Transition From Child to Adult Eating Disorder Services: A Qualitative Meta‐Aggregation

ABSTRACT

Background

Some young people with eating disorders (EDs) require transfer from paediatric to adult services, which can be difficult and distressing. While most research on this topic is qualitative, no qualitative focused synthesis yet exists.

Methods

Systematic review identified 21 qualitative studies, which were analysed using meta‐aggregation.

Results

Findings included: (1) Age‐related transfers deserve specific attention; (2) The distress of the young person, families, and clinicians must be considered; (3) Clear communication between all parties is essential; (4) Paediatric supports should include early conversations and build health management skills; (5) Timing should align with developmental readiness; (6) Plans should be personalised and account for concurrent life transitions; (7) Referrals should be straightforward; GPs need more training to support young people during referral gaps; [Correction added on 06 July 2026, after first online publication: The word “support” has been added to the preceding sentence.] (8) Joint supports include overlapping care, transition coordinators, transition passports, and peer support; (9) Paediatric and adult services should develop a shared philosophy/culture for emerging adults; (10) Parent/carer involvement should be balanced with building the young person's independence; (11) ED‐specific guidelines or interventions may be beneficial; (12) Adult supports include emerging adult programming, increased resources, and ED training for generalist services.

Discussion

While consistent with existing expertise based guidance, this synthesis provides a qualitative evidence base to inform intervention development and co‐production.

Highlights

• Twenty‐one qualitative reports on age transitions in eating disorder services have emerged over the last 15 years, providing us with a ‘critical mass’ of studies for synthesis.

• A meta‐aggregative approach was used, where the findings of multiple qualitative studies are synthesised without attempt to reinterpret the original data. It is the preferred method of qualitative synthesis when the aim is to develop recommendations for action.

• Clinicians and researchers may wish to pull from our 12 synthesised findings when developing pilot interventions or during service redesign.

1. Introduction

Eating disorders (EDs) are life‐threatening illnesses which impact both physical and psychological health (Treasure et al. 2020). The onset of EDs span adolescence and emerging adulthood, with a median age of onset of 18 (Solmi et al. 2022). This contradicts the structure of ED services, which are often separated into paediatric and adult divisions ¹ based on the age of majority (Treasure et al. 2021), which is 18 years in most countries. The problem of disease onset straddling services is not unique to EDs; across mental health diagnoses, transition from paediatric to adult services are often disjointed and challenging for young people (Hendrickx et al. 2020). Specific to EDs, the ego‐syntonic nature of some diagnoses (i.e., viewing EDs as compatible to one's values) may hinder individual motivation for further help‐seeking in adult services (Potterton et al. 2021).

Transition from paediatric to adult services are needed for a sizeable group of young people with EDs. Arcelus et al. (2008) showed that about a quarter of patients with anorexia nervosa (AN) treated in adult services between the ages of 16 and 25 had previous involvement with a child/adolescent ED service. Subsequent research by McClelland et al. (2020) followed a cohort of patients with EDs who had been treated in child/adolescent ED services, finding that 31.7% were subsequently treated in adult ED services before age 25. It has been estimated that one‐quarter to one‐third of children treated for an ED require continued care in an adult service (Herpertz‐Dahlmann and Schmidt 2023).

Age transitions—defined within this paper as the transfer from any paediatric service to any adult service, whether general or specialist—is a challenge facing this unique population, and proposed solutions are popular topics of research. There have been several recent attempts to collate the evidence on age transitions in EDs. For example, a systematic review by Wade (2023) examined studies with a focus on age transitions in EDs. Results were presented narratively, highlighting the problematic nature of these transitions—including poor communication and contrasting treatment philosophies—concluding that an all‐age service approach may outweigh the barriers of implementing such a service (i.e., that treating all ages within the same ED programme may help to reduce problematic transitions). A subsequent systematic review by Ragnhildstveit et al. (2024) also examined the issue of age transitions in ED services, narratively outlining challenges like timing, readiness, clinician competence, and systematic barriers, ultimately suggesting that a transition framework may improve illness trajectories. However, the strength of the evidence behind shared findings, as is the case in meta‐analytic approaches, has not yet been evaluated.

Few studies have quantitatively examined age transitions in EDs or evaluated related protocols or interventions, limiting the feasibility of a meta‐analysis. In the meantime, a critical mass of qualitative research offers valuable insights that warrant synthesis through a qualitative meta‐aggregation to inform timely, evidence‐based action. Unlike narrative approaches, which present results in words and text similarly to a traditional literature review, meta‐syntheses integrate findings across studies to establish a more robust conceptual account of a phenomenon (Chrastina 2018). Within the topic of age transitions in EDs, Stocker et al. (2022) suggests that a synthesis of qualitative work, including various stakeholder perspectives, is needed to overcome local specificities and create broader insights. To date, no in‐depth synthesis of the qualitative literature on this topic exists. This review aims to address that gap by synthesising the literature on transitions from paediatric to adult ED services, to inform practice and policy.

2. Methods

This study was conducted in accordance with the Johanna Briggs institute (JBI) guidance for meta‐aggregative reviews (Lockwood et al. 2020) and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist (Tong et al. 2012; see Supporting Information). A meta‐aggregative approach was used, whereby the findings of multiple qualitative studies are synthesised without attempt to reinterpret the original data but rather to present findings as intended by the original authors (Lockwood et al. 2015). This approach aligns with the process of systematic review while being sensitive to established practices in qualitative research. Meta‐aggregation is the preferred method of qualitative synthesis when the aim is to develop recommendations for action (Lockwood et al. 2020). However, it has been criticised by some in the field as reductionist (Bergdahl 2019). Despite this, meta‐aggregation is endorsed by the JBI as a pragmatic approach when the primary research question emphasises producing useful statements to inform healthcare practice and policy ​(Lockwood et al. 2015).

2.1. Search Strategy and Selection of Studies

A systematic search was conducted on MEDLINE, PsycInfo, and Embase from inception to February 28, 2026, using ED‐ and transition‐related terms combined with Boolean operators (See Supporting Information S1: Table S2 for full search strategy). Eligible studies were those using a qualitative approach to explore transitions from paediatric to adult services for ED treatment. All qualitative paradigms (e.g., phenomenological, grounded theory, ethnography), data generation methods (e.g., semi‐structured interviews, focus groups, photovoice), and publication types (e.g., grey literature such as dissertations/theses, conference abstracts, and charity reports) were permitted, with no restrictions on publication date or language (abstracts in languages other than English or French were screened with the support of Google Translate). A targeted hand search of grey literature via one thesis repository (Open Access Theses and Dissertations) and one preprint server (Research Square) were conducted on the same day. This hand search involved manual browsing and keyword searching using ED‐ and transition‐related terms combined with Boolean operators, with records screened against the same inclusion and exclusion criteria as the database search. Reference lists of included studies were also screened. Title and abstract screening was performed by two reviewers (AA, SS), with potential records proceeding to full text screening. Any discrepancies were resolved by consensus.

2.2. Data Extraction and Credibility Categorisation

Study characteristics were extracted by two of four reviewers (AA, MN, AK, or JL). Qualitative findings (verbatim interpretations of the results by primary authors) were extracted by one reviewer (AA), with French‐language findings double‐checked by JHG. Each finding was assessed for plausibility by AA, based on congruency with supporting examples (e.g., quotes) and categorised as: (1) unequivocal—accompanied by an illustrating quote that is beyond doubt, (2) equivocal/credible—accompanied by a quote that is lacking clear association and therefore open to challenge, or (3) unsupported—findings not supported by the data (Lockwood et al. 2020). Unsupported findings (n = 3) were excluded from the analysis.

2.3. Synthesis

Data synthesis was conducted by AA and followed the three‐step approach defined in Pearson et al. (2011). Findings (e.g., themes, categories, or metaphors described by the original authors (Hannes et al. 2018)) were extracted and were assigned a plausibility rating. Findings with similar meanings (may be conceptual or descriptive in nature, similar to a thematic approach (Hannes et al. 2018)) were then grouped into categories. Finally, categories that could be grouped together under a recommendation or guidance statement were grouped under an overarching ‘synthesised finding’ (Pearson et al. 2011). All data synthesis steps were performed by hand, that is, no software was used. To mitigate any potential bias during categorisation and synthesis, preliminary structures were repeatedly discussed with coauthors (M Singh, MN, GD) as a form of peer debriefing to increase credibility and enable alternate interpretations to be considered (Lincoln and Guba 1985).

2.4. Critical Appraisal

The methodological quality of all studies was evaluated via the JBI Critical Appraisal Checklist for Qualitative Research (Lockwood et al. 2015) independently by two reviewers (AA, SS). Discrepancies were resolved through consensus. The credibility and dependability of each synthesised finding was assessed by one reviewer (AA) using the Confidence in the Output of Qualitative research synthesis (ConQual) as described in Munn et al. (2014).

3. Results

A flow diagram of the search can be found in Figure 1. The systematic search generated 143 records after the removal of duplicates. Based on title and abstract screening, 26 records were eligible for a full‐text review. In total, 17 qualitative studies appearing across 21 reports were included in this review and meta‐aggregation. [Correction added on 06 July 2026, after first online publication: The values “14” and “18” in the preceding sentence have been corrected to “17” and “21”, respectively.]

FIGURE 1.

PRISMA flow diagram of search and study selection.

3.1. Characteristics of Included Studies

Reports were all from countries with a public healthcare system, mainly Canada (n = 8), with additional studies in France (n = 4), Norway (n = 3), the UK (n = 3), Denmark (n = 2) and Germany (n = 1). Two reports were dissertations/theses (Bove 2014; O’Loughlin 2012), one was a book chapter (Dimitropoulos et al. 2016), one was a publicly available pre‐print (Bryde et al. 2025), and all remaining reports were peer‐reviewed academic journal articles.

3.2. Participants

Of all reports included, eight focused on the experiences of young people (Bove 2014; Dimitropoulos et al. 2015, 2016; Gilsbach et al. 2024; Harboe et al. 2025; Lockertsen et al. 2020b; Mooney et al. 2023; Rezakhany et al. 2025), five on clinicians (Carles et al. 2023; Dimitropoulos et al. 2012, 2013; Lockertsen et al. 2020a; Stocker et al. 2022), two on parents/carers (Bryde et al. 2025; Lockertsen et al. 2021), five on a mix of young people and parents/carers (O’Loughlin 2012; Nadarajah et al. 2021; Nicula et al. 2025; Scanferla et al. 2025; Wales et al. 2021), and one on a mix of young people, parents/carers, and clinicians (Livanou et al. 2025). [Correction added on 06 July 2026, after first online publication: The in‐text citation “Harboe et al. 2025” has been added to the preceding sentence.]

3.3. Methodology

A range of theoretical approaches and methodologies were used across reports. Five reports cited interpretive phenomenological analysis as their guiding theory (O’Loughlin 2012; Carles et al. 2023; Harboe et al. 2025; Rezakhany et al. 2025; Scanferla et al. 2025). All four reports by Dimitropoulos et al. (2012, 2013, 2015, 2016) used grounded theory methodology. One report used social constructionism (Lockertsen et al. 2021), one used interpretive description (Nadarajah et al. 2021), one used qualitative description (Nicula et al. 2025), one used a critical incident approach (Bove 2014), one used a constructivist grounding approach (Stocker et al. 2022), and one used a contextualist approach (Livanou et al. 2025). The remainder did not specifically reference a theoretical or philosophical position. More detail on study characteristics can be found in Table 1.

TABLE 1.

Study and participant characteristics.

Study	Phenomenon of interest	Geographic region	Setting	Participants	Methodology	Collection method	Analysis	Cultural context
Bove (2014)	Helpful and hindering experiences of young people with AN in a past transition from adolescent to adult mental health services	Vancouver, Canada	Unspecified	7 young people with AN	Critical incident technique	Individual interviews	Inductive reasoning
Bryde et al. (2025)	Experience of parents of young people with AN after the transition from child and adolescent to adult mental health services	Capital Region of Denmark	Unspecified	7 parents (3 mothers, 3 fathers, 1 stepmother) of young people age 18–22 with AN or atypical AN	Theoretical position NR	Interviews (unspecified if individual or pairs)	Empirically testing thematic analysis	5/7 interviews conducted during COVID‐19 outbreak
Carles et al. (2023)	Perceptions of physicians supporting young people with EDs transition from adolescent to adult services	Paris, France	Various	13 physicians (8 psychiatrists, 4 pediatricians, 1 internist)	Interpretive phenomenological analysis	Individual interviews	Constant comparative analysis	Conducted during COVID‐19 outbreak
Dimitropoulos et al. (2012)	Perspectives of clinicians supporting young people transition from paediatric to adult ED programs	Toronto, Canada	Community and specialist care	23 clinicians and community practitioners	Grounded theory	Focus groups, individual interviews	Constant comparative analysis
Dimitropoulos et al. (2013)	Perspectives of clinicians on the facilitator and barriers to supporting young people transition from paediatric to adult ED programs	Toronto, Canada	Community and specialist care	23 clinicians and community practitioners	Grounded theory	Focus groups, individual interviews	Constant comparative analysis
Dimitropoulos et al. (2015)	Perspectives of young people with EDs who transitioned from adolescent to adult services	Toronto, Canada	Exiting specialist tertiary care, entering community or specialist care	15 young people with AN or BN, aged 18–22 (m = 19.1)	Grounded theory	Individual interviews	Constant comparative analysis	13/15 lived with their family
Dimitropoulos et al. (2016)	Perspectives of young people with EDs who transitioned from adolescent to adult services on the challenge of accepting familial support	Toronto, Canada	Exiting specialist tertiary care, entering community or specialist care	15 young people with AN or BN, aged 18–22 (m = 19.1)	Grounded theory	Individual interviews	Constant comparative analysis	13/15 lived with their family
Gilsbach et al. (2024)	Perspectives of young people with AN who had a previous inpatient admission and were either pre or post transition to adult services	Aachen, Germany	Exiting specialist care, entering community care	32 young people with AN, age 18–21 (m = 20.3)	Theoretical position NR	Individual interview	Reflexive thematic analysis
Harboe et al. (2025)	Perspective of young people with AN on the transition from child and adolescent to adult mental health services	Capital Region of Denmark	Exiting outpatient (family‐based treatment) to adult out‐, day‐, or in‐patient	3 young people with AN, all age 20	Interpretive phenomenological analysis	Individual interview	Interpretive phenomenological analysis
Livanou et al. (2025)	Experiences of young people, carers, and mental health professionals with insight into the transition process	England, UK (six sites)	Involved with or working for specialist care	6 young people age 16–21 (m = 19.17) with AN or BN, 9 carers (6 mothers, 2 fathers, 1 sister), 12 mental health professionals (5 nurses, 3 psychiatrists, 1 nutritionist, 1 psychologist, 1 psychotherapist 1 research assistant)	Contextualist (balancing constructionism and essentialism)	Individual interview (young people and carers), focus group (mental health professionals)	Reflexive thematic analysis	Part of larger experience‐based co‐design project
Lockertsen et al. (2020a)	Experience of mental health professionals supporting young people with AN transition from child and adolescent to adult mental health services	Oslo, Norway	Inpatient, outpatient, school	8 clinicians (psychiatrists, school nurses, psychologists, psychiatric nurses, GP)	Theoretical position NR	Individual interviews, multi‐step focus group	4‐step systematic text condensation
Lockertsen et al. (2020b)	Experience of young people with AN who had undergone a transition from child and adolescent to adult mental health services	Oslo, Norway	Inpatient, outpatient	10 current or former patients with AN age 19–29 (m = 22)	Theoretical position NR	Individual interviews, multistep focus group	4‐step systematic text condensation	User‐initiated project
Lockertsen et al. (2021)	Experience of parents of young people with AN who had undergone a transition from child and adolescent to adult mental health services	Oslo, Norway	Inpatient, outpatient, specialist, community	12 parents (9 mothers, 3 fathers)	Social constructionism	Individual interviews	4‐step systematic text condensation	User‐initiated project
O'Loughlin (2012)	Experience of young people and parents with a previous transition from child and adolescent to adult mental health services for an ED	Glasgow, Scotland, UK	Specialist, community	6 young people (AN n = 5, BN n = 1) and 5 parents	Interpretive phenomenological analysis	Individual interviews	Interpretive phenomenological analysis
Mooney et al. (2023)	Perspectives of young people previously treated in paediatric inpatient ED services on the role of education resources to support age transitions	St. John's, Canada	Transfer from inpatient	6 young people with AN or BN	Theoretical position NR	Individual interviews	Thematic (descriptive)
Nadarajah et al. (2021)	Experience of adolescents with AN and their parents facing an impending transition to adult services	Hamilton, Canada	Specialist care	5 young people with AN age 17–18 (m = 17.4), 5 parents	Interpretive description	Individual interviews	Summative content analysis	2 Indigenous families, 8 White families
Nicula et al. (2025)	Perceptions of adolescents and parents of a transition intervention when leaving paediatric ED care to other adult services	Hamilton, Canada	Transfer from specialist care to any adult care	7 young people and 6 parents	Qualitative description	Reflections (short written summaries) and individual interviews	Conventional and summative content analysis	Mainly virtual due to COVID‐19
Rezakhany et al. (2025)	Experiences of adolescents and young adults with AN before/during transition or after unsuccessful transition	Paris, France	Unspecified	13 young people with AN age 18–30 (m = 22)	Interpretive phenomenological analysis	Individual interviews	Interpretive phenomenological analysis
Scanferla et al. (2025)	Experience of patients and parents with a previous transition from paediatric ED care to adult inpatient care	Paris, France	Inpatient care	12 young people (inpatients) with AN age 19–30 (m = 22.5), 6 parents	Interpretive phenomenological analysis	Individual interviews	Interpretive phenomenological analysis
Stocker et al. (2022)	Experiences of physicians supporting young people with EDs transition from child and adolescent to adult mental health services	Southwestern France	Inpatient and outpatient care	16 physicians (15 psychiatrists, 1 paediatrician)	Constructivist	Individual interviews (1 joint interview by request)	Reflexive thematic analysis framework	3/16 physicians worked in the private system. 6/16 interviews held during COVID‐19.
Wales et al. (2021)	Experiences of patients and parents who had commenced/completed the transition from child and adolescent to adult ED services, and the experience of clinicians who support these transitions	Leicestershire, UK	Community care	5 patients with EDs (age NR), 6 parents, 22 clinicians (10 CAMHS, 12 adult)	Service evaluation. Theoretical position NR	Focus groups (clinicians), individual interviews (patients/parents)	Thematic

Abbreviations: CAMHS, Child and adolescent mental health services; NR, Not reported.

3.4. Meta‐Synthesis

Twelve synthesised findings were identified across studies (see Table 2).

1. Age‐related service transfers affect continuity and deserve specific attention.

   The main goal across age transition is to maintain the continuity of care during the process of service transfer (O’Loughlin 2012; Carles et al. 2023; Scanferla et al. 2025). However, multiple studies in this review highlighted the difficulty of age transition in ED services, using terms such as deterioration (Lockertsen et al. 2021), traumatic (Stocker et al. 2022), d'echec [failure] (Carles et al. 2023), and disruption (O’Loughlin 2012). The focus of much of the existing literature is on the difficulties of these transitions and/or how to remediate the difficulties.

   While the overwhelming perception of age transitions was negative, some studies observed that transitions can be neutral or even facilitate therapeutic development. O'Loughlin (2012) found that an age transition may not prompt any change, or they may facilitate further growth. This was echoed by Bove (2014) who suggests that an age transition may in some cases be helpful and motivational via a drive to recovery prior to transfer, increase‐perspective taking, a fear of chronicity, and therapeutic focus on understanding contributing factors of illness.

2. Consideration should be given to the distress of the young person, family, and clinician.

   There were multiple reports of distress among patients and parents/carers prior to transition. Patients felt abandoned (Rezakhany et al. 2025; Scanferla et al. 2025), unprepared and alone (Lockertsen et al. 2020b), fearful, but with some hopeful trepidation (O’Loughlin 2012), stressed and anxious (Nadarajah et al. 2021), loneliness and a lack of safety (Bove 2014), emotional loss (Livanou et al. 2025), concerns about losing their trusted clinician (Gilsbach et al. 2024; Rezakhany et al. 2025), and feeling like relational needs are unmet (Harboe et al. 2025). Similarly, parents/carers felt destabilised and helpless (Scanferla et al. 2025), shut out (Wales et al. 2021), frustrated (Livanou et al. 2025), and stressed and anxious (Nadarajah et al. 2021).

   Clinicians were also not immune to these feelings. Lockertsen et al. (2020a) commented on the lack of self‐confidence impacting clinicians in generalist adult mental health services when supporting ED transfers, and Stocker et al. (2022) highlighted that clinicians may need to soothe their own anxieties around transition to avoid burdening patients.

3. Clear communication between the young person, families, and services.

   Multiple studies noted the limited knowledge or understanding about the transition process for both the young person and their family (Bove 2014; Dimitropoulos et al. 2016; Lockertsen et al. 2021; Nadarajah et al. 2021). To that end, several studies underscored the need for clear communication with patients and families around the meaning and expectations of an age transition (Bove 2014; Dimitropoulos et al. 2015; Wales et al. 2021). Finally, Wales et al. (2021) suggest some additional methods to increase communication with patients and family during the transition process, including the use of video calls and peer support services.

   Service to service communication was also susceptible to discontinuity, with studies reporting a lack of communication between services (Bove 2014; Rezakhany et al. 2025; Wales et al. 2021), which Nadarajah et al. (2021) found led to patients and families having to re‐explain and re‐share information with adult services.

4. Paediatric supports include ( a ) early conversations and ( b ) fostering health management skills prior to transfer.

   Involvement of paediatric teams in age transitions in EDs is key (Nadarajah et al. 2021). Collaborative (Bove 2014) and multi‐component (Nicula et al. 2025) transition plans housed in paediatric services were perceived as helpful. Gilsbach et al. (2024) reported that patients found the transition as being too sudden, but Nicula et al. (2025) found that participants in a paediatric‐based transition intervention found that 3 months was generally perceived as an appropriate amount of time to complete the intervention. To that point, Nadarajah et al. (2021) highlighted the importance of timing when transition discussions occurred, with Nicula et al. (2025) explicitly implementing earlier transition conversations. Carles et al. (2023) more strongly suggested that patients with a severe course of illness should be identified for transitions early. Work by Lockertsen et al. (2020b) examined perspectives of young people, reminding readers that “how they [clinicians] see me and treat me affects my hope for the future” (4). Considering these findings together, having early conversations about transition process without labelling the adolescent as a ‘long‐term’ patient seems appropriate.

   This synthesised finding also reflects the importance of fostering emerging adult skills towards the end of stay in child ED services. Dimitropoulos et al. (2015) recommended that paediatric teams use collaborative approaches to treatment to include older adolescents in the goals of recovery and provide opportunities to develop practical self‐management skills for self‐care and help‐seeking prior to the transition. Similarly, Bove (2014) suggests that older adolescents be provided with opportunities to develop life skills in preparation for the transition, including self‐advocacy, external support, and communication skills.

5. Transition timing should consider developmental stage or readiness.

   Four studies commented on the suddenness of rigid age cut‐offs based on chronological age (Livanou et al. 2025; Lockertsen et al. 2021; O’Loughlin 2012; Wales et al. 2021), and four studies advocated for more flexible transition timing based on developmental stage and readiness (O’Loughlin 2012; Dimitropoulos et al. 2013, 2015; Rezakhany et al. 2025).

6. Transition plans should be personalised and consider other life goals and transitions.

   Carles et al. (2023) and Stocker et al. (2022) reported the importance of selecting an adult service with an intensity level that matches the clinical need of the individual patient. Scanferla et al. (2025) further stressed the importance of supporting personal (e.g., social, academic, professional) life goals. As a participant in Lockertsen et al. (2020b) further reminds us, “we are not all the same” (1). Participants in Rezakhany et al. (2025) suggested that adapted and personalised transitions include the young person's voice as well as consideration of their past medical history and experiences.

   In addition to personalisation based clinical acuity and personal goals, other life events and developmental factors that happen at the same time as an age transition (e.g., starting university, major exams, moving) should also be considered (Bove 2014; Wales et al. 2021). Finally, Mooney et al. (2023) highlighted that age transition may happen concurrently with level of care transitions (e.g., inpatient to outpatient).

7. Referral should be more straightforward; GPs supporting during referral gap need more ED training.

   Multiple studies referenced the difficulties of referral to adult services, including inequivalent adult services and high/rigid thresholds for entry (Bove 2014; Dimitropoulos et al. 2013; Livanou et al. 2025; Stocker et al. 2022; Wales et al. 2021). There was also a common experience of delayed care and waitlists (Bove 2014; Nadarajah et al. 2021; Scanferla et al. 2025). External physical monitoring by a family doctor/general practitioner (GP) during an age transition was suggested in three reports (Dimitropoulos et al. 2013, 2015; Nicula et al. 2025), but it was also noted that there can be a lack of ED‐specific support or expertise from these providers (Dimitropoulos et al. 2015; Scanferla et al. 2025).

8. Joint transition supports include (a) a period of overlapping care, (b) a key transition professional, (c) a transition passport or resource, and (d) peer support/lived experience involvement. Additional ideas are still emerging.

   Support strategies across services were mentioned in multiple studies and include a period of overlapping care (Bove 2014; O’Loughlin 2012; Nadarajah et al. 2021; Nicula et al. 2025), a transition coordinator or bridging professional (Bove 2014; Carles et al. 2023; Nadarajah et al. 2021), a transition passport, navigation guide, or educational resource (Mooney et al. 2023; Nadarajah et al. 2021; Nicula et al. 2025), and the involvement of peers with lived experience (Livanou et al. 2025; Nicula et al. 2025).

   Additional ideas for transition supports are still emerging. One study recommended that young people be accompanied and welcomed to the adult service (Scanferla et al. 2025), another suggested that child and adult services should ideally share the same space (Bove 2014), a third suggested facilitating self‐management skills (e.g., coping skills, harm management [Livanou et al. 2025]), and a fourth suggested a parent‐to‐parent session and the provision of a list of area‐specific providers, inducing private services (Nicula et al. 2025). [Correction added on 06 July 2026, after first online publication: The in‐text citation “Livanou et al. 2025” has been added to the preceding sentence.]

9. Paediatric and adult services should foster positive relationships and develop a shared philosophy/culture for emerging adults.

   Several studies commented on the shift in culture or ethos between paediatric compared to adult services treating EDs. One study found that paediatric services focused exclusively on weight (Livanou et al. 2025). Many others reflected the perception of adult services being more stringent or rigid (Bove 2014; Lockertsen et al. 2020a; O’Loughlin 2012; Scanferla et al. 2025; Wales et al. 2021). Dimitropoulos et al. (2015) extended this finding to suggest that patients and families should be educated about the difference in culture prior to transfer. One example of this culture shift the swift discharge process from adult care is if the patient is hesitant to engage or misses appointments (Wales et al. 2021). As a patient in Lockertsen et al. (2020b) noted, a trusting relationship can take time which is a luxury that is not always granted in adult services.

   Two studies found that the difference between services fostered ambivalence or even distrust between care teams (Carles et al. 2023; Lockertsen et al. 2020a). Three other studies captured the presence of breaks in communication between child/adolescent and adult services (Bove 2014; Nadarajah et al. 2021; Wales et al. 2021).

10. Parents and/or carers should be involved but balanced with building the young person's independence.

    Six studies commented on the helpful nature of parent involvement during and after transition from paediatric to adult services (Bove 2014; Dimitropoulos et al. 2016; Carles et al. 2023; Livanou et al. 2025; Nadarajah et al. 2021; Scanferla et al. 2025). Five additional studies added some nuance to this suggestion, advocating that the caregiver role changes for this age group, and that full parental control as typically seen in paediatric services, is no longer appropriate in adult services (Dimitropoulos et al. 2012, 2013, 2016; Harboe et al. 2025; Stocker et al. 2022). Alongside the importance of family, eight studies had findings around autonomy, both as a challenge and as an opportunity (Bove 2014; Carles et al. 2023; Dimitropoulos et al. 2012; Gilsbach et al. 2024; Harboe et al. 2025; Mooney et al. 2023; Nadarajah et al. 2021; Scanferla et al. 2025). Dimitropoulos et al. (2012) specifically noted that illness disrupts normative developmental processes, and that levels of autonomy may need to be considered with this in mind.

11. EDs present unique challenges; transition guidelines and interventions specific to EDs may support consistent transfers.

    Three studies highlighted the unique challenges of EDs for age transitions, including denial and ambivalence (Dimitropoulos et al. 2012), lack of insight (Stocker et al. 2022), late age of onset in comparison to other paediatric illnesses, and cyclical symptoms (Mooney et al. 2023). Accordingly, Carles et al. (2023) suggested that a protocol for age transitions specific to EDs may be useful, while Bove (2014) outlined the elements of an ‘ideal’ transition. Dimitropoulos et al. (2015) also noted inconsistent transfer procedures across age transitions in EDs, which also bolsters support for more standardized transfer protocols or guidelines.

12. Adult supports include ( a ) programming specific to emerging adults, ( b ) increased resources, and ( c ) more ED training for generalist mental health services.

    Four studies underscored the importance of providing additional resources within adult services (Bove 2014; Gilsbach et al. 2024; Livanou et al. 2025; Mooney et al. 2023). Bove (2014) detailed that adult services are often characterised by the limited number of individual therapy sessions they offer, a greater reliance on group sessions, a lack of comprehensive services, a lack of support for general mental health concerns like depression and anxiety, and limited support for moderate (rather than high) severity EDs. As a result of these limitations, some patients were left to look for private services to fill this gap (Bove 2014). One study highlighted that adolescents transition to peer‐based support and groups in adult services (Harboe et al. 2025). Other studies described how adult ED services lacked support for psychiatric comorbidities (Livanou et al. 2025; Mooney et al. 2023), and how they lacked individualised/tailored care (Gilsbach et al. 2024; Livanou et al. 2025).

    Furthermore, two studies detailed providing programming specific to emerging adults, (i.e., with the explicit goal of assisting young people with the responsibilities of adulthood [Bove 2014]) as well as autonomy and independence (e.g., housing, financial skill [Dimitropoulos et al. 2015]). Finally, two studies highlighted the concerns around ED‐specific competency in generalist adult mental health services (Bove 2014; Gilsbach et al. 2024).

TABLE 2.

Synthesised findings.

Synthesised finding	Category	Finding
1. Age‐related transfers affect continuity and deserve specific attention.	The goal across age transitions is to maintain continuity of care	Continuity of care (Scanferla et al. 2025)
		Common objective: Continuity of care during the transition (Carles et al. 2023)
		Process of transition (O’Loughlin 2012)
	Age transitions are often unsuccessful	Lack of continuity is often followed by deterioration and relapses (Lockertsen et al. 2021)
		Traumatic transitions (Stocker et al. 2022)
		Experience of failure in transitions from paediatric clinician perspective (Carles et al. 2023)
		Outcome of transition—Disruption (O’Loughlin 2012)
		[Dis]satisfaction with the transition process (Gilsbach et al. 2024)
	Age transitions can also be helpful (motivational, a moment of positive change, or stability)	Outcome of transition—Development (O’Loughlin 2012)
		Helpful—Smooth transitions—Adult programs are helpful [once patient has adapted] (Bove 2014)
		Helpful—Perspective taking [transition to adult service with other psychiatric disorders] (Bove 2014)
		Wishlist—Counselling needs—Deepened understanding [of contributing factors in adult services] (Bove 2014)
		Helpful—Transition motivation—Fear of chronicity (Bove 2014)
		Helpful—Transition motivation—Recovery without disruption [drive to recovery to avoid transition] (Bove 2014)
		Outcome of transition—No change (O’Loughlin 2012)
2. Consideration should be given to the distress of the young person, family, and clinician.	Patient feelings of loss and abandonment	Patients' feelings (fear, overwhelm, abandonment) (Scanferla et al. 2025)
		Intense emotional experience—Feelings of being abandoned (Rezakhany et al. 2025)
		‘Being unprepared and alone in the transition process’ (Lockertsen et al. 2020b)
		Feelings about transition [fearful, some hopeful trepidation] (O’Loughlin 2012)
		Feelings of stress and anxiety [adolescent] (Nadarajah et al. 2021)
		Lost in translation [adolescent] (Scanferla et al. 2025)
		Hindering—Loneliness and lack of safety (Bove 2014)
		Major concerns about the transition process—Losing hope and being affected by meeting older, more severe and chronically ill patients (Gilsbach et al. 2024)
		Major concerns about the transition process—Losing well known psychotherapist and having to tell their entire history to a new provider (Gilsbach et al. 2024)
		Intense emotional experience—Trust‐based relationship and difficulty in creating a new therapeutic alliance (Rezakhany et al. 2025)
		The shadow of separation—Emotional losses (Livanou et al. 2025)
		Relational needs unmet during transition (Harboe et al. 2025)
	Parent/carer feelings of powerlessness	Feelings of the carers (destabilisation, helplessness, powerlessness) (Scanferla et al. 2025)
		Communication between services and parent/carer [different level of involvement, may feel shut out] (Wales et al. 2021)
		[Remembering] experiences entering into the paediatric ED programme (Nadarajah et al. 2021)
		Feelings of stress and anxiety [parent] (Nadarajah et al. 2021)
		Lost in translation [parent] (Scanferla et al. 2025)
		We need carers involved—Practical downfalls for carers (Livanou et al. 2025)
	Clinician anxiety and lack of self confidence	Soothing the transition to avoid burdening the patients with our anxieties (Stocker et al. 2022)
		Clinician factors such as lack of self‐confidence (AMHS) (Lockertsen et al. 2020a)
3. Clear communication between the young person, families, and services	Limited patient and family knowledge around transition	Limited understanding about the transition (Nadarajah et al. 2021)
		Some knowledge about the transition (Nadarajah et al. 2021)
		Wishlist—Transition needs—Transition information (Bove 2014)
		Prior to discharge—Discuss adult treatment options, post‐discharge plan, and emergency resources with patient and families (Dimitropoulos et al. 2015)
		Lack of [parent] involvement and information (Lockertsen et al. 2021)
		Knowledge—An important factor for developing a trusting relationship between parents and clinicians [in the context of transfer to general adult mental health services] (Lockertsen et al. 2021)
	Communication with patient and family around meaning and expectations of transition	Prior to discharge—Discuss meaning of leaving paediatric care (does not indicate full recovery) (Dimitropoulos et al. 2015)
		Communication between services and service user (Wales et al. 2021)
		Hindering—Communication—[Lack of] service user and provider communication (Bove 2014)
		New ways of engagement [skype, peer support] (Wales et al. 2021)
		Planning needs—Prepping expectations (Bove 2014)
		Challenges with accepting familial support—Unclear expectations about adult care system (Dimitropoulos et al. 2016)
	Communication between services	Re‐explaining and re‐sharing information to adult healthcare providers (Nadarajah et al. 2021)
		Communication between services (Wales et al. 2021)
		Hindering—Communication—[Lack of] programme communication (Bove 2014)
		Preparation of the transition material—Communication between professionals (Rezakhany et al. 2025)
4. Paediatric supports include (a) early conversations and (b) fostering health management skills prior to transfer.	Paediatric team involvement is important—Plan and have conversations early without labelling patients as ‘long term’	Facilitator—Involvement of paediatric healthcare team (Nadarajah et al. 2021)
		Helpful—Smooth transitions—Planned [collaboratively] (Bove 2014)
		Hindering—Bridging—Lack of planning (Bove 2014)
		Wishlist—Planning needs—Planning and preparation (Bove 2014)
		A five‐part transition intervention in paediatric care is helpful and informative (Nicula et al. 2025)
		Patients perceived transition as being too sudden (Gilsbach et al. 2024)
		A 3‐month paediatric transition intervention period is appropriate (Nicula et al. 2025)
		Timing of discussions on transitions (Nadarajah et al. 2021)
		Earlier transition conversations (Nicula et al. 2025)
		Identify severe patients early (Carles et al. 2023)
		‘How they see me and treat me affects my hope for the future’ (Lockertsen et al. 2020b)
	Fostering health management skills while still in paediatric services may be helpful.	Recommendations during paediatric treatment—Use collaborative approaches to include young adults in their recovery (Dimitropoulos et al. 2015)
		Recommendations during paediatric treatment—Provide patients with opportunities to develop practical skills recovery (Dimitropoulos et al. 2015)
		Helpful—Managing treatment—Growth and independence [beginning in adolescent services] (Bove 2014)
		Wishlist—Healthcare management needs—Self advocacy (Bove 2014)
		Wishlist—Healthcare management needs—Communication and interpersonal skills (Bove 2014)
5. Transition timing should consider developmental stage or readiness.	Strict age cut‐off	Rigid cut‐off age 18 (Wales et al. 2021)
		Sudden discharge from CAMHS at age 18 (Lockertsen et al. 2021)
		Timing of transition [based on chronological age] (O’Loughlin 2012)
		Navigating the complexity of transitions—Developmental concerns and harsh cut‐offs (Livanou et al. 2025)
	Time transition to developmental stage/readiness	The timing of transition—Determined by readiness and not by age (Dimitropoulos et al. 2013)
		Developmental stage, rather than chronological age, should determine readiness (Dimitropoulos et al. 2015)
		Wishlist—Service needs—Developmentally appropriate services [transition when developmentally ready] (Bove 2014)
		Wishlist—Administrative needs—Flexibility [no arbitrary age requirements, transitions during stable life periods] (Bove 2014)
		The need of an adapted and personalised transition—Discrepancy between developmental and chronological age (Rezakhany et al. 2025)
6. Transition plans should be personalised and consider other life goals and transitions.	Personalise and individualise the intervention	Choose a structure adapted to the severity (Carles et al. 2023)
		A transition matching clinical needs: Support the patient's autonomy (Stocker et al. 2022)
		Supporting the achievement of personal life goals (Scanferla et al. 2025)
		‘We are not all the same’ (Lockertsen et al. 2020b)
		The need of an adapted and personalised transition—Having a voice in decision making (Rezakhany et al. 2025)
		Preparation of the transition material—Consideration of the individual medical history (Rezakhany et al. 2025)
	Additional transitions	Life events [cause more transition at the same time] (Wales et al. 2021)
		Hindering—Development and context [factors that occur at the same time as service transition] (Bove 2014)
		Transition versus discharge [simultaneous age transition and level of care transition] (Mooney et al. 2023)
7. Referral should be more straightforward; GPs supporting during referral gap need more ED training.	Adult referral difficulties	Difficulties referring to specialised services (Stocker et al. 2022)
		Hindering—Administration—Referral process (Bove 2014)
		Wishlist—Administrative needs—Changes to referral process [open referral] (Bove 2014)
		Hindering—Administration—Transition gaps (Bove 2014)
		Hindering—Administration—Funding (Bove 2014)
		Hindering—Administration—Programme requirements (Bove 2014)
		Treatment threshold (Wales et al. 2021)
		Systemic barriers to recovery after a transfer [lack of access to adult care] (Dimitropoulos et al. 2015)
		The shadow of separation—Lost in the ‘between zone’ (Livanou et al. 2025)
	Delay in admission to adult services unless extremely severe	Lack of support while waiting for uptake into adult health system (Nadarajah et al. 2021)
		Delayed access to adult care (adverse effects) (Scanferla et al. 2025)
		Hindering—Administration—Waitlists (Bove 2014)
		Wishlist—Administrative needs—Shorter waitlists (Bove 2014)
		Helpful—Triaging [short wait times for those able to verbally express that they were crisis] (Bove 2014)
	GPs often bridge the gap, with limited knowledge/resources	Coordinated medical follow‐up during service transition (Dimitropoulos et al. 2013)
		After discharge [if not transferring to adult services]—Continued external monitoring (Dimitropoulos et al. 2015)
		Family doctor contact as part of a transition intervention is helpful (Nicula et al. 2025)
		Systemic barriers to recovery after a transfer [family doctor lacked sufficient knowledge] (Dimitropoulos et al. 2015)
		Lack of support from health care providers [GP] (Scanferla et al. 2025)
8. Joint transition supports include (a) a period of overlapping care, (b) a key transition professional, (c) transition passport/resource, and (d) peer support/lived experience involvement. Additional ideas are still emerging.	A period of overlapping care	Process of transition [planning and preparation, including parallel care or joint meetings] (O’Loughlin 2012)
		Wishlist—Transition needs—Carry over (Bove 2014)
		Hindering—[lack of] bridging services (Bove 2014)
		Phasing out (Nadarajah et al. 2021)
		Period of parallel care (Nicula et al. 2025)
		The need of an adapted and personalised transition—Progressive transition process (Rezakhany et al. 2025)
	A key transition professional	Transition coordinator (Nadarajah et al. 2021)
		Transition needs—Bridging professionals (Bove 2014)
		Identify a coordinating doctor and strengthen networking (Carles et al. 2023)
		Helpful—Central or familiar professionals—Professionals who prolonged care (Bove 2014)
		Helpful—Central or familiar professionals—Characteristics of caring professionals (Bove 2014)
	A transition passport or similar resource	Transition passport (Nadarajah et al. 2021)
		The value and content of an educational resource—Resource as a connection tool (Mooney et al. 2023)
		The value and content of an educational resource—Resource as a benchmark (Mooney et al. 2023)
		A digital navigation guide is convenient and helpful (Nicula et al. 2025)
	Involvement of peers/lived experience	A youth to youth session is convenient and helpful (Nicula et al. 2025)
		Transitions for ED youth intervention suggestions—The inclusion of peers with lived experience (Livanou et al. 2025)
	Emerging transfer supports	Being accompanied and welcomed in the adult care facility (Scanferla et al. 2025)
		Wishlist—Service needs—Integration of services [same physical space] (Bove 2014)
		Transitions for ED Youth intervention suggestions—Facilitating self‐management (Livanou et al. 2025)
		Provide a list of featuring area‐specific providers, for example private care (Nicula et al. 2025)
		A parent to parent session is convenient and helpful (Nicula et al. 2025)
9. Paediatric and adult services should foster positive relationships and develop a shared philosophy/culture for emerging adults.	Paediatric and adult services have different cultures/philosophies	Arrival in adult care services, a cultural change (Scanferla et al. 2025)
		[Different] ways of working (Wales et al. 2021)
		Different treatment cultures (Lockertsen et al. 2020a)
		Shift in treatment ethos—Confidentiality, change in treatment approach, autonomy (O’Loughlin 2012)
		It's not all about weight [CAMHS focus on weight] (Livanou et al. 2025)
		Counselling—Adjustment to counselling deliveries [changes in philosophy, family to individual or group, less focus on physical and more on psychological] (Bove 2014)
		Prior to discharge—Educate patient and families about differences between paediatric and adult care cultures (Dimitropoulos et al. 2015)
	Adult services are perceived as more stringent/rigid than paediatric services	Experience with AMHS—More demanding, much more responsibility, less guidance than CAMHS (Gilsbach et al. 2024)
		Experience with AMHS—Less familiar, more reserved than CAMHS (Gilsbach et al. 2024)
		Hindering—Managing treatment [adult services have different expectations, more responsibility] (Bove 2014)
		‘It takes time to create a trusting relationship’ (Lockertsen et al. 2020b)
		Discharge process [too quick from adult] (Wales et al. 2021)
	Delicate paediatric service/adult service relationship	Distrust between CAMHS and AMHS (Lockertsen et al. 2020a)
		Ambivalence from paediatric clinicians towards adult services (Carles et al. 2023)
		Lack of trust between services and not enough focus on building a new alliance (Lockertsen et al. 2020a)
10. Parents/carers should be involved but balanced with building independence.	Involve family/carers in transition	Facilitator—Parental involvement (Nadarajah et al. 2021)
		Continue to integrate the family into the transition (Carles et al. 2023)
		Involvement of carers (emotional and operational support) (Scanferla et al. 2025)
		We need carers involved—‘It's thanks to my mum for fighting’ (Livanou et al. 2025)
		Helpful aspects of familial support—Involvement in treatment [physical and practical aspects, accountability and motivation] (Dimitropoulos et al. 2016)
		Helpful aspects of familial support—Emotional support [talking, listening, validation via group or family therapy] (Dimitropoulos et al. 2016)
		Helpful—Support [family, partner, friends] (Bove 2014)
		Wishlist—Healthcare management needs—Outside support (Bove 2014)
	Parent role evolves, full control no longer appropriate	Parental involvement changes during transition process (Dimitropoulos et al. 2012)
		Family interventions to facilitate service transition [more individual work prior, parent groups after] (Dimitropoulos et al. 2013)
		Family's role in the turmoil (parents being kept at a distance, loss of authority) (Stocker et al. 2022)
		Unhelpful aspects of familial support [control rather than involvement] (Dimitropoulos et al. 2016)
		Unhelpful aspects of familial support—Emotional support [lack of understanding, volatile responses] (Dimitropoulos et al. 2016)
		Challenges with accepting familial support—Young adults have mixed feelings about recovery, relapse is both opportunity and threat (Dimitropoulos et al. 2016)
		Challenges with accepting familial support—Young adults have mixed feelings about parental involvement in recovery, desire for both autonomy and ongoing support (Dimitropoulos et al. 2016)
		The changing role of family (Harboe et al. 2025)
	Autonomy and independence are an opportunity and a challenge	Moving towards adulthood (Scanferla et al. 2025)
		A programme to support towards autonomy (Carles et al. 2023)
		Autonomy and independence (Nadarajah et al. 2021)
		Helpful—Managing treatment—Managing independently without family involvement (Bove 2014)
		Concerns about the transition process—Being unable to cope with the responsibility and autonomy expected of adults (Gilsbach et al. 2024)
		Illness interrupts normative developmental processes (Dimitropoulos et al. 2012)
		Issues in adult care—New autonomy (Mooney et al. 2023)
		Sudden shift in responsibility (Harboe et al. 2025)
11. EDs present unique challenges; transition guidelines or interventions specific to EDs may support consistent transfers	EDs present specific challenges	Illness related factors—Denial and ambivalence (Dimitropoulos et al. 2012)
		Clinical specificities hindering the transition process (Stocker et al. 2022)
		Unique challenges for ED patients—Late age of onset [in comparison to other paediatric illnesses] (Mooney et al. 2023)
		Unique challenges for ED patients—Cycle of symptoms (Mooney et al. 2023)
	Transfer procedures lack consistency, guidelines or interventions indicated	A protocol as for other chronic diseases (Carles et al. 2023)
		Accounts of inconsistent transfer procedures (Dimitropoulos et al. 2015)
		Wish list—Transition needs—Elements of a successful transition [individual transition plan, early preparation, communication, planning, organization, bridging, co‐management] (Bove 2014)
12. Adult supports include (1) programming specific to emerging adults, (2) increased resources, and (3) more ED training for generalist mental health services.	Additional resources for transitioning youth needed within adult services	Hindering—Counselling—Individual counselling [limited sessions in adult services] (Bove 2014)
		Wishlist—Counselling needs—Increased individual counselling [in adult services] (Bove 2014)
		Hindering—Counselling—Group and family [more group focused than individual] (Bove 2014)
		Transition to treatment with peers (Harboe et al. 2025)
		Hindering—Service availability—[Lack of] comprehensive services (Bove 2014)
		Wishlist—Service needs—Comprehensive services (Bove 2014)
		Hindering—Service availability—General eating disorder services [lack of resources for moderate severity] (Bove 2014)
		Wishlist—Service needs—[More] levels of support (Bove 2014)
		Hindering—Service availability—Private services [when lack of public healthcare] (Bove 2014)
		Wishlist—Service needs—Other resources [think outside the box, refer outside the community] (Bove 2014)
		Wishlist—Counselling needs—Generalised counselling [for anxiety, depression] (Bove 2014)
		Issues with adult care—[No support for] comorbidities (Mooney et al. 2023)
		Experiences with AMHS—Desire for more treatment offers for young adults with AN, complained of lack of individualised care (Gilsbach et al. 2024)
		Navigating the complexity of transitions—Systemic and service‐based challenges [lack of tailored care, support for comorbidities] (Livanou et al. 2025)
	Emerging adult programming	Wishlist—Transition needs—Emerging adult groups (Bove 2014)
		Interventions for young adults to help facilitate service transitions [skills groups] (Dimitropoulos et al. 2013)
		Wishlist—Transition needs—Emerging adult programs (Bove 2014)
	Lack of expertise in EDs in general adult mental health services	Hindering—Competency—[Lack of] experience with eating disorder treatment (Bove 2014)
		Hindering—Competency—[Lack of] professional support (Bove 2014)
		Aspects that kept patients at CAMHS—Doubts about the expertise of AMHS therapists in treating EDs (Gilsbach et al. 2024)

Abbreviations: AMHS, Adult mental health services; CAMHS, Child and adolescent mental health services.

3.5. Critical Appraisal and Credibility Check

Details on the critical appraisal findings by individual study can be found in Supporting Information S1: Table S1. The combined dependability and credibility of each synthesised finding can be found in Table 3.

TABLE 3.

ConQual summary of findings.

Review title: Experience of transitions from child to adult eating disorder services: A qualitative meta‐aggregation
Population: All stakeholders in the transition from paediatric to adult ED services, that is, patients, parents/carers, clinicians
Phenomenon of interest: The experiences of these stakeholders in the transition from paediatric to adult ED services.
Synthesised finding	Type of research	Dependability a	Credibility b	ConQual score
Age‐related service transfers affect continuity and deserve specific attention.	Qualitative	No change	−1	Moderate
Consideration should be given to the distress of the young person, family, and clinician.	Qualitative	−1	−1	Low
Clear communication between the young person, families, and services	Qualitative	−1	−1	Low
Paediatric supports include (a) early conversations and (b) fostering health management skills prior to transfer.	Qualitative	−1	−1	Low
Transition timing should consider developmental stage or readiness.	Qualitative	−1	−1	Low
Transition plans should be personalised and consider other life goals and transitions.	Qualitative	−1	−1	Low
Referral should be more straightforward; GPs supporting during referral gap need more ED training.	Qualitative	−1	−1	Low
Joint transition supports include (a) a period of overlapping care, (b) a key transition professional, (c) transition passport or resource, and (d) peer support/lived experience involvement. Additional ideas are still emerging.	Qualitative	−1	−1	Low
Paediatric and adult services should foster positive relationships and develop a shared philosophy/culture for emerging adults.	Qualitative	−1	−1	Low
Parents/carers should be involved but balanced with building the young person's independence.	Qualitative	−1	−1	Low
EDs present unique challenges; transition guidelines or interventions specific to EDs may support consistent transfers	Qualitative	No change	−1	Moderate
Adult supports include (a) programming specific to emerging adults, (b) increased resources, and (c) more ED training for generalist mental health services.	Qualitative	No change	−1	Moderate

^a Downgraded one level if most studies had no statement locating the researcher and no acknowledgement of their influence on the research.

^b Downgraded one level if the relevant studies have a mix of unequivocal and equivocal/credible findings.

4. Discussion

This study aimed to synthesise and appraise the qualitative data on transitions from paediatric to adult services for EDs, using a meta‐aggregative approach, which is the preferred method of qualitative synthesis when the aim is to develop recommendations (Lockwood et al. 2020). Results from reports were integrated into 12 synthesised findings (see Table 3). Our findings broadly support previous reviews on the topic on the problematic nature of age transitions in EDs and the contributing factors (Ragnhildstveit et al. 2024; Wade 2023). Our approach adds to the previous research by integrating an additional 11 qualitative reports—providing additional nuance to the lived experiences of age transitions in ED care—and examining the strength of the evidence behind each finding.

Our results also align with suggested components of transition presented in existing guidance documents, including the UK Royal College of Psychiatrists (2017) guidelines for managing transitions when a patient has an ED, the UK‐based ED charity Beat's (2020) best practice standards for transitions across ED services, and the NHS East of England (2022) transition standards for ED services. Our findings also fit with the Ragnhildstveit et al. ’s (2024) TRIPS (Timely talks, Readiness, Inclusion, Preparation, Synergy) framework—which serves to guide age transitions in ED services—as well as the general ethos of the Canadian guideline on transitions for youth and young adults with EDs, which broadly recommend an integrated and collaborative transition approach (Dimitropoulos et al. 2025).

While the synthesised findings reported in this review are largely consistent with previous reviews and existing guidance, this is the first review to evaluate the level of confidence underpinning potential discrete components of a transition plan or protocol in ED services. This work therefore provides a bridge between existing expert opinion and consensus‐based guidance with future intervention development, including ongoing co‐design initiatives (e.g., Dimitropoulos et al. 2023; Livanou et al. 2026). Rather than proposing new transition components, this review offers an evidence‐informed basis for selecting and implementing transition plan components in clinical practice. In this way, the current review contributes to the field's movement towards more explicitly evidence‐based approaches to transition care in ED services.

4.1. Limitations

There are several limitations to our work. The descriptive nature of meta‐aggregation, in contrast to interpretive or theory building approaches, means that the rich contextual detail present in many of the included original studies was diluted, and nuance flattened. Meta‐aggregation also combined qualitative studies across diverse epistemological positions, resulting in underlying assumptions about knowledge generation and meaning could not be fully preserved. There may be utility in further interpretive synthesis on this topic. Secondly, while a meta‐aggregative approach is considered an ‘objective’ method for qualitative synthesis, the grouping of findings and the resulting recommendation statements still involved subjective judgement; alternative hierarchical structures of findings and overarching statements are therefore possible. It is also possible that studies using certain methods contributed more substantially to the overall findings. For example, Bove's (2014) use of critical incident technique provided quantitatively more units of evidence in comparison to other approaches which favoured broad, overarching themes.

There were also methodological limitations to the individual studies which reduced the confidence. More specifically, 15 reports did not include a statement locating the researcher culturally or theoretically, nor did they explore the influence of the researcher on the research findings or the research process on the researcher, which decreased the level of dependability (Munn et al. 2014). Further, some studies did not provide a clear illustration, such as a participant quote, for themes or subthemes, which resulted in reduced credibility for some synthesised findings (Munn et al. 2014). Future research in this area may wish to prioritise the inclusion of positionality statements as well as supporting data for each reported finding.

The extent that the findings from the meta‐aggregation can be applied to all international settings is unclear, and likely, limited. As became apparent during the review, age transitions in ED services look different across healthcare systems and in rural versus urban settings. In some of the included studies, participants were treated in specialist ED services for children before being transferred to specialist ED services for adults, some were treated in generic paediatric mental health services before transferring to specialist adult ED services, and others were treated in specialist paediatric ED services before transferring to generic adult mental health services. Given the differential impact of specialist versus non‐specialist settings on ED treatment outcomes (House et al. 2012), it seems logical that the specialist ED services involved in transfers to or from generalist mental health services may have to put in ‘extra legwork’ to foster smooth transitions. It is also important to note that our findings cannot be generalised outside of the public and mixed healthcare systems in Western Europe and Canada, for example, to nations with primarily private healthcare systems or to low‐ and middle‐income countries. Further, no studies were based in Australia and the United States, countries that are major providers of ED services. Finally, many of the studies in the review focused on anorexia nervosa, and therefore transition experiences of young people with other ED diagnoses are likely unrepresented.

4.2. Clinical Implications and Future Research Directions

Given the relatively low ConQual scores (see Table 3) of many of the synthesised findings, these results should not be interpreted as a gold standard for transition care or a prescriptive list to inform policy. However, they are well placed to inform further development efforts, such as co‐design projects, pilot interventions, and local service design or quality improvement. ED services may wish to implement a combination of the synthesised findings as best suits their context and the young person in front of them.

Finally, as suggested by Scanferla et al. (2025), transitions, and any subsequent attempts to improve them, should be tracked using patient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMS). The impact of transition interventions in everyday clinical settings may be most illuminating when transition‐related measures are embedded within a programme of minimum routine outcome measurement (e.g., Austin et al. 2023; Bryant et al. 2023; Child Outcome Research Consortium (CORC) 2025; Jewell et al. 2025). Longitudinal data extending beyond the initial transition period is needed to better determine whether a ‘successful’ outcome has been achieved. Future qualitative research may also wish to examine how age transitions in EDs impacts those also navigating co‐occurring mental or physical health conditions and/or multiple services.

5. Conclusion

This qualitative meta‐aggregation provides a patient, parent/carer, and clinician‐informed foundation for improving age‐based transitions in ED services. Synthesising insights from 21 reports, we identified 12 actionable recommendations. While these generally align with existing components from existing guidance, we provide an appraised qualitative evidence base to support their use and refinement. As the field moves towards more evidence‐informed transition care, these findings offer a starting point for co‐design projects, pilot interventions, and local service design or quality improvement.

Author Contributions

Amelia Austin: conceptualization, formal analysis, investigation, methodology, project administration, writing – original draft. Manya Singh: project administration, validation, writing – original draft. Sela Scott: validation, writing – review and editing. Maria Nicula: conceptualization, validation, writing – review and editing. Andrea Krishnapillai: validation, writing – review and editing. Jayden Lee: validation, writing – review and editing. Cheryl Webb: validation, writing – review and editing. Ana Cláudia Vieira de Almeida: validation, writing – review and editing. Mehar Sesan: validation, writing – review and editing. Heidi Vander Steen: validation, writing – review and editing. Julia Hews‐Girard: validation, writing – review and editing. Christopher J. Mushquash: supervision, writing – review and editing. Melissa Kimber: supervision, writing – review and editing. Jennifer Couturier: conceptualization, funding acquisition, supervision, writing – review and editing. Gina Dimitropoulos: conceptualization, funding acquisition, supervision, writing – review and editing.

Funding

This research was funded by the CIHR, (Grant 47904).

Ethics Statement

The authors have nothing to report.

Consent

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Supporting Information S1

Austin, Amelia , Singh Manya, Scott Sela, et al. 2026. “Transition From Child to Adult Eating Disorder Services: A Qualitative Meta‐Aggregation,” European Eating Disorders Review: 34. no. 6), 1471–1495. 10.1002/erv.70134.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.