Setting

This audit can take place in child and adolescent psychiatry for patients diagnosed with attention-deficit hyperactivity disorder (ADHD) where the guideline from the National Institute for Health and Clinical Excellence (NICE) (2008) recommends transition planning.

Background

Over recent years, ADHD has been re-conceptualised as a chronic disorder (Willoughby, 2003; Faraone et al, 2006). Using DSM–IV criteria for the definition of ADHD, the rate of persistence is about 15% at age 25. Using an alternative definition of impairing symptoms of ADHD that do not meet the full criteria of ADHD (partial remission) the persistence rate is 40–60% (National Institute for Health and Clinical Excellence, 2008). Young people who have had their ADHD managed by a child and adolescent mental health service (CAMHS) are likely to require ongoing treatment for ADHD from adult mental health services. This transition of care requires planning.

Standards

The following points of the NICE guideline on ADHD were audited:

ᐅ Patients with ADHD should be reassessed at school-leaving age to establish the need for continuing treatment.

ᐅ During the transition to adult services, a formal meeting involving CAMHS and/or paediatrics and adult psychiatric services should be considered.

ᐅ The young person and, when appropriate, the parent or carer should be involved in the planning and full information should be provided to the young person about adult services.

Method

Data collection

All patients of school-leaving age (i.e. in year 11 or more at UK secondary school) who had ADHD were identified. This stage was reliant on the department having some system of recording patients by diagnosis. The audit can either look only at cases still open, or can also include patients who are in the same age cohort and who have ADHD but have been discharged. This makes the audit more useful in terms of identifying unmet needs. Notes were reviewed to find evidence of transition planning documented either in letters or minutes of meetings or in written records to establish the following:

ᐅ the transition to adult services or the need for ongoing management from age 18 had been discussed with the parent(s)

ᐅ the transition to adult services or the need for ongoing management from age 18 had been discussed with the young person

ᐅ if transition was thought to be necessary, a transition planning meeting had been arranged

ᐅ the transition process had been started by contacting adult services.