Delphi consensus on the transition from pediatric to adult care in Italian ADHD youth

Abstract

This study aimed to develop consensus-based recommendations for improving the transition of care for young adults with Attention-deficit/hyperactivity disorder (ADHD) from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) in Italy. A modified Delphi consensus method was employed, involving 27 stakeholders, including child psychiatrists, psychiatrists, psychologists, primary care physicians, young adults with ADHD, and parents. Recommendations were drafted by combining data from prior phases of the Transition in young adults with Diabetes, Epilepsy, and ADHD (TransiDEA) project and international guidelines (e.g., NICE, Ready Steady Go). Stakeholders evaluated 33 proposed recommendations across two rounds, rating their relevance and feasibility. Consensus was defined as ≥ 75% agreement per item. Consensus was achieved on 22 recommendations organized into four categories: planning (14 items), passage (4 items), monitoring (1 item), and services (3 items). Key recommendations included starting transition planning at age 16, involving families and interdepartmental teams, implementing practical tools for information exchange, and monitoring young adults outcomes post-transition. Training for clinicians and service self-assessment were emphasized to address systemic barriers. The final shared recommendations integrate multiple perspectives and international best practices and provide a structured, adaptable framework for improving ADHD care transitions in Italy. Future efforts should evaluate their implementation and expand the methodology to other neurodevelopmental conditions.

Keywords: ADHD; Delphi consensus; Shared recommendations; Transition care.