The transition age
Late adolescence is a period rife with changes and transitions, such as leaving education, starting work, and/or moving out of the childhood home. When you are a young person with ADHD, the challenges that these transitions present can be heightened.
In addition to experiencing the major life changes that come with progressing to adulthood, most young people in the UK with ADHD do not successfully transition from child and adolescent mental health care to adult ADHD services. Adolescence is also the period during which many conditions that often co-occur with ADHD start to appear and a critical developmental phase for determining future outcomes. It is clear that this transition period is an important time for young people with ADHD. What requires more clarity is how we can best support young people during this time.
ADHD over time
Traditionally, it was thought that children with ADHD either grow out of the condition by adulthood or that they have a stable, persisting condition. However, such estimates were typically based on very limited time points. A recent study in the US by Sibley and colleagues suggests that taking a longitudinal approach to studying ADHD reveals variable long-term ADHD trajectories. The majority of participants in the study showed fluctuating ADHD symptoms over a follow-up period after initial assessments, suggesting that ADHD symptoms and impairment change over time more than initially thought, likely related to environmental factors and health behaviours.
The question is, what is the relationship between environmental factors, health behaviours and ADHD symptoms? Or perhaps the first question we should be asking is: what are the factors that impact ADHD symptoms? There is increasing scientific evidence that exercise can be beneficial for managing ADHD symptoms, although more research is needed. ADHD medication, the first-line treatment for the condition, tends to have good tolerability and improve ADHD in the majority of cases. However, UK primary care data suggests that only 18% of young people prescribed ADHD medication in their early teens continue to receive prescription post-18. In addition, many individuals who do receive prescriptions do not take their medication regularly. If we want to support young people in symptom management, we need to better understand the reasons for irregular and discontinued medication use, as well as the impact of lifestyle factors such as exercise on ADHD symptoms in the long-term.
Closing the gap
I work as part of a team within the Social, Genetic & Developmental Psychiatry (SGDP) Centre at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) that researches the transition to adulthood in young people with ADHD using remote measurement technology (RMT). RMT is an exciting new approach to the study of health conditions, allowing for continuous data collection on a wide range of health and lifestyle factors using wearable technology such as smartphones and smartwatches. The research programme will address three core questions on the transition to adulthood for individuals with ADHD: (1) What changes take place?; (2) What predicts these changes?; and (3) How can we prevent negative outcomes and support healthy lifestyles?
To answer these questions, the study uses RMT to remotely monitor young people over a two-year continuous assessment period. Rather than being asked to come into a lab to complete various surveys or tasks, we use an app to send these to participants at regular intervals. We also collect some data passively, meaning the participant does not have to do anything for it to be collected. This includes activity and sleep data from a Fitbit and some details of phone usage. The study is observational, presenting no changes to the participants’ lives other than using a Fitbit and two new apps on their phones. At the end of the study period, the team will work with young people with ADHD to co-design a prototype for an app to support young people through the transition period. This app will be designed to prevent negative outcomes and support healthy lifestyles by facilitating self-management, personalisation of treatment and engagement with adult services.
If you are UK-based, aged 16-17, diagnosed with ADHD and interested in contributing to this important ADHD research on the transition to adulthood (or know someone who is), we are recruiting now! To learn more, get in contact with the team at art-transition@kcl.ac.uk or check out our website.