Dose of Methylphenidate during Service Transition for Adults with ADHD

Why young people stop taking their attention deficit hyperactivity disorder medication: A thematic analysis of interviews with young people

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that can persist into adulthood. Young people often stop taking ADHD medication during adolescence despite evidence that continuation would be beneficial. Increasingly, young people are restarting medication in early adulthood suggesting that cessation was premature. In this paper we explore the reasons given by young people for discontinuing ADHD medication.

METHODS

Qualitative data from the Children and Adolescents with ADHD in Transition between Children's and Adult Services (CATCh-uS) project was analysed to look for reasons for stopping medication. Semi-structured interviews with three groups of young people were analysed using thematic and framework analysis; this included young people prior to transition (n = 21); young people that had successfully transitioned to adult services (n = 22); and young people who left children's services prior to transition but re-entered adult services later (n = 21).

RESULTS

Reasons given by young people for stopping ADHD medication included the following: the perceived balance between benefits and adverse effects of medication; perceptions of ADHD as a childhood or educational disorder; life circumstance of the young person and challenges young people faced in accessing services.

CONCLUSIONS

A multidimensional approach is needed to address discontinuation of ADHD medication in order to improve the long-term prospects and quality of life for these young people. Possible approaches include access to non-pharmacological treatments and improved psychoeducation. As many reasons given by young people are not unique to ADHD, these findings are also of relevance to medication adherence in other chronic childhood conditions.

Advancing services for adult ADHD: the development of the ADHD Star as a framework for multidisciplinary interventions

BACKGROUND

Attention Deficit Hyperactivity Disorder is prevalent in adulthood, resulting in serious impairment across multiple domains of living. Despite clinical guidance recommendations, the relative infancy of research on service provision for adults with ADHD, along with the evidence transfer gap, means that there is a lack of specific frameworks for service delivery. Igniting research and developing service delivery frameworks within adult ADHD is an essential step in the provision of effective services for adults with ADHD.

METHOD

Following the methodology used in previous related research that utilises a Participatory Action Research approach, we gathered data from clinicians and service users on the domains of living in which they wish to create change, and the steps and end point of the change process. This data was utilised, alongside data gathered from previous research and policies, to develop the domains of assessment for the ADHD Star, and the scale on which change is assessed.

RESULTS

The resulting tool, the ADHD Star, consists of eight domains: understanding your ADHD, focus and attention, organising yourself, friends and social life, thinking and reacting, physical health, how you feel and meaningful use of time. Each domain is rated on a five-point scale, the 'ladder of change', ranging from 'stuck' to 'choice'.

CONCLUSIONS

The ADHD Star offers a guiding framework for the development of care pathways and subsequent service provision for adults with ADHD, based on multi-disciplinary, holistic and person-centred care.

ADHD and transitions to adult mental health services: a scoping review

There is increased awareness that attention deficit hyperactivity disorder (ADHD) continues into adulthood. Thus, health services are faced with a new challenge in providing a 'smooth' transition to adult services appropriate for young people with ADHD. This scoping review sought to identify the literature addressing transition for young people with ADHD to adult mental health services (AMHS). A scoping review, in which the search terms 'ADHD' and 'Transition' or 'Transfer' were entered into eight healthcare publication databases facilitated by NHS Evidence to identify both published and unpublished papers between 2000 and June 2013. Additional informal searches were also undertaken. Twenty-three papers were selected for this review. This review confirms the lack of research explicitly tracking transition from Paediatrics/Child and Adolescent Mental Health Services (CAMHS) to AMHS for young people with ADHD. Only four papers directly studying transition for ADHD patients were identified. Three further studies surveyed clinician perspectives. Taken together, the studies address a number of issues in relation to transition, including the developmental course of ADHD symptoms, appropriate adult care, knowledge and communication, unmet need, comorbidities, environmental demands and medication cessation/dosage during the transition period. While literature surrounding transition exists, the scope of the evidence showing successful and unsuccessful transition activity from Paediatric and CAMHS to AMHS for young people with ADHD is limited. Future quality research in the form of audits, longitudinal tracking studies and service evaluations are required if we are truly to understand and identify what is needed and currently available for successful transition to an appropriate adult service for ADHD patients.