Transitioning from child and adolescent mental health services with attention‐deficit hyperactivity disorder in Ireland: Case note review

Tatlow‐Golden, Mimi; Gavin, Blánaid; McNamara, Niamh; Singh, Swaran P.; Ford, Tamsin; Paul, Moli; Cullen, William R.; McNicholas, Fiona

doi:10.1111/eip.12408

Cited by 23 publications

(50 citation statements)

References 44 publications

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“… 3 A study from the Republic of Ireland used the same methodology and found 20 ADHD cases from 4 CAMHS teams annually requiring transition, with only 3 individuals successfully transitioning to an adult service. 4 Similarly there are a lack of comparative international data on transition in ADHD; an ongoing European study on transition focuses on mental health transition generally but is not specific to ADHD. 14 Given the rise in prescriptions for ADHD over the past decades, 15 estimates may quickly become out of date as later cohorts are likely to contain a higher proportion of young adults who may have benefitted from medication and therefore wish to continue to take it.…”

Section: Discussionmentioning

confidence: 99%

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Transition between child and adult services for young people with attention-deficit hyperactivity disorder (ADHD): findings from a British national surveillance study

et al. 2019

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BackgroundOptimal transition from child to adult services involves continuity, joint care, planning meetings and information transfer; commissioners and service providers therefore need data on how many people require that service. Although attention-deficit hyperactivity disorder (ADHD) frequently persists into adulthood, evidence is limited on these transitions.AimsTo estimate the national incidence of young people taking medication for ADHD that require and complete transition, and to describe the proportion that experienced optimal transition.MethodSurveillance over 12 months using the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System, including baseline notification and follow-up questionnaires.ResultsQuestionnaire response was 79% at baseline and 82% at follow-up. For those aged 17–19, incident rate (range adjusted for non-response) of transition need was 202–511 per 100 000 people aged 17–19 per year, with successful transition of 38–96 per 100 000 people aged 17–19 per year. Eligible young people with ADHD were mostly male (77%) with a comorbid condition (62%). Half were referred to specialist adult ADHD and 25% to general adult mental health services; 64% had referral accepted but only 22% attended a first appointment. Only 6% met optimal transition criteria.ConclusionsAs inclusion criteria required participants to be on medication, these estimates represent the lower limit of the transition need. Two critical points were apparent: referral acceptance and first appointment attendance. The low rate of successful transition and limited guideline adherence indicates significant need for commissioners and service providers to improve service transition experiences.Declaration of interestNone.

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Section: Discussionmentioning

confidence: 99%

“…Some studies have attempted to quantify national estimates for transition, but they have either focused on all neurodevelopmental conditions rather than just ADHD or were limited geographically. 3 , 4 …”

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confidence: 99%

Transition between child and adult services for young people with attention-deficit hyperactivity disorder (ADHD): findings from a British national surveillance study

et al. 2019

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“…Others have argued that transition planning should incorporate a developmental perspective (Singh, Anderson, Liabo, & Ganeshamoorthy, 2016) which may be particularly important for young people with ADHD, who by definition have poor executive functioning and selfmanagement (Fogler et al, 2017); the recommendations from the expert policy paper (Asherson et al, 2017) also emphasise that the transition should be planned as developmentally appropriate for the patient which is not mentioned by NICE. The transition to an adult service also often occurs at a critical time when young people are also encountering changes in education, employment and independence from parents (Tatlow-Golden et al, 2017). Boilson et al (2013) suggests that information regarding the patient's employment, social circumstances and quality of life is important to support effective transition, which is highlighted in the general NICE guidance (NG43), but overlooked in the more specific recommendations for ADHD (NG87).…”

Section: Discussionmentioning

confidence: 99%

“…If those who partially meet the full criteria, or are considered to be in partial remission, are included this figure rises to 65% at 25 years (Faraone, Biederman, & Mick, ). This has led to the increasing recognition that ADHD is a life span disorder (Tatlow‐Golden et al., ) which raises the issue of transition from child to adult services. Several studies, government documents and policy guidelines highlight the difficulty for young people who require a transition between children's services (usually Child and Adolescent Mental Health Services (CAMHS) or Paediatrics) and adult services (Singh, Paul, Ford, Kramer, & Weaver, ).…”

Section: Introductionmentioning

confidence: 99%

Review: Transition from children's to adult services: a review of guidelines and protocols for young people with attention deficit hyperactivity disorder in England

Eke

Janssens

Ford

2018

Child Adoles Ment Health

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Background In recent years, the difficulty for young people with mental health issues who require a transition to adult services has been highlighted by several studies. In March 2018 the National Institute of Health and Care Excellence (NICE) produced detailed guidelines for the diagnosis and management of attention deficit hyperactivity disorder (ADHD), updated from previous versions in 2008 and 2016, which included general recommendations for transition to an adult service. Yet, there is limited research on transition specifically for those with ADHD. This review aims to systematically identify, review and compare guidelines, specifically focussed on transition for young adults with ADHD within England. Methods Following the general principles for systematic reviewing as published by the University of York, 10 electronic databases were searched. Further documents were identified through searches of grey literature and additional sources. Results Sixteen documents were included. Results indicate very limited publically accessible guidelines in England for transition of young people with ADHD. Nearly all identified documents based their recommendations for transition on the existing NICE guidelines. Neurodevelopmental conditions such as ADHD are often encompassed within one overarching health policy rather than an individual policy for each condition. Conclusions Guidelines should be available and accessible to the public in order to inform those experiencing transition; adjusting the guidelines to local service context could also be beneficial and would adhere to the NICE recommendations. Further review could examine transition guideline policies for mental health in general to help identify and improve current practice.

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“…Taking an approach that plans for the cessation of services or young people's disengagement from services may result in better outcomes than unplanned disengagement. 23 CAMHS services should consider teaching young people to recognise their own symptoms and impairments, and triggers for crises, to manage their mental health, and to participate in shared decision-making; this may improve outcomes following a gap or cessation of CAMHS/AMHS input. This may be especially important for those young people identified as at risk of disengagement.…”

Section: Identifying Those Most At Risk Of Negative Outcomesmentioning

confidence: 99%

Experience of transfer from child to adult mental health services of young people with autism spectrum disorder

Merrick

King²,

Parr

et al. 2020

BJPsych open

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Background Transition from child-centred to adult mental health services has been reported as challenging for young people. It can be especially difficult for young people with autism spectrum disorder (ASD) as they manage the challenges of adolescence and navigate leaving child and adolescent mental health services (CAMHS). Aims This study examines the predictors of transfer to adult mental health services, and using a qualitative analysis, explores the young people’s experiences of transition. Method A UK sample of 118 young people aged 14–21 years, with ASD and additional mental health problems, recruited from four National Health Service trusts were followed up every 12 months over 3 years, as they were discharged from CAMHS. Measures of mental health and rich additional contextual information (clinical, family, social, educational) were used to capture their experiences. Regression and framework analyses were used. Results Regression analysis showed having an attention-deficit hyperactivity disorder diagnosis and taking medication were predictors of transfer from child to adult mental health services. Several features of young people's transition experience were found to be associated with positive outcomes and ongoing problems, including family factors, education transitions and levels of engagement with services. Conclusions The findings show the importance of monitoring and identifying those young people that might be particularly at risk of negative outcomes and crisis presentations. Although some young people were able to successfully manage their mental health following discharge from CAMHS, others reported levels of unmet need and negative experiences of transition.

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Transitioning from child and adolescent mental health services with attention‐deficit hyperactivity disorder in Ireland: Case note review

Cited by 23 publications

References 44 publications

Transition between child and adult services for young people with attention-deficit hyperactivity disorder (ADHD): findings from a British national surveillance study

Transition between child and adult services for young people with attention-deficit hyperactivity disorder (ADHD): findings from a British national surveillance study

Review: Transition from children's to adult services: a review of guidelines and protocols for young people with attention deficit hyperactivity disorder in England

Experience of transfer from child to adult mental health services of young people with autism spectrum disorder

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