Role of education settings in transition from child to adult health services for young people with ADHD

Figures & data

Figure 1. Three groups of young people representing different stages in the transition process (adjusted from Janssens et al. 2020)

Table 1. Young people with ADHD participant details

Young People with ADHD	Age range and gender	Occupational Status	Comorbidities	Living Arrangements	Criminal Justice
Group 1: Pre-transition total = 21	Ages = 14–17 Female = 5; Male = 16	School = 7; Special school = 2; FE College = 3; Excluded = 1; Home schooled = 1; Sixth form = 2; Vocational Training = 1; Unknown = 4	Yes = 9; None = 11; Unknown = 1; Confirmed ASD = 8	Across groups:- Living with parents = 55; Living independently = 17; In a residential special school = 1; Unknown = 1.	Across groups. Reported contact with the criminal justice system = 16 (12 of these re-entered services).
Group 2: Post-transition total = 22	Ages = 17–21 Female = 9; Male = 13	FE = 2; HE = 3; In education – unspecified = 6; Unknown = 4; Employment = 4; NEET = 3;	Yes = 14; None = 6; Unknown = 2; Confirmed ASD = 10
Group 3: Re-entered total = 21	Age = 19–29 Female = 6; Male = 15	HE = 2; Employment = 7; NEET = 8; Unknown = 3; Vocational Training = 1	Yes = 13; None = 8; Unknown = 0; Confirmed ASD = 7

NEET – Not in Employment Education or Training.

Table 2. Themes and key elements

Theme	Key elements	Educational Phase
1. ADHD – medication: a means to an end.	The use of ADHD medication was often considered in relation to school behaviour and academic performance. Many young people with ADHD expressed that they thought that medication was beneficial for learning. Data for these perspectives came from all groups. Once on medication young people reflected on their improved concentration and academic achievement. Child clinicians often considered educational demands in their decisions regarding medication dosage and withdrawal, but more non-pharmacological and holistic support might also provide educational and emotional benefits	Secondary school, FE college and sixth forms
2. The influence of educational setting upon health service transition	Approaches to transitions from child to adult health services were inconsistent, and often complicated by moving accommodation to progress their education. Data for these perspectives came from all groups except from clinicians working in adult services. Transition inconsistencies Transition from child to adult health services typically took place while the young people with ADHD were in education. Although there was no consistency in approach across educational settings, clinicians valued the multi-agency health service transitions which were led by special schools. Added complication of leaving home for education If changing educational settings meant a young person was relocating, this introduced complexity in managing service provision. Young people were often left in limbo between services and experienced variable support from health services and universities.	FE colleges, sixth forms, and university

Table 3. Recommendations

1. Joint DfE, OfS and NICE supported multi-agency service statutory health care transition model or protocols which include sixth forms, FE colleges and post 18 educational settings such as universities. Ideally with consideration of the pastoral and multi-agency approach taken in special schools. 2. All UK educational settings should have access to expertise and training to enable educational staff to provide sustained mental health and study support for young people with ADHD to facilitate smooth transitions across education setting and health service boundaries. This support could include improvements in knowledge of ADHD medication, its impacts on learning, challenges of transition between services and anticipation of challenges in education transitions. This could be expertise either dedicated and located in one educational setting or shared across multiple educational settings.

3. Ongoing joint oversight of child to adult education, training and employment and adult to adult health service transition effectiveness.

Janssens, A., H. Eke, A. Price, T. Newlove-Delgado, S. Blake, C. Ani, P. Asherson, et al. 2020. “The Transition from Children’s Services to Adult Services for Young People with Attention Deficit Hyperactivity Disorder: The CATCh-uS Mixed-methods Study.” Southampton (UK): NIHR Journals Library; 2020 Nov. PMID: 33211453.

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