gms | German Medical Science

Background: ADHD is a disorder that appears in childhood and adolescence. But there is little information on the persistence of the symptoms after age 18 and on the care of patients in transition from adolescence to adulthood. A 2007 GEK study provides some initial findings about the care expectations of parents. The study’s subjects all had a child between the ages of 6 and 18 years of age in 2006 and taking at least one stimulant ADHD prescription [1]. Some 40% of the subjects believed that their child would continue to need medical treatment for ADHD after 18. A much smaller percentage thought that behavioural therapy or other forms of psychotherapy would be needed.

In the following study, adolescents with ADHD are asked to express their own views. This study uses a questionnaire to gather information about treatments for adolescents, their current condition, and the presence of typical ADHD symptoms. Also of interest is whether adolescents speak about assistance and the continuation of medical treatment for ADHD after the age of 18, and whether those who reported of psychological strains seek therapeutic help.

Materials and Methods: A written questionnaire was sent to 3,727 BARMER-GEK insurees (3,075 men, 652 women), for the most part between the ages of 18 and 21, who had at least two verified ADHD diagnoses before the age of 18 as recorded by medication claims data. The identification of adolescent population and the sending of the questionnaires were performed by the BARMER-GEK in May of 2012. A pre-test review resulted in a written 15-question survey that covered three topic areas (treatment before the age of 18, current problems and treatment, treatment during the transition from adolescence to adulthood) and that additionally solicited socio-demographic data. The questionnaire consists of tick boxes and free text fields. The returned questionnaires were assessed using descriptive statistics. Regression analysis was used to estimate the relationships among the responses.

Results: 623 surveys were returned (response rate: 17%). 19% of the respondents were young women; 81% were young men. The ratio of 4 men to 1 women corresponds to the sex ratio of the population who received the questionnaire and to the ratio of boys and girls with ADHD presented in epidemiological studies.

Most respondents were being treated with medication, and of them 94% received methylphenidate and/or atomoxetine. Those who were diagnosed with ADHD before the age of 11 had a significantly higher likelihood of being treated with an ADHD stimulant. A little over half of the respondents (57%) reported receiving medication for more than three years. Between just under 30% and 50% indicated that the medication helped them adjust better in school (37%), perform better in class (48%), or feel considerably better (27%). A roughly equal number reported undesired effects (sleep disorders, decreased appetite).

Asked about their current situation, 37% described strong to very strong problems typical of ADHD. 28% agreed with the statement that ADHD currently remains significant in their lives. Around 50% continued to receive medication after the age of 18. Some indicated difficulty getting an appointment with a therapist. About half of those who reported still having strong symptoms were not receiving treatment for ADHD.

Conclusion: The survey shows that a considerable percentage of ADHD patients have symptoms in young adulthood and require further treatment. The transition from care in adolescence to care in adulthood must be prepared in a targeted and timely fashion. An important preliminary measure is the establishment of consultation hours for young adults and staffed by experts in child, adolescent, and adult psychiatry. Generally, primary care doctors must be sensitised for the problem of persistent ADHD in young adulthood.