Managing Life Transitions in ADHD: Why Early Preparation is Critical

“We don't help our families and kids with ADHD prepare for transitions—and these transitions are difficult,” says Timothy Wilens, MD, Chief, Division of Child and Adolescent Psychiatry at Massachusetts General Hospital and Harvard Medical School.

Psych Congress Network sat down with Dr Wilens at the 2023 Psych Congress meeting in Nashville, Tennessee, to talk more about the key symptoms and challenges that people living with attention-deficit/hyperactivity disorder (ADHD) may encounter during the transition from childhood to adulthood. Dr Wilens explains what clinicians are currently doing right and how they can better support patients during periods of transition.

For more ADHD news and resources, visit our Pediatric ADHD and Adult ADHD topic centers here on Psych Congress Network.

For more information about the 2024 Psych Congress in Boston, MA, from October 29 through November 2, visit the meeting website.

Read the Transcript

Timothy Wilens, MD: Hi, my name is Dr. Tim Wilens. I'm chief of the Division of Child and Adolescent Psychiatry at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School, and I'm delighted to be interviewed today.

Psych Congress Network: How do the symptoms and challenges associated with ADHD affect the transition from childhood to adulthood? What are some key considerations that psychiatrists should keep in mind when managing ADHD during this transition?

Dr Wilens: One of the things we've learned is that transitions for kids with ADHD growing up can be very challenging. I always say that I think we're doing, as a field, a pretty good job identifying and treating ADHD. We do a nice job and I think practitioners should feel very happy about how much they've learned in the past two decades and the sophistication that a lot of them bring. That's the good news.

The problem side of it is we do everything right, and we don't help our families and kids prepare for transitions—and these transitions are difficult. These are kids who are losing structure, who are growing up and expected to do more, who probably are slightly developmentally behind neuromaturation, and have more and more on their plate simultaneously. In addition to that, many of these kids struggle with transitions. They just don't do transitions well. They have a rigidity and inflexibility, they're nervous, they get anxious, which then further exacerbates their capacity with transitions.

And what are some of these transitions? These transitions could be as simple as going from elementary school, which is a very structured smaller endeavor, single teacher with the kids you've grown up with for time to middle school, which is you're starting to rotate classes in a bigger school and with not as much oversight. Or it goes to high school where now you're dealing with even bigger schools, less oversight, more changes, more responsibility, and a lot more material being thrown at you simultaneously. Those challenges could be big.

 I think then the biggest challenge is when you're done with high school, these kids move on. They're moving on into the trades, they're moving on into working into other occupations. Some of them are going into the military, some of them are going to college. Each of these, you're largely leaving home. You're leaving the oversight of what you've been doing time and time again by usually your parents, and that's starting to evaporate, and these kids are to fend for themselves. They have to learn how to deal with the structure they create, not the structure somebody else creates. They have to learn how to manage a lot of material that's going to be thrown at them without a lot of direction on how to manage that. On top of that, they deal with the stuff that all of us deal with. I got to find a room, I got to figure out a way to pay for it. I got to make my insurance payment on my car. I want to date and go out. I don't want to drink too much, or they may want to drink too much. And all of these, they're also sort of juggling and navigating, and that can be very overwhelming for kids with ADHD.

I think it's very important that you start talking about transitions 2 to 3 years in advance. So, we start talking in middle school and high school about kids’ transition out of high school. Why is it important that you, if you're on medicines, you take your medicines every day? Why is it important that you try to get everything done during the day where, for example, if you're on stimulants, that's where the efficacy is going to be manifest? Can't wait until the end of the day to get things done. How do you not procrastinate? How do you start to see your academic career as a job where you go in, you do it during the day, you finish it at the end of the day, so when medicines wear off, you've accomplished what you've wanted for the day.

That's just one example. But I think these are issues that we haven't done a good enough job on. I think we have to see this, and the best approach is preventive medicine where we start working on this well in advance.

Timothy E. Wilens, MD, is the Chief of Child and Adolescent Psychiatry, and (Co) Director of the Center for Addiction Medicine at the Massachusetts General Hospital. He is a Professor of Psychiatry at Harvard Medical School. Dr. Wilens specializes in the diagnosis and treatment of ADHD, substance use disorders, and bipolar disorder. Widely published, Dr Wilens has more than 350 original articles, reviews, chapters, books and editorials to his credit. Dr. Wilens is a consultant to the National Football League, Major/Minor League Baseball, Bay Cove Human Services and Gavin Foundation and is consistently named one of the Best Doctors in Boston and in America for psychiatry.