ADHD and driving safety
=======================

* Laurence Jerome

Margaret Weiss and Candice Murray's article on the management of attention-deficit hyperactivity disorder (ADHD) in adults1 was exemplary but did not mention one important area of functional impairment: problems with driving.

The greater prevalence of motor vehicle collisions among ADHD patients was first described in follow-up studies of childhood ADHD2 and has since been confirmed by other researchers.3 , 4 , 5 Adults with ADHD who have been characterized as impulsive, fast drivers with attention problems are also prone to aggressive driving and so-called “road rage.”

Although CMA recommendations on assessment of fitness to drive6 now include uncontrolled ADHD as a medical condition reportable to the provincial ministry of transport, the efficacy of medical interventions in reducing driving risk in adults with ADHD is not well established. In a case series of 100 adults with ADHD whose symptoms were effectively treated with stimulants (either methylphenidate or dextroamphetamine), spouses rated the patients as significantly less impulsive and generally safer while driving over a 36-month follow-up period.7 Similar supportive studies have demonstrated better driving performance with stimulants than without any medication.8

Inquiring about driving history would now seem to be an important part of establishing a profile of functional impairment among adults with ADHD. Further research is needed to establish the efficacy of stimulants and newer nonstimulant medications in reducing collisions in this high-risk population. 

**Laurence Jerome** Consultant Psychiatrist Amethyst ADHD Programme London, Ont.

## References

1.  1. Weiss M, Murray C. Assessment and management of attention-deficit hyperactivity disorder in adults. CMAJ 2003;168(6):715-22.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjgvNi83MTUiO3M6NDoiYXRvbSI7czoyMToiL2NtYWovMTY5LzEvMTYuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. Hechtman L, Weiss G, Berlman T. Young adult outcome of hyperactive children who received long term stimulant treatment. J Am Acad Child Psychiatry 1984;23:261-9. 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=6736490&link_type=MED&atom=%2Fcmaj%2F169%2F1%2F16.1.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=A1984SS67500003&link_type=ISI) 

3.  3. Barkley RA, Guevremont DC, Anastopoulos AD, DuPaul GJ, Shelton TL. Driving-related risks and outcomes of attention deficit hyperactivity disorder in adolescents and young adults: a 3- to 5-year follow-up survey. Pediatrics 1993; 92: 212-8.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTA6InBlZGlhdHJpY3MiO3M6NToicmVzaWQiO3M6ODoiOTIvMi8yMTIiO3M6NDoiYXRvbSI7czoyMToiL2NtYWovMTY5LzEvMTYuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

4.  4. Barkley RA, Murphy KR, DuPaul GI, Bush T. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse oputcomes, and the role of executive functioning. J Int Neuropsychol Soc 2002;8:655-72. 
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1017/S1355617702801345&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=12164675&link_type=MED&atom=%2Fcmaj%2F169%2F1%2F16.1.atom) 
    
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5.  5. Jerome L, Segal A. ADHD, executive function and problem driving. ADHD Rep 2000;8(2):7-11. 
    
    

6.  6. Behavioural and learning difficulties. In: *Determining medical fitness to drive: a guide for physicians*. 6th ed. Ottawa: Canadian Medical Association; 2000. p. 57.
    
    

7.  7. Jerome L, Segal A. Benefit of long-term stimulants on driving in adults with ADHD. J Nerv Ment Dis 2001;189:63-4. 
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1097/00005053-200101000-00013&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=11206669&link_type=MED&atom=%2Fcmaj%2F169%2F1%2F16.1.atom) 

8.  8. Cox DJ, Merkel RL, Kovatchev B, Seward R. Effect of stimulant medication on driving performance of young adults with attention-deficit hyperactivity disorder.J Nerv Ment Dis 2000; 188:230-4. 
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1097/00005053-200004000-00006&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=10790000&link_type=MED&atom=%2Fcmaj%2F169%2F1%2F16.1.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000086467900006&link_type=ISI)