ADHD and driving safety

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.