ADHD Remote Technology and ADHD transition: predicting and preventing negative outcomes (ART-transition)

Late adolescence is a highly challenging and potentially critical period for young people with attention deficit hyperactivity disorder (ADHD) that can lay the foundations for diverging adulthood trajectories. Many of the conditions that frequently co-occur with ADHD, such as depression, delinquency and substance misuse, often first emerge in adolescence. Major life transitions at this age, such as leaving education, starting work or moving out of the parental home, lead to multiple new demands and changes in available support networks, further increasing the vulnerability of young people with ADHD. This vulnerable phase coincides with the transition from child and adolescent mental health care to adult ADHD services, which itself is a focus of major current clinical concern: new UK data show that most youth with ADHD do not successfully transfer to adult services, despite significant needs for ongoing treatment. Therefore, many young people with ADHD do not receive appropriate interventions at a time when they may need them most. Opportunities for intervention are currently not fully realised due to both the young people's disengagement from clinical services and our limited understanding of real-world targets for more holistic interventions. We propose a research programme that directly addresses these needs and matches recently highlighted research priorities: (1) a 2022 review of recommendations for ADHD transition highlights the lack of longitudinal tracking studies through transition and the need for modern tools such as smartphone apps, as part of ADHD mental health care; (2) a 2022 publication from the longitudinal Multimodal Treatment study of ADHD (MTA) suggests ADHD is typically a 'chronic but waxing and waning disorder', where environmental factors likely influence when the biological vulnerability leads to clinically significant symptoms and impairment. The MTA study highlights environmental factors and health behaviours that can trigger fluctuations in symptoms and impairment as a key research priority.

Remote measurement technology (RMT) offers the potential to: a) obtain ongoing, long-term, real-world data at a level of detail that was previously impossible; b) identify real-world targets for intervention that include environmental factors and health behaviours; and c) transform monitoring, self-management, personalised treatment and engagement with clinical services during ADHD transition. Our team is in a unique position to drive these advances, using RMT we have developed specifically for ADHD (ages 16+): the ADHD Remote Technology system. We will address three core questions on the transition to adulthood for individuals with ADHD: what changes take place, what predicts them, and how can we prevent negative outcomes and support healthy lifestyles? We will remotely monitor 250 young people with ADHD over a two-year continuous assessment period, using both active and passive monitoring. The active monitoring involves the participant completing questionnaires and a speech task on a purpose-built smartphone Active App and completing cognitive tasks on a home computer. The passive monitoring involves data collection using a wearable device and a purpose-built smartphone Passive App (e.g. on physical activity, sleep, social interaction, relative location, digital usage). We then co-design, with young people with ADHD, a prototype for a new ADHD-transition smartphone app. It aims to prevent negative outcomes and support healthy lifestyles, by facilitating self-management, personalisation of treatment and engagement with adult services. App components may include personalised feedback, personalised educational components, prompts, alerts and data sharing with clinicians. Our approach focuses on giving young people with ADHD greater autonomy in how they manage their ADHD, in collaboration with their clinician, and places the emphasis on modifiable environmental factors and the prevention of negative outcomes.

Late adolescence is a highly challenging and potentially critical period for young people with attention deficit hyperactivity disorder (ADHD) that can lay the foundations for diverging adulthood trajectories. Yet most young people with ADHD do not receive appropriate interventions during this vulnerable period due to both their disengagement from clinical services during the transition to adult ADHD services and our limited understanding of real-world targets for more holistic interventions. Remote measurement technology offers the potential to: a) obtain ongoing, long-term, real-world data at a level of detail that was previously impossible; b) identify real-world targets for intervention that include modifiable environmental factors and health behaviours; and c) transform monitoring, self-management, personalised treatment and engagement with clinical services during ADHD transition. Using our new ADHD Remote Technology (ART) system, which incorporates a wearable device and purpose-built smartphone Active and Passive Apps, we will remotely monitor 250 transition-age young people with ADHD continuously for 24 months. We address three main aims: Aim (1) To identify, with precision, the nature and timing of the real-world changes that take place in the transition to adulthood. We measure changes in ADHD and co-occurring psychiatric symptoms; treatment adherence and engagement with clinical services; healthy lifestyle behaviours (physical activity, sleep, daily structure, online lifestyle), social support and employment/studies; and objective markers (digital signals and cognition). Aim (2) To identify what predicts such changes. Aim (3) To co-design, with young people with ADHD, clinicians and engineers, a prototype for a new ADHD-transition interactive smartphone app. It aims to prevent negative outcomes and support healthy lifestyles, by facilitating self-management, personalisation of treatment and engagement with adult services.