The Transition from adolescence to adulthood mental health services for young people with ADHD in Italy

Aims Ensuring a successful transition to Adult Mental Health Services (AMHS) is fundamental for ADHD patients to prevent adverse scenarios in adults (e.g., psychiatric disorders, substance or alcohol abuse). Yet, most European nations do not have appropriate transition guidelines. This study aims to enquire about the current transition paths in Italy and the perceived experiences of the patients and their clinicians. Methods The present qualitative, observational study collected 36 interviews with young adults with ADHD who turned 18 between 2017 and 2021. Simultaneously, two questionnaires were filled in by the clinicians (both from pediatric and adult mental health services) who were involved in their transition paths. These tools collected information about the transition process, the services that cared for the young adults, and well-being indicators such as impairment in daily life, employment status, and the presence of sentinel events (e.g., critical stage accesses to the emergency room or hospitalizations). Successful and failed referrals were analyzed. Results A referral to an AMHS was attempted for sixteen young adults (8 before age 18 and 8 when turning 18), and 8 patients (22.2% overall) were successfully taken into the care of the AMHS. Twenty patients were not referred since it was deemed unnecessary ( N =6) or because of the lack of specialized services or compliance ( N =14). At the time of the interview, only nine participants were still under AMHS care. Of eleven individuals with a high need for care (identified by the level of impairment, support needs, or sentinel events), five were not followed by a mental health professional at the time of the interview. Conclusions For the majority of ADHD young adults, a transition path was never started or completed. While this is partly due to mild levels of impairment, in many cases it was difficult to find a service that could care for the adult patient. Only 1 out of 4 young adults are successfully transferred to AMHS care. Creating or improving evidence-based transition guidelines should be a priority of the public health system to ensure healthcare for as many patients as possible. The results of this study will converge towards the need for recommendations for the transition of services from adolescence to adulthood for young people with ADHD for Italian clinical practice. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research is part of the project "Transition care between adolescent and adult services for young people with chronic health needs in Italy", funded by the Italian Ministry of Health (RF-2019-12371228). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study is part of a wider project ("Transition care between adolescent and adult services for young people with chronic health needs in Italy", RF-2019-12371228) that was approved by the IRCCS "Carlo Besta" Ethics Committee (ethics committee of reference for the Mario Negri IRCCS Institute) (8 September 2021, protocol n. 87). The present study as part 2 of the project was approved by the IRCCS "Carlo Besta" Ethics Committee (9 November 2022, protocol n. 09) and notified to all the involved centers' Ethics Committees. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data presented in this study are available on the Zenodo platform (). The materials used (structured interview and questionnaires) are available online as supplementary material. * ADHD : Attention Deficit/Hyperactivity Disorder CAMHS : Child and Adolescent Mental Health Services AMHS : Adult Mental Health Services GP : general practitioner NICE : National Institute for Clinical Health and Excellence TransiDEA : Transition in Diabetes, Epilepsy, and ADHD patients.