Clinical practice gaps, uncertainties and need for guidance
ADHD is a lifelong condition and treatment and support needs may vary over one’s life. Well-managed transitions between services at key developmental stages throughout the lifespan of people with ADHD are important to ensure continuity of care but are absent in many services (Ford, 2020; Paul et al., 2013). Many individuals drop out of services at these transition points, particularly during adolescence and early adulthood (Montano & Young, 2012), resulting in increased anxieties for people with ADHD and their families during this period (Shanahan, Ollis, Balla, Patel, & Long, 2020).
Poor transition contributes to long-term negative health and social outcomes for people with ADHD (Appleton, Elahi, Tuomainen, Canaway, & Singh, 2021; Young, Asherson, et al., 2021) and potentially death (Dalsgaard, Østergaard, Leckman, Mortensen, & Pedersen, 2015) if left untreated.
Even when paediatric (or child and adolescent mental health) services recognise the need to refer people to other services, there are barriers that may prevent effective transfer of care (Marcer, Finlay, & Baverstock, 2008). These barriers include inadequate ADHD education in primary care (Montano & Young, 2012), lack of expert services to which adults with ADHD can be referred (Coghill, 2017; Hall et al., 2013), lack of planning, differences in service delivery models between adult and mental health services (Ford, 2020), gaps in communication between child and adult services (Hall et al., 2013), and perceived unhelpful attitudes of some healthcare professionals experienced by people with ADHD (Matheson et al., 2013; Tatlow-Golden, Prihodova, Gavin, Cullen, & McNicholas, 2016). There is a strong need to ensure clear guidance on clinical transitions for people with ADHD, to prevent these negative outcomes and overcome the identified transition barriers.