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AHDS therapy: Difficult transition to adult medicine

AHDS therapy: Difficult transition to adult medicine



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Difficulties in young ADHD patients transitioning to adult medicine
Attention Deficit Hyperactivity Disorder (ADHD) is an extremely common diagnosis in children and adolescents. However, the disease does not suddenly end with the transition to adulthood. However, therapy often stops when the child reaches the age of majority, and those affected feel - and rightly so - neglected by medicine.

In ADHD patients, there is often a break in medical treatment during adulthood, even if the disorder persists - with its risks - warn researchers at the Carl von Ossietzky University of Oldenburg in view of the results of their current investigation. Together with colleagues from the University of Marburg, they evaluated health insurance data in order to examine the therapeutic care of ADHD patients at different ages. The results were published in the "Deutsches Ärzteblatt".

Data from 24 million insured persons evaluated
The Oldenburg health care researcher Professor Dr. Falk Hoffmann, the Oldenburg psychiatrist Prof. Dr. For their study, Alexandra Philipsen and the Marburg child and adolescent psychiatrist Prof. Christian Bachmann analyzed the data of around 24 million AOK insured persons from 2008 to 2014. The researchers looked specifically at certain age groups. For example, data from a group of 4,340 boys and 1,253 girls who were at the age of 15 at the start of the recordings and accompanied for a period of six years were evaluated.

ADHD patients in adulthood are not adequately cared for
At the age of 21, the diagnosis only persisted in 31.2 percent of young people, although a persistent disorder would be expected in about 50 percent, the researchers explain. According to Prof. Philipsen, the view that ADHD grows with puberty has long since become obsolete. "Half of ADHD patients still show symptoms in adulthood, as we know from other studies," explains the expert. Drug treatment decreased even more over the same period. While 51.8 percent of 15-year-olds were still on ADHD medication, the 21-year-olds only had 6.6 percent of the original group, the researchers report.

Risks associated with untreated ADHD
If ADHD is not treated, then there are various risks, such as a higher risk of depression or personality disorders, according to the doctors. Those affected also often face a poorer school-leaving certificate or job loss, as well as a higher risk of accidents and mortality. If the responsibility of the child and adolescent psychiatrist or pediatrician ends when the child reaches the age of 18 or 21 at the latest, a good transition to adult medical care is therefore all the more important, the researchers emphasize.

Lack of continuity in care
According to the experts, the lack of continuity in medical care has a negative impact on the health, well-being and professional potential of those affected. Possibly some of the young people fall through the grid when changing their place of residence due to the start of their studies or training, said Prof. Hoffmann. This phenomenon can also be observed in chronic physical illnesses. Adolescents would not always arrive in adult medicine because, for example, they do not have a doctor on site after a move, and only reappear when their symptoms worsen.

Declining medication in adolescents
However, the study authors were also able to find some positive developments. For example, they rated it as a gratifying result that the trend of the years-long increasing prescriptions of ADHD medications in children and adolescents was apparently stopped. While almost 52 percent of 13- to 14-year-old ADHD patients were prescribed medication in 2009, according to the analysis in 2014 it was still around 43 percent. However, the reason for this remains unclear. "According to the University of Oldenburg, it cannot be deduced from the study data whether this trend is also due to the increased use of psychotherapeutic therapy options such as behavior therapy or parent training.

Extremely high frequency of diagnosis
The persistently high frequency of diagnoses among children and adolescents remains striking, for example in the case of nine-year-old boys in 2014, with a share of 13.9 percent. According to this, every seventh boy of this age suffers from ADHD. This is probably an expression of "overdiagnosis", the authors report. The researchers assume that the reason for this is more in other areas. These could be, for example, the "school adaptation processes"; because at that age the decision about the secondary school is pending.

Increasing medication rate among adults
According to the researchers, the frequency of diagnosis has increased in all age groups. This also applies to adults. In 2009, the frequency of AOK insured persons aged up to 69 was 1.17 percent, in 2014 it already reached 1.51 percent. A good two thirds of ADHD patients are male. And while the frequency of drug treatment for ADHD patients decreased in childhood and adolescence, it has increased in adults, the scientists write. The experts attribute the higher frequency of diagnosis and medication rate in adults to increased awareness of the persistence of ADHD in adults and to an improved care situation.

Furthermore, many undetected cases
Despite the increasing frequency of diagnosis in adults, the scientists still expect many unrecognized ADHD cases in adulthood. The frequency of diagnosis among 18- to 69-year-olds increased from 0.22 percent in 2009 to 0.4 percent in 2014. But in fact at least one percent of adults should have ADHD - "and that would be cautiously estimated," said Prof. Philipsen. The study authors spoke in favor of expanding the ADHD adult outpatient clinic in order to better shape the transition from young ADHD patients to adult care in the future. Today, given the lack of facilities, months of waiting for an appointment can be expected here. (fp)

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Video: ADHD in Adults - Lecture 1 - Prof David Nutt, Imperial College, London (August 2022).