ADHD in the lifespan - how transition can succeed

In the meantime, the common assumption that attention-deficit/hyperactivity disorder (ADHD) develops during adolescence has been refuted on the basis of numerous scientific publications. However, the symptoms so typical of children change, which means that many complaints are then no longer recognized. How can the transition to adulthood still succeed?

In childhood and adolescence, the prevalence of attention-deficit/hyperactivity disorder (ADHD) is between 3 and 5%; in adults, 1-4% are thought to be affected. Accordingly, the persistence of the developmental disorder is about 80%. Yet many adults with ADHD are underdiagnosed and undertreated. This is due in part to the fact that many patients are “lost” in the transition from adolescent to adult. The reasons for this are complex. Thus, a certain therapy fatigue often sets in among the young people, not least because of their changed role in society. The willingness for regular therapy and medication decreases and also the influence and interest of the parents diminishes. In the UK, it was revealed that hardly any ADHD patients were still receiving specific medication at the age of 21.

But there is another problem: the symptom triad of attention deficit disorder, hyperactivity and impulsivity is changing. Attention deficit disorder does persist and remains in approximately 80% of those affected. However, this tends to manifest itself later in life in difficulties with work accuracy. Childhood motor hyperactivity transforms into inner restlessness and impulsivity decreases in 40% of patients. It is then often still recognizable when participating in road traffic. Moreover, additional symptoms such as disorganization and emotional dysregulation occur in adults. It is not uncommon for comorbidities such as addictive disorders, depression, or anxiety disorders to occur, which can mask the clinical picture of ADHD.

Good networking is the be-all and end-all

In everyday practice, the situation is such that the child and adolescent psychiatrist is only allowed to treat his patient up to the age of 18 . After that, the handover to the adult psychiatry colleague is scheduled. This is the point at which many sufferers no longer receive any support. The years of childhood trust must be broken by a new doctor – if patients present to an adult psychiatrist at all. Ideally, child and adolescent psychiatrists and their adult colleagues are well connected. In this way, relevant information can be exchanged and consultation can take place as needed. Also, the inhibition threshold would certainly decrease if there was the possibility of a handover meeting where all parties involved were sitting at the same table. In order to do justice to the particular complexity and the associated challenges of the disease, there should be a discussion about breaking down the rigid age limits. This is because, due to delayed brain maturation, neurobiological adulthood in ADHD sufferers does not begin until around the age of 25.

Caution also with medication changes

Special attention should also be paid to medication. Methylphenidate is considered the therapeutic gold standard, not only in children but also in adults, based on data and established evidence. But while numerous methylphenidate preparations are available for children, the situation is different for adults. Only a few formulations have full approval. Depending on the provider, it is therefore not possible to simply switch from the “children’s preparation” to the one for adults. If this is not addressed and discussed in a timely manner, therapy may be discontinued.