title: Clinical service use as people with Attention Deficit Hyperactivity Disorder transition into adolescence and adulthood: a prospective longitudinal study.
abstract: While Attention Deficit Hyperactivity Disorder (ADHD) often persists into adulthood, little is known about the needs and service use among adolescents and young adults with ADHD. The present study followed-up a cohort diagnosed with ADHD as children and assessed their: 1) needs, 2) correlates of contact with clinical services, and 3) experiences of transition from child to adult health services.
  
  
  
  Ninety one young people aged 14-24 were recruited from the UK subset of the International Multi-Centre ADHD Genetics (IMAGE) Project. Affected young people and parents conducted face-to-face interviews and self-completion questionnaires including a modified version of the Client Services Receipt Inventory, The Barkley's ADHD rating scale, The Clinical Interview Schedule-Revised, and the Zarit Burden Interview. Changes in key need characteristics (e.g. ADHD symptoms and impairments) over a 3-year period were examined using fixed effect models. Generalised Estimating Equations (GEE) were used to explore how key characteristics (such as ADHD symptoms) were associated with contact with clinical services across the three years.
  
  
  
  At baseline 62 % met diagnostic criteria for ADHD and presented with a range of ADHD related impairments, psychiatric comorbidities, and significant caregiver burden. While ADHD symptoms and related impairments lessened significantly over the three years, psychiatric comorbidities and caregiver burden remained stable. The strongest correlate of contact with clinical services was age (OR 0.65 95 % CI 0.49-0.84) with the odds of reported contact with clinical services decreasing by 35 % for each year increase in age at baseline and by 25 % for each year increase in age over time. Only 9 % of the sample had experienced a transfer to adult services, with the majority reporting unmet needs in healthcare transition.
  
  
  
  Despite continuing needs, few were in contact with adult health services or had received sufficient help with transition between child and adult health services. The main determinant of health service use for adolescents and young adults with ADHD is age - not needs. Service models should address the needs of ADHD individuals who are no longer children.
authors.affiliation: Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. hanna.eklund@kcl.ac.uk.
authors.forename: Hanna
authors.identifier: 0000-0001-5938-5281
authors.initials: H
authors.lastname: Eklund
authors.affiliation: Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Cadman
authors.affiliation: Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
authors.forename: James
authors.initials: J
authors.lastname: Findon
authors.affiliation: Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Hayward
authors.affiliation: Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Howley
authors.affiliation: Personal Social Services Research Unit, Cowdray House, London School of Economics and Political Sciences, Houghton Street, London, WC2A 2AE, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beecham
authors.affiliation: Behavioural Genetics Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
authors.forename: Kiriakos
authors.initials: K
authors.lastname: Xenitidis
authors.affiliation: Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Declan
authors.initials: D
authors.lastname: Murphy
authors.affiliation: MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Asherson
authors.affiliation: Institute of Gerontology, Department of Social Sciences, Health and Medicine, King's College London, Strand, London, WC2R 2LS, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Glaser
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy; D017028:Caregivers; D015897:Comorbidity; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D010290:Parents; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care; D006113:United Kingdom; D055815:Young Adult
keywords: Adolescence; Attention deficit hyperactivity disorder; Clinical service use; Transition; Young adulthood