Discontinuity in the Transition from Pediatric to Adult Health Care for Patients with Attention–Deficit/Hyperactivity Disorder

Abstract

Background: Although attention–deficit/hyperactivity disorder (ADHD) is a chronic disorder, treatment declines dramatically in adolescence and into early adulthood. This premature termination of care is likely compounded by the difficulty many patients have switching from a pediatric to an adult provider. Objective: To review, from the adult primary care provider perspective, the barriers to continuity of care and their implications for patients with ADHD who transition from pediatric to adult health care. Design: Literature review. Approach: Relevant articles were identified by searches of the PubMed and EMBASE databases and by reviewing the reference lists of articles obtained from these searches. Results: Health care transition for adolescents and young adults with ADHD remains a crucial area of research. The current literature reveals a number of barriers to the continuity of care, including disparities and inadequacies in ADHD education in primary care and internal medicine residencies, prohibitive prescribing practices with respect to stimulants, inadequate clinic staffing, lack of support in the college health care system, inadequate health insurance coverage, and failure to conduct transitional planning. Without improved continuity of care and adherence to medication, adolescents and young adults with ADHD are at greater risk of academic, social, and vocational difficulties, as well as behavioral problems, including substance abuse, unsafe driving, and criminal activity. Conclusion: If we are to adequately address the health care needs of adolescents and young adults with ADHD, we need to educate primary care providers and support additional research.

Keywords:

• attention-deficit/hyperactivity disorder
• adult
• primary care
• continuity of patient care
• transition planning