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AHDS Therapy Difficult transition to adult medicine
Attention Deficit / Hyperactivity Disorder (ADHD) is an extremely common diagnosis in children and adolescents. However, the disease does not stop abruptly with the transition into adulthood. However, the therapy often stops when one reaches the age of majority and those affected feel - rightly - neglected by the medicine.
In ADHD patients, the onset of adulthood often shows a break in medical treatment, even if the disorder - with its risks - persists, researchers at Carl von Ossietzky University Oldenburg warn against the results of their current investigation. Together with colleagues from the University of Marburg, they have carried out an evaluation of health insurance data in order to examine the therapeutic care of ADHD patients at different ages. The results were published in the "Deutsches Ärzteblatt".
Patients with attention-deficit hyperactivity disorder (ADHD) often suffer from a lack of continuity of care as they transition into adulthood. (Image: L.Klauser / fotolia.com) Data from 24 million insured evaluated
The Oldenburg health care researcher Professor dr. Falk Hoffmann, the Oldenburg psychiatrist Prof. Dr. med. Alexandra Philipsen and the Marburg child and adolescent psychiatrist Prof. Dr. med. Dr. Christian Bachmann analyzed the data of around 24 million AOK insured persons from 2008 to 2014 for their study. The scientists deliberately looked at specific age groups. For example, the data of a group of 4,340 boys and 1,253 girls were evaluated at the beginning of the record at the age of 15 and accompanied over a six-year period.
Adult ADHD patients are not adequately cared for
At the age of 21 years, the diagnosis was sustained by only 31.2 percent of young people, although a persistent disorder of about 50 percent would be expected, the researchers explain. According to Prof. Philipsen, the view that ADHD grows out of adolescence is outdated today. "Half of ADHD patients still show symptoms in adulthood, as we know from other studies," explains the expert. The drug treatment has decreased even more in the same period While still 51.8 percent of 15-year-old patients receiving drugs for ADHD, it was in the 21-year-olds only 6.6 percent of the original group, the researchers continue.
Risks in untreated ADHD
If ADHD is not treated, this implies, according to the physicians, various risks such as a higher risk of depression or personality disorders. Also threatened sufferers often a poorer school leaving or job loss and a higher risk of accidents and mortality. Therefore, if the child or adolescent psychiatrist or pediatrician falls short of the age of 18 at the age of 21, a good transition to adult medical care is even more important, the researchers emphasize.
Lack of continuity in care
According to the experts, the lack of continuity in medical care has a negative impact on the health, well-being and professional potential of those affected. It is possible that some of the young people are falling through the grid when they change their place of residence due to the start of their studies or training, says Prof. Hoffmann. This phenomenon is also observed in chronic physical diseases. Adolescents do not always arrive in adult medicine because, for example, they do not have a doctor on the spot after moving, and only reappear when their symptoms get worse.
Declining medication in adolescents
However, according to their own statements, the study authors also noted some positive developments. For example, they rated it as a gratifying result that the trend of prescriptions of ADHD drugs in children and adolescents, which has continued to rise for years, has apparently stopped. While almost 52 percent of 13- to 14-year-old ADHD patients were prescribed medication in 2009, according to the 2014 analysis, it was still around 43 percent. The cause of this remains unclear. "Whether this trend is due to a greater use of psychotherapeutic treatment options - such as behavioral therapy or parent training - can not be deduced from the study data, according to the University of Oldenburg.
Extremely high frequency of diagnosis
The persistently high frequency of diagnoses among children and adolescents, which landed among the nine-year-old boys in 2014 at a rate of 13.9 percent, is also striking. According to this, every seventh boy at the age suffers from ADHD. This is probably an expression of "overdiagnosis," the authors report. The researchers assume that the reason for this lies more in other areas. These could be, for example, the "school adaptation processes"; because at the age of the decision on the secondary school is pending.
Rising medication rate in adults
According to the researchers, the frequency of diagnosis has increased in all age groups. This also applies to the adults. While the incidence of AOK insured persons aged 69 and under stood at 1.17 percent in 2009, they already reached 1.51 percent in 2014. A good two-thirds of ADHD patients are male. And while the frequency of drug treatment for ADHD patients in childhood and adolescence has decreased, it has increased among adults, the researchers write. The higher frequency of diagnosis and the rate of medication in adults led the experts to an increased awareness of the persistence of ADHD in adults and to an improved care situation.
Furthermore, many unrecognized cases
However, despite the growing frequency of diagnoses in adults, scientists continue to expect many unrecognized ADHD cases in adulthood. Although the diagnostic frequency among 18- to 69-year-olds increased from 0.22 percent in 2009 to 0.4 percent in 2014. But in fact, at least one percent of adults should have ADHD - "and that would still be cautiously esteemed," says Prof. Philipsen. The authors of the study advocated the expansion of ADHD adult outpatient clinics to improve the transition of young ADHD patients into adult care in the future. Today, given the lack of facilities with months of waiting time to expect an appointment here. (Fp)