patients up to 18 years of age regardless of school status. It has been suggested that AMHS are often too rigid in their age criteria for transition, with reports of refusals to consider transition until the individual reaches the age of 18 [3]. To further complicate issues it is reported anecdotally that whatever the technical cut-off age may be, many paediatric and CAMHS teams continue to see young people well past this age, due to the difficulties in transferring care to adult services [33].…”
The aim of this consensus statement was to discuss transition of patients with ADHD from child to adult healthcare services, and formulate recommendations to facilitate successful transition. An expert workshop was convened in June 2012 by the UK Adult ADHD Network (UKAAN), attended by a multidisciplinary team of mental health professionals, allied professionals and patients. It was concluded that transitions must be planned through joint meetings involving referring/receiving services, patients and their families. Negotiation may be required to balance parental desire for continued involvement in their child’s care, and the child’s growing autonomy. Clear transition protocols can maintain standards of care, detailing relevant timeframes, responsibilities of agencies and preparing contingencies. Transition should be viewed as a process not an event, and should normally occur by the age of 18, however flexibility is required to accommodate individual needs. Transition is often poorly experienced, and adherence to clear recommendations is necessary to ensure effective transition and prevent drop-out from services.
Key Points
Question
Is primary care continuity during the transition from pediatric to adult care services associated with better outcomes in young adulthood for adolescents with severe mental illness?
Findings
In this population-based cohort study of 8409 adolescents aged 12 to 16 years with severe mental illness, there was a 30% increase in risk of mental health–related hospital admission in young adulthood (age 19-26 years) for those with no primary care physician and a 20% increase for those with discontinuous primary care during transition to adult care compared with continuous care.
Meaning
For adolescents with severe mental illness, continuity with a primary care physician during transition to adult care was associated with decreased mental health–related hospitalizations and emergency department visits.
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