Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-28T12:38:18.721Z Has data issue: false hasContentIssue false
  • English
  • Français

Review of international clinical guidelines for adolescents on transition to Adult Mental Health Services and adults with attention-deficit hyperactivity disorder and their application to an irish context

Published online by Cambridge University Press:  18 January 2016

G. C. Hughes ,
S. O’Hanrahan ,
G. Kavanagh  and
F. McNicholas
G. C. Hughes*
Affiliation:
Senior Registrar in Child & Adolescent Psychiatry, Beechpark Autism Service, Bryan S Ryan Building, Main Road, Tallaght, Dublin
S. O’Hanrahan
Affiliation:
Educational Psychologist in Training, Lucena Clinic, 59 Orwell Road, Rathgar, 6Dublin
G. Kavanagh
Affiliation:
Child & Adolescent Psychiatrist, Lucena Clinic, Wicklow Town, Co. Wicklow
F. McNicholas
Affiliation:
Professor of Child & Adolescent Psychiatry, Department of Child & Adolescent Psychiatry, Our Lady’s Children’s Hospital, Crumlin, 12Dublin Professor of Child & Adolescent Psychiatry, Lucena Clinic, 59 Orwell Road, Rathgar, 6Dublin & University College Dublin
*
*Address for correspondence: G. C. Hughes, Linn Dara CAMHS Inpatient Unit, Child & Adolescent Mental Health, Ballyowen Lane, Palmarstown, Dublin 20, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To review the available clinical guidelines from Canada, North America, Europe and the United Kingdom for the diagnosis and management of attention-deficit hyperactivity disorder (ADHD) for adolescents previously diagnosed in Child and Adolescent Mental Health Services (CAMHS) on transition to Adult Mental Health Services (AMHS) and for adults presenting with a diagnostic query re-ADHD. This article seeks to apply the available guidelines to an Irish context.

Method

Various clinical guidelines and consensus statements were identified by a literature search of PubMed, incorporating literature from the past 10 years from English speaking countries and inclusion of any additional guidelines of clinical relevance. A clinical guideline with specific reference for Irish clinicians was proposed for the diagnosis and management of adults presenting for the first time with a diagnostic query re-ADHD and also to include those young adults previously diagnosed in CAMHS on transition to AMHS.

Conclusions

ADHD is a lifelong disorder, which if undiagnosed or untreated can lead to significant impairment resulting in a high economic cost for society. Stimulant medication is a first-line treatment option for adults with ADHD; however, some formulations are unlicensed in Ireland. Recent licensing of Atomoxetine, for both adolescents on transition and for adults with newly diagnosed ADHD is a welcome development. Third-line agents are rarely prescribed due to their side effect profiles and are prescribed off-label:

It is important to establish clinical guidelines for an Irish context incorporating a biopsychosocial approach. Further discussion amongst clinicians and stakeholders is needed to plan service development.

Keywords

ADHDadolescentadultconsensus statementguidelinestransition
Type
Review Article
Information
Irish Journal of Psychological Medicine , Volume 34 , Issue 1 , March 2017 , pp. 59 - 73
Copyright
© College of Psychiatrists of Ireland 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

AADD-UK (2014). The site for and by adults with ADHD (http//:www.aadduk.org/help-support/specialists-support-and-coaches/). Accessed 8 August 2014.Google Scholar
Barkley, RA, Fischer, M, Edelbrock, CS, Smallish, L (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: an 8-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry 29, 546–587.CrossRefGoogle ScholarPubMed
Beirne, M, McNamara, N, O’Keeffe, G, McNicholas, F (2013). Survey examining the views of adult psychiatry consultants and senior registrars regarding ADHD. Irish Journal of Psychological Medicine 30, 197–203.CrossRefGoogle ScholarPubMed
Biederman, J (2004). Impact of comorbidity in adults with attention deficit/hyperactivity disorder. Journal of Clinical Psychiatry 65, 3–7.Google ScholarPubMed
Biederman, J, Faraone, SV, Spencer, T, Wilens, T (1993). Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. The American Journal of Psychiatry 150, 1792–1798.Google ScholarPubMed
Bolea-Almanac, B, Nutt, DJ, Adamou, M, Asherson, P, Bazire, S, Coghill, D, Heal, D, Müller, U, Nash, J, Santosh, P, Sayal, K, Sonuga-Barke, E, Young, SJ (2014). Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: Update on recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 1–25.Google Scholar
CADDRA Canadian ADHD Practice Guidelines (2011) (http://www.caddra.ca/practice-guidelines/download). Accessed 15 April 2014.Google Scholar
Faraone, S, Biederman, J, Mick, E (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine 36, 159–165.CrossRefGoogle ScholarPubMed
Fischer, M, Barkley, R, Smallish, L, Fletcher, K (2007). Hyperactive children as young adults: driving abilities, safe driving behavior, and adverse driving outcomes. Accident: Analysis and Prevention 39, 94–105.Google Scholar
Hall, C, Newell, K, Taylor, J, Sayal, K, Swift, K, Hollis, C (2013). Mind the gap’ – mapping services for young people with ADHD transitioning from child to Adult Mental Health Services. BMC Psychiatry 13, 186.Google Scholar
Jerome, L, Segal, A, Habinski, L (2006). What we know about ADHD and driving risk: a literature review, meta-analysis and critique. Journal of the Canadian Academy Child and Adolescent Psychiatry 15, 105–125.Google Scholar
Kessler, RC, Adler, L, Barkley, R, Biederman, J, Connors, C, Demler, O, Faraone, S, Greenhill, L, Howes, M, Secnik, K, Spencer, T, Ustan, B, Walters, E, Zaslavsky, A (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. The American Journal of Psychiatry 163, 716–723.CrossRefGoogle ScholarPubMed
Kirley, A, Fitzgerald, M (2002). Adult ADHD: a controversial diagnosis? Irish Journal of Psychological Medicine 19, 86–91.Google Scholar
Kooij, S, Bejerot, S, Blackwell, A, Caci, H, Casas-Brugue, CP, Edvinsson, D, Fayyad, J, Foeken, K, Fitzgerald, M, Gaillac, V, Ginsberg, Y, Henry, C, Krause, J, Lensing, M, Manor, I, Niederhofer, H, Nunes-Filipe, C, Ohlmeier, M, Oswald, P, Pallanti, S, Pehlivanidis, A, Ramos-Quiroga, J, Rastam, M, Ryffel-Rawak, D, Stes, S, Asherton, P (2010). European consensus statement on diagnosis and treatment of adult ADHD: the European Network Adult ADHD. BMC Psychiatry 10, 67.Google Scholar
Liebson, CL, Long, KH (2003). Economic implications of attention-deficit hyperactivity disorder for healthcare systems. Pharmacoeconomics 21, 1239–1262.Google Scholar
McCarthy, S, Asherson, P, Coghill, D, Hollis, C, Murray, M, Potts, L, Sayal, K, de Soysa, R, Taylor, E, Williams, T, Wong, ICK (2009). Attention-deficit hyperactivity disorder: treatment discontinuation in adolescents and young adults. The British Journal of Psychiatry 194, 273–277.Google Scholar
McGough, J, Smalley, S, McCracken, J, Yang, M S, Del’Homme, M, Lynn, E, Loo, S (2005). Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. The American Journal of Psychiatry 162, 1621–1627.Google Scholar
McNamara, N, McNicholas, F, Ford, T, Paul, M, Gavin, B, Coyne, I, Cullen, W, O’Connor, K, Ramperti, N, Dooley, B, Barry, S, Singh, S (2013). Transition from child and adolescent to Adult Mental Health Services in the Republic of Ireland: an investigation of process and operational practice. Early Intervention in Psychiatry 1, 291–297.Google Scholar
Medicines Information. Online – strattera indications (http://www.medicines.ie/medicine/11666/SPC/Strattera/). Accessed 12 September 2015.Google Scholar
Morris, T (2012). How do current guidelines measure up in managing ADHD? ADHD Educational Institute, Shire (http://www.adhd-institute.com/disease-management/guidelines/). Accessed 1 April 2013.Google Scholar
Munoz-Solomando, A, Townley, M, Williams, R (2010). Improving transitions for young people who move from Child and Adolescent Mental Health Services to mental health services for adults: lessons from research and young people’s and practitioners’ experiences. Current Opinion in Psychiatry 23, 311–317.CrossRefGoogle Scholar
Murphy, K, Barkley, RA (1996). Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Comprehensive Psychiatry 37, 393–401.Google Scholar
Murphy, KR, Barkley, RA, Bush, T (2002). Young adults with attention-deficit hyperactivity disorder: subtype differences in comorbidity, education and clinical history. Journal of Nervous and Mental Disease 190, 147–157.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2008). Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults. Clinical Guideline 72. NICE: London.Google Scholar
Nutt, DJ, Fone, K, Asherson, P, Bramble, D, Hill, P, Matthews, K, Morris, KA, Santosh, P, Sonuga-Barke, E, Taylor, E, Weiss, M, Young, S (2007). Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 21, 10–41.Google Scholar
Rowland, AS, Lesesne, C, Abramowitz, A (2002). The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view. Mental Retardation and Developmental Disabilities Research Reviews. 8, 162–170.Google Scholar
Shekim, WO, Asarnow, RF, Hess, E, Zaucha, K, Wheeler, N (1990). A clinical and demographic profile of a sample of adults with attention deficit hyperactivity disorder, residual state. Comprehensive Psychiatry 31, 416–425.Google Scholar
South London and Maudsley Adult ADHD Service. (https//:www.national.slam.nhs.uk/services/adult-services/adultadhd/). Accessed 10 September 2014.Google Scholar
St. Patrick’s Mental Health Services (2014). Up to 120,000 adults in Ireland with undiagnosed ADHD say experts at The Dean Clinics (http//:www.stpatricks.ie/blog/120000-adults-ireland-undiagnosed-adhd-say-experts-dean-clinics). Accessed 8 August 2014.Google Scholar
Stockl, KM, Hughes, TE, Jarrar, MA, Secnik, K, Perwien, AR (2003). Physician perceptions of the use of medications for attention deficit hyperactivity disorder. Journal of Managed Care Pharmacy 9, 416–423.Google Scholar
Syed, H, Masaud, TM, Nkire, N, Iro, C, Garland, MR (2010). Estimating the prevalence of adult ADHD in the psychiatric clinic: a cross-sectional study using the adult ADHD self-report scale (ASRS). Irish Journal of Psychological Medicine 27, 195–197.Google Scholar
Turner, T (2010). The general adult psychiatrist and ADHD. ADHD in Practice 2, 18–21.Google Scholar
Ward, MF, Wender, PH, Reimherr, FW (1993). The Wender-Utah Rating Scale: an aid in the retrospective diagnosis of childhood ADHD. The American Journal of Psychiatry 150, 885–890.Google Scholar
Young, S, Murphy, C, Coghill, D (2011). Avoiding the ‘twilight zone’: recommendations for the transition of services from adolescence to adulthood for young people with ADHD. BMC Psychiatry 11, 174.Google Scholar