The transition from adolescence to the age of majority for young people with ADHD

Aim. To investigate the current management of transition from CAMHS (Child and Adolescent Mental Health Services) to AMHS (Adult Mental Health Services) in Italy for patients with ADHD (Attention Deficit and Hyperactivity Disorder). Methods. Observational study placed within phase 2 of the TransiDEA (Transitioning in Diabetes, Epilepsy and ADHD patients) project, sponsored by the Mario Negri Institute for Pharmacological Research. Analysis of the direct experience of a group of 36 young patients with ADHD who turned 18 between 2017 and 2021 and clinicians (Child Neuropsychiatrists and Psychiatrists) involved in their care pathways before, during and after the transition process. Patients were offered a structured interview via video call while clinicians filled out a questionnaire. The questions covered diagnosis, symptomatology, different therapeutic interventions, service management of transition, success rate of referral from CAMHS to AMHS and outcome from clinical and sociooccupational point of view. Results. In our sample, the rate of diversion from services during transition process is about 50% if we consider attempted referrals from CAMHS to AMHS, and it reaches 75% of the total if we consider successful referrals. For 7 patients, referral was not deemed necessary due to mild symptomatology. For 9 patients, referral was not made due to the absence of sufficiently specialized services for adults with ADHD and for the remaining 5 due to poor compliance by the family. According to the patients’ reports, in 50% of the cases no specific interventions aimed at managing the transition were put in place, in 19% informational meetings between child neuropsychiatry and family were carried out, in 25% a clinical report was sent, and in 6% a case discussion was carried out between professionals. These data are roughly in line with those reported by professionals. With regard to clinical outcome, particular attention was paid to the occurrence of “sentinel events”, indicative of likely severe clinical picture (e.g., ER admissions for substance use, drunken driving accidents and fights), occurred in the period between discharge from CAMHS and the time of the interview. At least one of these episodes was observed in 36% of the young adults not in treatment at the time of the interview and in 14% of those under AMHS’ care. Conclusions. The results reported in this paper confirm the urgency of putting in place interventions to facilitate the transition process from pediatric to adult services for patients with ADHD. The third phase of the TransiDEA project, currently nearing completion, gathered the information obtained in phases 1 and 2 to draft a document containing organizational and practical directions addressed to treatment services in order to enable better structuring of the transition process in Italy.