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Table 3 Specific recommendations for transition of care from children’s to adult services

From: Recommendations for the transition of patients with ADHD from child to adult healthcare services: a consensus statement from the UK adult ADHD network

1. A planned transfer to an adult service should be made if the young person continues to have significant symptoms of ADHD or other co-existing conditions that require treatment
2. Transition should be planned well in advance by both referring and receiving services. Timings of transition may vary but should ordinarily be completed by the age of 18 years. Transition between teams should be a gradual process and should be thought of as a ‘process’ and not a ‘single event’.
3. Patients should be involved in discussion about transition and informed of the outcome of any transition assessment. The transition process should proceed according to need in terms of future medical care (e.g. involvement of general practitioner [GP] services, specialist adult ADHD teams, adult learning disability services, adult physical health teams). Importantly, the GP should be involved throughout the process.
4. Discussion, and where necessary, joint meetings between child and adult services must ensure that the needs of the young person will be appropriately met. It is important to consider the presence of comorbid and/or related problems, which may involve further discussion and collaboration with educational, or occupational and social agencies.
5. CAMHS practitioners and paediatricians should foster engagement with AMHS through open discussion and psychoeducation about ADHD, the benefit of evidenced-based psychological and pharmacological treatment where appropriate, and the risks of disengagement. It is important to address concerns about stigma associated with referral to AMHS.
6. For young people aged 16 years or over in CAMHS, a CPA should be used to aid transfer. CPAs are not available in paediatric practice, and so a planned assessment of need with the young person and their parents/carers and a clearly documented plan of action is recommended.
7. Parents/carers need to be prepared and facilitated to aid their child’s gradual move towards independence and autonomy (with respect to the management and treatment of their ADHD). The referring and receiving healthcare teams should be mindful of possible parental ADHD and when this is present (or suspected) provide appropriate support.
8. Shared care arrangements between primary and secondary care services for the prescription and monitoring of ADHD medications should be continued into adulthood.
9. Direct psychological treatment should be considered (individual and/or group Cognitive Behavioural Therapy) to support young people during key transitional stages. This should have a skills development focus and target a range of areas including ADHD symptoms, social skills, interpersonal relationship problems (with peers and family), problem solving, self-control, dealing with and expressing feelings. Active learning strategies should be used.
10. Specific protocols need to be developed for young people who are not accepted by AMHS criteria, but whom the referring service strongly believe need ongoing support. Care needs to be taken that these patients are not left without the support they need during this very important transition period.
11. Separate care pathways should be developed for young people who drop out of CAMHS or paediatric services when they are under 18 years of age, and who later re-present in the healthcare system as adults.
12. Separate care pathways should be developed for patients who come to the attention of the healthcare system on account of ADHD for the first time as adults.
13. The referral letter from children’s services should provide a comprehensive account of the patient, including: diagnostic summary and formulation; treatment history; rationale and response; side effects, compliance, abuse and diversion issues, and ongoing treatment needs; any psychiatric and medical comorbidities, their impact on ADHD and treatment; any other ongoing needs - social, financial, accommodation or occupational and an updated risk assessment.
14. The adult service should acknowledge the receipt of the referral. The patient should not be discharged by the children’s services until they have been seen by the adult services and their care has formally been taken over by the adult services. This provides a safety net and reduces the likelihood of patients dropping out of the services during the transition period.
15. Following acceptance of the referral, the adult service should allocate a key worker/lead clinician who will coordinate the care needed.
16. When dealing with patients who are anxious about the transfer of care to adult services or those with complex needs, it may be necessary for children’s services to joint work with adult services for a few months to facilitate the transfer of care.