Over the past few years, researchers at the Center for Injury Research and Prevention (CIRP) at Children’s Hospital of Philadelphia (CHOP) have been using the New Jersey Safety and Health Outcomes (NJ-SHO) Data Warehouse in collaboration with the Center for Management of ADHD at CHOP to establish the scientific foundation for safe mobility among teens with attention-deficit hyperactivity disorder (ADHD) and other neuro-diverse conditions. As part of this effort, we recently published research in the Journal of Developmental and Behavioral Pediatrics that, for the first time, characterizes the management and monitoring of ADHD during late adolescence by primary care providers.
ADHD is a chronic condition affecting an estimated 1 in 10 teens. While 30 to 60 percent of teens with ADHD no longer meet the diagnostic criteria for the condition, those with a history of ADHD are at an increased risk for adverse outcomes, including motor vehicle crashes and unsafe driving citations. In fact, previous research found a 37 percent increased rate of crashes among teens with ADHD over the first four years after getting licensed and a 62 percent increased rate of crashing the first month after licensure. This data shows a continued need to clinically monitor these adolescents as they develop through young adulthood.
To examine changes in ADHD care during the transition from childhood to adolescence, we conducted a retrospective, longitudinal study of patients diagnosed with ADHD before age 10 to assess changes from preadolescence through adolescence in:
- frequency by which primary care providers offer ADHD care to patients
- range of concerns assessed during patient encounters
- treatments implemented or recommended
After identifying 262 patients from three practices of the CHOP Healthcare Network, clinical care was compared among preadolescence (age 9-11), early adolescence (age 12-14), and late adolescence (age 15-18). Specifically, we selected participants who were born in 1996-1997 because these patients entered late adolescence by 2012 when the American Academy of Pediatrics (AAP) updated its guidelines for the evaluation and treatment of ADHD.
Findings Raise Concerns About ADHD Management
Our findings raise concerns about how primary care providers manage adolescents with a history of ADHD, based on evidence about patients documented in the electronic medical record:
- 90 percent of adolescents received monitoring for depression, suicide, and substance abuse during their primary care visits.
- Less than half of adolescents (47 percent) were monitored for risky sexual activity during their primary care visits.
- Only two adolescents had driver readiness discussed during their primary care visits.
In order to address this missed opportunity, primary care providers need to receive effective training and resources to ensure that these conversations occur. Future research should explore the knowledge and needs of healthcare providers in order to promote successful communication during the transition to adolescence and adulthood.
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