For people with ADHD, periods of change can be challenging. Disruptions to routine, changing relationships, and employment or school transitions can cause coping mechanisms to fail and exacerbate or highlight existing symptoms. As ADHD patients age and enter new life phases, this may also lead to changing symptom presentations.
Let’s explore how you can support ADHD patients through life transitions and continuity of care.
What life transitions can impact people with ADHD?
For children and young adults, educational transitions, such as starting or changing school, and moving to college or university, are significant periods of change. They often bring new social environments, growing academic demands, increasing independence, and more complex relationships.
Similar transitions occur throughout adulthood, like changes in employment, romantic relationships, parenthood, and aging. Some of these life transitions also involve moving between healthcare services, such as from pediatric to adult care.
It is possible that these transition points may lead to patient disengagement and treatment cessation. Here's where your role as their mental healthcare provider is critical.
What do life transitions look like for ADHD patients?
Exploring real patient experiences
Dr. Aaron Dodini recounts a story from when his daughter Sydney started college that led to an ADHD assessment and subsequent diagnosis:
“Now she’s in a dorm room with other women who are in some cases taking the same classes, have the same assignments, and she can now see, oh – this is taking me two, three, four times as long…We did a variety of different tests. We use one that I think is a really exceptional way of measuring the symptoms of ADHD. It gives us objective data. It’s called the QbCheck.”
Evelyn Polk-Green, a past president of ADDA, describes how motherhood highlighted ADHD symptoms that previously went unnoticed:
“I often felt like a failure as a mother. I could not understand why I could not do all the things that others did. And I worked; I've always worked. I went right back to work after they were born and so I could never figure out why I couldn't do it all the way other people did it all successfully. Like why my house always looked like a tornado had hit it and why, you know, kids didn't have lunch like they should and all those kind of things. Until I finally just came to terms with realizing what it is, and it was part of living with [ADHD].”
Clinical red flags to watch for during patients’ life transitions
ADHD symptoms may change across one's lifespan. In younger children, hyperactivity and impulsivity symptoms may be more common. As children enter adolescence, hyperactivity-impulsivity symptoms may improve, but inattentive symptoms may become more persistent.
Adults, whose ADHD may have gone undiagnosed for years, can develop scaffolding, masking, or coping strategies. These can make ADHD symptoms harder to notice. However, periods of intense stress, such as divorce, moving home, becoming a parent, or changes at work, may cause these strategies to collapse and expose previously masked symptoms.
Penny Lazell, Senior Clinical Advisor at Qbtech, shares how hormone levels dropping after childbirth can cause scaffolding to fail:
“If that scaffolding goes, that's when you're going to see that symptomology. So, somebody may appear to be managing really well, you know, able to write lists, have the time to do it and then something changes, and that's when you see the catastrophic changes in that person who looked able to manage. And that could be a trigger from that massive reduction in estrogen after giving birth; that could just trigger those ADHD symptoms to really come out.”
How to support ADHD patients through life transitions
You can support patients by preparing them, their families, educators, and employers through psychoeducation, coordinating care across services, developing personalized strategies, and arranging additional follow-ups during periods of change.
Patient psychoeducation
If you’re looking for an ADHD patient resource, our psychoeducation pack includes experiences of ADHD at different life stages and the conversations that may come up in clinic with parents, children, teens, and adults with ADHD.
If possible, work with your patients’ educators to ensure adequate support is available during transitions between schools. For one of our Qb-users, Individualized Education Program (IEP) goals and Section 504 plans helped students with ADHD get the accommodations they need.
Support during the pediatric-to-adult service transition
Age-related transitions between ADHD services may also present problems. Discontinuation of ADHD treatment peaks between 18 and 19 years of age. This coincides with transitioning from pediatric to adult mental health services, which people often “perceive as poorly managed.” You could help your patients transition to adult ADHD services by working with adult providers to help book their first appointment and offer additional support.
Studies have also highlighted that something as simple as text messaging-based interventions can help maintain continuity of care between service providers.
How objective data helps with lifelong ADHD monitoring and care
ADHD patients often find self-assessment of symptoms difficult. Subjective assessment methods can present an incomplete, conflicting, or biased assessment of symptoms that can compromise ADHD diagnostic accuracy. During stressful life periods, patients may find it even harder to present a balanced and accurate measure of symptoms.
Digital ADHD tools like QbCheck can help assessments by providing objective data on attention, activity, and impulsivity. The test is repeatable, allowing you to make direct comparisons with results across a patient’s life and before and after treatment.
By adding QbCheck results to your patients’ Electronic Health Records, you can ensure that historical symptom data is available to all future clinicians reviewing their care. QbCheck can be used in a suitable home environment with high reliability and is a useful objective measure for remote monitoring of ADHD medication. This can enable you to continue treating a patient, even if they move.
Frequently Asked Questions (FAQs)
Patients disengaging from ADHD care, failing to transition between services, or discontinuing medication can have a serious impact. A study of adult ADHD patients taking methylphenidate-LA found that 49.6% relapsed within 6 months of stopping medication.
Children who do not transition to adult ADHD care may present as adults with serious mental health problems and also experience increased rates of Accident and Emergency attendances, and interactions with the criminal justice system, and Departments of Employment, Learning and Social Services.
NICE (NG87) recommends that children and adults taking ADHD medication are seen regularly for health monitoring as follows:
- Children 10 years and under – measure weight every 3 months and height every 6 months
- Children & young people over 10 years – measure weight at 3 and 6 months after starting treatment, then every 6 months (or more if concerns)
- Adults – Measure weight every 6 months
- Additionally: For patients of all ages – heart rate and blood pressure should be checked after each dose change and every 6 months, and medication should be reviewed at least once a year
To support a patient transferring between ADHD services, you should provide:
- Details of ADHD diagnosis and symptom history
- Details of current medication and treatment plan, including dose, and treatment response (including any adverse effects)
- Details of comorbid and coexisting conditions (e.g. mental health issues, substance misuse, learning difficulties)
- Evidence of functional impact (in education or employment and social/family issues)
- Risk factors (e.g. substance misuse, history of treatment discontinuation)
- Any other information specific to the patient that may be relevant
The NICE document 'Transition from children’s to adults’ services for young people using health or social care services' is a comprehensive guide to supporting patients through service transitions. Key recommendations include:
- Starting transition planning early and transferring during a stable period
- Involving the young person, family/carers, and clinical staff in annual meetings pre-transition
- Assigning a dedicated worker to support the patient during transfer
- Actively following up if the young person does not engage with the new adult service provider
Digital ADHD tests can provide you with objective symptom data that can be used for monitoring ADHD symptoms and treatment effects across the lifespan. The repeatable nature of Qb testing allows you to make direct comparisons between baseline and repeat tests.
Offering ADHD testing remotely can also help patients maintain continuity in ADHD care, even during transitional times in their life. More flexible telehealth appointments can also help during periods of higher stress, when symptoms may be exacerbated and physically attending a clinic feels harder.