Transitioning from childhood to adulthood is a challenging time for any young person, but for those with Attention-Deficit/Hyperactivity Disorder (ADHD), it requires particular attention and planning. Youths with ADHD often experience significant long-term impairments, and many go on to develop concurrent mental health issues or physical health difficulties as they grow older. Without continued support, these challenges can lead to further burdens for the individual and society. Unfortunately, research shows that only a small proportion of young people with ADHD successfully transition to adult mental health services worldwide, resulting in unmet needs and disrupted care pathways.
This blog aims to highlight the importance of early transition planning for young people moving from Child and Adolescent Mental Health Services (CAMHS) to adult services. Drawing from the latest research and clinical perspectives, we will explore the critical factors needed for a successful transition and identify the barriers that prevent effective care continuity.
Why is Transition Planning Important for Youths with ADHD?
Research confirms that young people with ADHD face continued challenges into adulthood, including educational struggles, employment issues, relationship difficulties, and increased risk of mental health disorders (Adamo et al., 2024). However, the reality is that many adolescents with ADHD do not transition into adult services, missing out on the support they need to manage their condition. This gap in care can lead to worsening symptoms and diminished quality of life, with increased costs for both the individual and society.
By ensuring that transition planning starts early and is carefully managed, we can provide continuity of care that addresses these risks. A well-planned transition should focus on identifying which young people require continued support and ensuring that the transition is tailored to their needs and developmental readiness.
Key Points for Successful Transition Planning
- Assessing Developmental Readiness: It’s essential to assess a young person’s “developmental readiness” when transitioning to adult ADHD services. This involves understanding their sense of autonomy, their readiness to manage their condition independently, and their views on the level of support they need from family, education, and health services (McNamara et al., 2017). Some young people may be hesitant to continue care, often due to a lack of awareness of ADHD’s persisting nature in adulthood. Psychoeducation is critical here, providing young people with the knowledge they need to understand the ongoing nature of their condition and reduce the stigma associated with ADHD in adulthood.
- Timing of Transition: Transition should not be seen as a single event but as a process that occurs over time. Early planning is essential, ideally starting a year or two before the expected transition date. This allows enough time to involve the young person in decision-making and prepares them for the change. Many young people (and their families) are not aware of the differences in adult services and may be resistant to transitioning, particularly if they feel their ADHD symptoms will subside after school. Research shows that while parents often anticipate the need for ongoing care, many young people do not envisage requiring ADHD medication beyond their teenage years. However, their views often change as they mature, with many adults later expressing frustration at the limited treatment options available (Janssens et al., 2020; Reale et al., 2015).
- Identifying Service Needs: It is crucial to tailor transition plans based on the individual’s specific needs. For some, this will mean continued pharmacological treatment, while others may benefit from psychological support or occupational therapy. It is also important to recognize the impact of ADHD on various aspects of life, from education and employment to social and emotional well-being. Adults with ADHD often report that services focus too heavily on medication and not enough on other types of support (Janssens et al., 2020).
- Psychoeducation and Reducing Stigma: Many young people with ADHD are unaware of the long-term nature of their condition and may view continued care as unnecessary. Educating them on ADHD’s potential persistence into adulthood and the importance of ongoing support can empower them to engage in their care actively. Providing psychoeducation not only addresses stigma but also helps young people understand the value of continued management of their ADHD (Matheson et al., 2013; McNicholas et al., 2015).
- Collaboration Between Services: Successful transitions require collaboration between CAMHS and adult services. A lack of communication and coordination between these services is one of the primary reasons why many young people fall through the cracks during the transition process. Creating a clear transition plan that outlines the roles and responsibilities of each service, as well as maintaining open lines of communication, is essential.
- Listening to the Young Person’s Voice: The young person’s views should always be central to any transition plan. Their level of autonomy, how they view their condition, and their preferences for ongoing care should be explored in depth. Involving them in decision-making fosters a sense of ownership over their care and increases the likelihood of a successful transition (McNamara et al., 2017; Merrick et al., 2020).
Barriers to Effective Transition
Despite the clear need for transition planning, numerous barriers still exist:
- Lack of Standardized Guidelines: Transition practices vary significantly across countries, and even within the same country, there may be inconsistencies in how services handle transitions. This lack of standardization can create confusion and delays.
- Inadequate Resources: Many adult ADHD services are underfunded and cannot provide the same level of support as CAMHS. Limited availability of services and long waiting times often discourage young people from seeking care.
- Perceived Lack of Need: As mentioned earlier, some young people with ADHD do not believe they will need ongoing care, especially if they are not fully aware of how ADHD affects them in adulthood (Swift et al., 2013).
Conclusion
Transitioning young people with ADHD from CAMHS to adult services is crucial for ensuring continued support and reducing long-term impairment. Early planning, tailored care, psychoeducation, and collaboration between services are key to making this transition successful. It is essential to address the barriers that prevent young people from accessing the care they need and to listen carefully to their views on their condition and support needs.
The ultimate goal is to ensure that youths with ADHD can move seamlessly into adult services with the confidence and resources needed to manage their condition effectively into adulthood.
References:
- Adamo, N., Singh, S. P., Bölte, S., Coghill, D., Newcorn, J. H., Parlatini, V., … & Banaschewski, T. (2024). Practitioner Review: Continuity of mental health care from childhood to adulthood for youths with ADHD – who, how and when? Journal of Child Psychology and Psychiatry, 65(8), 897-912. https://doi.org/10.1111/jcpp.14036
- Janssens, A., Williams, C., Tomlinson, M., Logan, S., & Whitaker, R. (2020). Children and Adolescents with ADHD in Transition between Children’s and Adult Services (CATCh-uS). European Child & Adolescent Psychiatry, 29(7), 889-899.
- Matheson, L., Asherson, P., Wong, I. C., Hodgkins, P., Setyawan, J., Sasane, R., & Clifford, S. (2013). Adult ADHD patient experiences of impairment, service provision and clinical management in England: a qualitative study. BMC Health Services Research, 13, 184.
- McNamara, R., Norman, P., Ingram, J., & Thompson, R. (2017). The role of health beliefs in the transition from child to adult services in patients with ADHD: a prospective study. BMC Psychiatry, 17, 313.
- Merrick, H., King, N., McConachie, H., Parr, J. R., & Le Couteur, A. (2020). Factors influencing family and clinician agreement on symptoms of autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(10), 3646-3656.
- Swift, K. D., Sayal, K., & Hollis, C. (2013). ADHD and transitions to adult services: A scoping review. Child: Care, Health and Development, 40(6), 775-786.
