Transitioning to Adult Mental Health Services for young people with ADHD: an Italian-based Survey on practices for Pediatric and Adult Services

Abstract

The present study assessed the transitioning process of Attention-Deficit/Hyperactivity Disorder (ADHD) patients in Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Italian territory. We asked child and adult psychiatrists to report the current state of services and their observations on limitations and possible future matters that need to be addressed. Seventy-seven centers (42 CAMHS, 35 AMHS) filled in a web-based survey in which they reported the number of ADHD patients, how many transitioning patients they had within the past year, and how they structured transition. A fragmented picture emerged from the survey. Lack of resources, training, and communication between services hinder the transition process, and many adult patients remain under CAMHS' care. While some services have a protocol, there is no structured guidance that can help improve integration and continuity of treatment. The observed situation reflects a need for improvement and for standard guidelines to enable a successful transition process, considering both clinicians' and patients' necessities.

The Transition from adolescence to adulthood mental health services for young people with ADHD in Italy

“…Low referral acceptance and lack of communication between CAHMS and AMHS contribute to the loss of care for approximately half of patients. Such mechanisms result from scarce services and resources, as previously highlighted elsewhere (Eke et al ., 2020; Appleton et al ., 2023; Roberti et al ., 2023b).…”

“…Several factors contribute to this discontinuity of care in adolescence: lack of organization, scarce resources and collaboration between services, stigma, concerns about peers judgement, and low family compliance (Anderson, Newlove-Delgado and Ford, 2022; Roberti et al ., 2023b). The result is feeling left alone (Driver et al ., 2022) and a later worsening of symptoms with urgent service re-entries (Anderson, Newlove-Delgado and Ford, 2022).…”

“…This need is particularly evident and urgent in Italy: in a country where the estimated ADHD prevalence ranges from 1.1 to 3.1% among youth aged 5 to 17 years (Reale and Bonati, 2018), no shared transition practices by CAMHS and AMHS currently exist. This observation emerged within the first phase of the Transition care between adolescent and adult services for young people with chronic health needs in Italy project (TransiDEA – Transition in Diabetes, Epilepsy, and ADHD patients), designed to assess the current state of transitioning practices, the experience of patients, their families and the clinicians of both CAMHS and AMHS (Roberti et al ., 2023b). Indeed, amongst forty-two services that participated in the 2022 Survey (Phase 1), only twenty-one declared having a transition protocol, and even fewer (six in total) provided a copy.…”

Protocols for transitioning to adult mental health services for adolescents with ADHD

“…Two surveys were developed, one for pediatric and one for adult services. The details of the survey's structure and the results of the 42 Child and Adolescent Mental Health Services (CAMHS) and 35 Adult Mental Health Services (AMHS) who filled in the survey have been reported in a previous study [22]. The current study was notified to the IRCCS "Carlo Besta" Ethics Committee (8 September 2021, protocol n. 87).…”