Continuity in ADHD care

By Joel Young, MD & Benjamin Young, MD, Wayne State University 

Jake was diagnosed with ADHD when he was in third grade after exhibiting telltale symptoms—he had trouble waiting his turn in class, couldn’t stop fidgeting, and struggled to finish tasks. His pediatrician, who was familiar with diagnosing ADHD in young boys, prescribed Jake a stimulant and recommended academic accommodations for the duration of his schooling. When Jake moved away for college, he and his parents assumed that aging out of the pediatrician’s office also meant aging out of his ADHD diagnosis. With no apparent health issues, Jake didn’t seek out a new primary care provider.

During his first year at university, Jake began struggling with time management and missing classes, and he increasingly relied on cannabis and alcohol to cope with the mounting stress. His behavior seemed “normal” to his peers, but by the time he returned home that summer, he had failed two courses and was on academic probation.

Contrary to misconceptions that children will “grow out of” ADHD, the condition often persists into adulthood. While hyperactivity tends to be more prevalent in children, inattentive symptoms are common in adults. Moreover, the proportion of women diagnosed becomes more balanced with men, as ADHD symptoms are more likely to be recognized in women at older ages.

Life transitions, like going away for college, can cause different symptoms to emerge and existing symptoms to worsen. The abrupt loss of parental support, lack of structure, and social and academic pressures can be difficult for students with ADHD. This population is particularly at risk of developing mental health disorders. Students with ADHD are more likely to experience depression, substance abuse disorders, risky behavior, learning and physical disabilities, insomnia, and suicidal behavior.

Although 6% of college students in the U.S. have ADHD, continuity of care across this major life transition is often overlooked. When adolescents move from pediatric to adult psychiatric care, many wind up falling through the cracks; this is the most common time patients are lost to follow-up. A lapse in care can be detrimental to a patients’ progress and leave them more vulnerable to negative outcomes. Preparation is the best safeguard to ensure patients continue to receive the care they need.

To ensure success during the transition of care, you can talk with patients and families about the following:

1. Identify a new medical provider before moving.

College health services may not prescribe stimulants. It’s preferable to maintain a relationship with a prescriber close to the student’s home to make sure prescriptions continue and can be adjusted if needed. Telepsychiatry visits with a familiar prescriber can facilitate the transition.

2. Make a plan for obtaining prescriptions.

If moving to a new area, find the local pharmacy and develop a plan for medication delivery.

3. Establish time management and project management habits.

Strategies might include using smart phone notifications, sticky notes, and breaking up long-term projects into smaller, earlier deadlines. ADHD coaches can be helpful in establishing these techniques.

4. Find academic support services.

Find out how to request academic accommodations and identify academic resources. Students might consider tutoring or disability services.

ADHD is a lifelong condition that requires consistent management. Like other chronic childhood illnesses—such as diabetes, asthma, and sickle cell disease—the shift from pediatric to adult care is a critical juncture. Effective transition involves education, medication, and therapy to help patients and families understand their challenges and prepare for longterm success.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.