Impairments generally persist when children diagnosed with attention-deficit/hyperactivity disorder (ADHD
) mature into adolescence
. To examine changes in ADHD
care during the transition from childhood to adolescence
, we conducted a retrospective, longitudinal cohort study of patients diagnosed with ADHD
before the age of 10 years to assess changes from preadolescence through adolescence
in (1) frequency by which primary care
providers offer ADHD
care to patients, (2) range of concerns assessed during patient encounters, and (3) treatments implemented or recommended.
We identified patients from 3 practices included in a large primary care
network who (1) were born between 1996 and 1997, (2) were diagnosed with ADHD
before the age of 10 years, and (3) received primary care
continuously from age 9 through late adolescence
. Clinical care was compared among patients in preadolescence (age 9–11), early adolescence
(age 12–14), and late adolescence
Children diagnosed with ADHD
before the age of 10 years were less likely to have a documented visit for ADHD
during late adolescence
(41% of patients) compared with preadolescence (63%, p
< 0.001). Evidence of monitoring for depression, suicide, and substance abuse increased from preadolescence to adolescence
< 0.001) and occurred in about 90% of adolescent patients. However, monitoring for risky sexual activity occurred in only about 50% of adolescents. Discussions of medication diversion and driver readiness were essentially not documented.
The findings raise concerns about how primary care
providers manage adolescents with a history of ADHD
. Improving monitoring of risky sexual behavior and driver readiness and providing patient education about medication diversion are needed.