Health care transition refers to the medical treatment and support during the process of switching from pediatric care to the adult care model. The goal of transition for young adults with special health care needs is to maximize their self-management skills, enabling individuals to seek out and utilize appropriate medical care by themselves.

To this end, pediatric patients need support in acquiring appropriate understanding of their medical condition, health management skills, and readiness adjusting to adult care models to ensure a smooth and uninterrupted transition of medical care to new physicians and other providers of care.

There are two major issues in health care transition support: patient autonomy and a functional medical framework. Promoting appropriate health care transition will be possible only when these two aspects become adequately operational. Autonomy (independence) support for pediatric patients refers to support in acquiring developmentally-appropriate health literacy to become an autonomous patient capable of decision-making regarding their own medical care, requiring support in accordance with the maturity of each patient. In addition, it is hoped support for autonomy (independence) in the health care setting will become available in coordination with other community initiatives for autonomy support.

This article discusses health care transition from the viewpoint of pursuing the patients' best interests, describing the knowledge and attitudes necessary for providing the best medical care to patients regardless of the type of disorder involved.

The transition of healthcare for adult patients with childhood-onset chronic diseases (APCCD) from pediatric to adult healthcare has become a topic of attention worldwide. Health care transition first addressed in the United States in the 1980s, was not an issue in Japan until the 1990s when the question was raised, although only in terms of whether the transition should take place under the direction of pediatric or adult medical care. The Japan Pediatric Society established a committee for the health care transition of APCCD in 2010, followed by a research committee convened by the Ministry of Health, Labour and Welfare focusing on issues related to social, educational, and medical support for APCCD. While the concept of health care transition has since spread over the last 10 years, it is hoped that transition for patients with child-onset psychiatric illness will come to be discussed with due consideration to impairment characteristics and the reality of care available in Japan.

Health care transition for youth with intellectual disabilities and developmental disorders was discussed through the role of medical care from school age to adulthood in dealing with issues surrounding attachment, the educational framework, and over-adaptation in ASD, with strong effects on adaptation in adulthood. Characteristic psychiatric symptoms are observed, and early transition to psychiatric care is considered desirable when such symptoms appear. However, few psychiatrists are familiar with the psychiatric symptoms and appropriate modes of dealing with intellectual disabilities and developmental disorders. The timing of transition is dependent upon the medical resources available in the region where the patient resides. Shared understanding of psychiatric symptoms among child psychiatrists, pediatricians, and psychiatrists through case studies and other such ways of collaboration are considered vital for smooth transition of care, which could also contribute to the circumventing onset of further mental disease.

The stage of transition into adulthood places all youth at risk for mental health and social adaptation issues due to drastic changes in their physical functioning and social roles. Thus, transition support for adolescents is necessary particularly for those in out-of-home placement, with minimal support from family and relatives and influence of past adverse experience such as poverty or child maltreatment. While high school education has become standard even for adolescents in out-of-home placement, advancement rates to college remain low at 12.4% and employment immediately after high school the norm for such adolescents—meaning an earlier and shorter period of transition compared to the contemporary average. And despite the higher needs for support, there exists a substantial blank in services available between the ages of 15 and 20, making development of extensive services covering this gap a matter of great urgency. The diverse support needs for such adolescents call for services provided through multi-disciplinary collaboration. In recent years, high school-based transition support programs have come to be regarded as an appropriate and advantageous approach for adolescents aged 15 to 18 including those in out-of-home placement, because almost all youth of this age group are enrolled in high school. From the viewpoint of developmental psychopathology, specific transition support should be recognized as being essential for every adolescent, as such support is crucial not only for ameliorating current issues but also for improving social adaptation and health, for a safer transition into adulthood.

Transition support from adolescence to adulthood for people with developmental disorders is an essential issue facing us today. In this article, we examine the issues in transition support for such individuals in relation to the social welfare system, particularly for those with autism spectrum disorder. The goal of support for people with disabilities is to help them attain higher qualities of life building upon their needs for self-realization. In order to successfully transition into adulthood, it is of utmost importance that guardians and practitioners respect and support the decision making of the individuals they are supporting. Key issues associated with the transition include higher education, vocational training, employment, disability pension, disability certification, and leisure activities, for which support should be individualized, focusing on the unique features and needs of each individual.

Objective: This study investigated the SNS activities of Japanese university students to clarify the features of depressive symptoms from patterns of SNS postings.

Method: College students utilizing Twitter (n=158, 94 males, 63 females, 1 unknown; average age=18.89, SD=0.90, valid response rate=73.8%) were grouped into depressive categories: normal (n=57), mild (n=75), and moderate or more (n=26), based on Self-Rating Depression Scale (SDS) scores. Twitter activity data was collected for one month from the participants' Twitter accounts to explore difference between groups.

Result and Discussion: Group differences in Twitter activity data revealed higher rates of original tweets (monologues) in the morning in the mild and moderate or more groups. Text mining was applied to 1,919 original tweets posted in the morning, and the relationship between depressive category and extracted words was examined by correspondence analysis. Two components— “busy in real life” and “escape from real life”—were obtained. Further, drawing from the diagram of correspondence analysis, the mild group tended to express realities of their daily situation such as busyness with academic activities, while the moderate or more group tended towards expression of escapist attitudes from present reality and features that could be regarded as manic defense. In future, expanding the range of targeted posts should be helpful to determine if the findings obtained in this study hold true for all segments of the day.

This study was designed to clarify the characteristics of maternal attachment (MA) in mothers of children with attention-deficit/hyperactivity disorder (ADHD). The subjects of the study were 115 mothers of children diagnosed with ADHD and 115 mothers of typically developing children attending regular school classes. A questionnaire on MA was devised, and subjects were asked to rate actual and ideal MA using the same items. Factor analysis on the items regarding actual MA for the ADHD group revealed three factors: affection for the child (affection), understanding of the child (understanding), and warm attitude towards the child (attitude). Intra- and inter-group analyses of the three-factor scores for actual and ideal MA showed significantly higher nearly perfect scores for ideal MA in both groups, while the actual MA score was significantly lower in mothers of children with ADHD. Next, actual MA values were subtracted from the ideal MA values for each of the subjects to determine disparity between scores. A two-way analysis of variance was then performed with groups and factors as the parameters. As a result, score difference for the ADHD group was found to be significantly greater than that of the control group, but no main effect was observed between factors. As there were significant interactions, multiple comparisons were performed between factors for each group. In the control group, the score difference was significantly greater for understanding and attitude than for affection. In contrast, score difference in the ADHD group was smaller for understanding than for affection and attitude. These findings suggest that while mothers of children with ADHD have an understanding of their child as well as the disorder and wish to interact with their child in a warm and positive manner, they are also aware of their struggle in making this a reality.