Table 1 Transition practice in Leicestershire

Leicestershire have developed a robust transition protocol ensuring that all referrals from children’s services are carefully reviewed and appropriate action is taken. In Leicestershire, referral acceptance by the adult ADHD service is 100 %. Children services are advised to start the referral well in advance of the point of transition on the patient’s 18th birthday. They are also advised not to discharge the patient before they have been seen by the adult service. This ensures that the patient is never lost between the two services. In case the patient does not attend the appointment arranged by the adult ADHD clinic, the referring clinician is contacted for further advice and efforts are made to encourage the patient to attend. When dealing with complex cases or difficult to engage patients, a period of joint working has also been found to be useful.

Recognising the vulnerability of patients through this period of transition and the need to ensure continuity of care and stability, a great degree of flexibility is exercised when dealing with this group of patients. Even when the patient is not keen on taking the medication or attending further reviews, they are not discharged from the service. Time is spent with patients providing psychoeducation about the disorder, its course and the consequences of untreated ADHD. During these discussions it is important to acknowledge the patient’s views and reservations, for example, stigma about a psychiatric diagnosis label, their wish for autonomy, their view that they can manage their symptoms without the help of medication etc. They are offered a further appointment and are encouraged to take their time before making a final decision. In the large majority of cases, patients decide in favour of continuity of care.