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Review of international clinical guidelines for adolescents on transition to Adult Mental Health Services and adults with attention-deficit hyperactivity disorder and their application to an irish context

Published online by Cambridge University Press:  18 January 2016

G. C. Hughes ,
S. O’Hanrahan ,
G. Kavanagh  and
F. McNicholas
G. C. Hughes*
Affiliation:
Senior Registrar in Child & Adolescent Psychiatry, Beechpark Autism Service, Bryan S Ryan Building, Main Road, Tallaght, Dublin
S. O’Hanrahan
Affiliation:
Educational Psychologist in Training, Lucena Clinic, 59 Orwell Road, Rathgar, 6Dublin
G. Kavanagh
Affiliation:
Child & Adolescent Psychiatrist, Lucena Clinic, Wicklow Town, Co. Wicklow
F. McNicholas
Affiliation:
Professor of Child & Adolescent Psychiatry, Department of Child & Adolescent Psychiatry, Our Lady’s Children’s Hospital, Crumlin, 12Dublin Professor of Child & Adolescent Psychiatry, Lucena Clinic, 59 Orwell Road, Rathgar, 6Dublin & University College Dublin
*
*Address for correspondence: G. C. Hughes, Linn Dara CAMHS Inpatient Unit, Child & Adolescent Mental Health, Ballyowen Lane, Palmarstown, Dublin 20, Ireland. (Email: [email protected])
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Abstract

Objectives

To review the available clinical guidelines from Canada, North America, Europe and the United Kingdom for the diagnosis and management of attention-deficit hyperactivity disorder (ADHD) for adolescents previously diagnosed in Child and Adolescent Mental Health Services (CAMHS) on transition to Adult Mental Health Services (AMHS) and for adults presenting with a diagnostic query re-ADHD. This article seeks to apply the available guidelines to an Irish context.

Method

Various clinical guidelines and consensus statements were identified by a literature search of PubMed, incorporating literature from the past 10 years from English speaking countries and inclusion of any additional guidelines of clinical relevance. A clinical guideline with specific reference for Irish clinicians was proposed for the diagnosis and management of adults presenting for the first time with a diagnostic query re-ADHD and also to include those young adults previously diagnosed in CAMHS on transition to AMHS.

Conclusions

ADHD is a lifelong disorder, which if undiagnosed or untreated can lead to significant impairment resulting in a high economic cost for society. Stimulant medication is a first-line treatment option for adults with ADHD; however, some formulations are unlicensed in Ireland. Recent licensing of Atomoxetine, for both adolescents on transition and for adults with newly diagnosed ADHD is a welcome development. Third-line agents are rarely prescribed due to their side effect profiles and are prescribed off-label:

It is important to establish clinical guidelines for an Irish context incorporating a biopsychosocial approach. Further discussion amongst clinicians and stakeholders is needed to plan service development.

Keywords

ADHDadolescentadultconsensus statementguidelinestransition
Type
Review Article
Information
Irish Journal of Psychological Medicine , Volume 34 , Issue 1 , March 2017 , pp. 59 - 73
Copyright
© College of Psychiatrists of Ireland 2016 

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