Driving and Road Rage Associated with Attention Deficit Hyperactivity Disorder (ADHD): a Systematic Review

  • Parikshit DeshmukhEmail author
  • Dhara Patel
ADHD (G Kulkarni, Section Editor)
Part of the following topical collections:
  1. Topical Collection on ADHD


Purpose of Review

The main objective of the present review was to give an overall idea regarding the impacts of ADHD on driving and road rage. In addition, we have also discussed the possible treatment options for ADHD drivers in brief.

Recent Findings

Attention deficit hyperactivity disorder (ADHD) is a type of developmental disorder, which is characterized by hyperactivity, impulsivity, and inattention. ADHD affects around 2.5% of the population. Individuals with ADHD have numerous impairments of cognitive, emotional, and social functioning. And this affects their day-to-day life. One of the major daily activities, which get affected due to ADHD, is driving. Individuals with ADHD have been reported to be involved in greater number of driving accidents due to their aggressive behavior and anger. Moreover, it has been related with augmented number of traffic violations, associated injuries, and increased chances of dying during a driving accident.


In the current review, we have discussed how ADHD affects driving behavior and leads to road rage.


Attention deficit hyperactivity disorder ADHD Driving Road rage 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Liddle EB, Hollis C, Batty MJ, Groom MJ, Totman JJ, Liotti M, et al. Task-related default mode network modulation and inhibitory control in ADHD: effects of motivation and methylphenidate. J Child Psychol Psychiatry Allied Discip. 2011;52:761–71. Scholar
  2. 2.
    Sergeant J. The cognitive-energetic model: an empirical approach to attention-deficit hyperactivity disorder. Neurosci Biobehav Rev. 2000;24:7–12. Scholar
  3. 3.
    Kuntsi J, Wood AC, Rijsdijk F, Johnson KA, Andreou P, Albrecht B, et al. Separation of cognitive impairments in attention-deficit/hyperactivity disorder into 2 familial factors. Arch Gen Psychiatry. 2010;67:1159–67. Scholar
  4. 4.
    • Simon V, Czobor P, Bálint S, Mészáros Á, Bitter I. Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry. 2009;194:204–11. meta-analysis provides detailed prevalence of ADHD.CrossRefGoogle Scholar
  5. 5.
    •• Biederman J, Petty CR, Woodworth KY, Lomedico A, Hyder LL, Faraone SV. Adult outcome of attention-deficit/hyperactivity disorder: a controlled 16-year follow-up study. J Clin Psychiatry. 2012;73:941–50. study includes one of the longest follow-up of ADHD patients.CrossRefPubMedGoogle Scholar
  6. 6.
    Mannuzza S, Klein RG, Bessler A, Malloy P, Lapadula M. Adult psychiatric status of hyperactive boys grown up. Am J Psychiatry. 1998;155:493–8. Scholar
  7. 7.
    Biederman J, Faraone SV, Keenan K, Knee D, Tsuang MT. Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. J Am Acad Child Adolesc Psychiatry. 1990;29:526–33. Scholar
  8. 8.
    Faraone SV, Biederman J, Keenan K, Tsuang MT. Separation of DSM-III attention deficit disorder and conduct disorder: evidence from a family-genetic study of American child psychiatric patients. Psychol Med. 1991;21:109–21. Scholar
  9. 9.
    Biederman J, Faraone SV, Mick E, Spencer T, Wilens T, Kiely K, et al. High risk for attention deficit hyperactivity disorder among children of parents with childhood onset of the disorder: a pilot study. Am J Psychiatry. 1995;152:431–5. Scholar
  10. 10.
    • Purper-ouakil D, Grosbellet E, Gorwood P (2019) Neurobiology of attention deficit / hyperactivity disorder neurobiology of attention deficit / hyperactivity disorder pathophysiological hypotheses. Potential risk factors. 1–11. DOI: This study provides detailed etiology of ADHD. CrossRefGoogle Scholar
  11. 11.
    •• Nomura Y, Marks DJ, Halperin JM. Prenatal exposure to maternal and paternal smoking on attention deficit hyperactivity disorders symptoms and diagnosis in offspring. J Nerv Ment Dis. 2010;198:672–8. study evaluates whether prenatal maternal and paternal smoking and ADHD are associated. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    •• Tice P, Hunter D, Bose J, Hedden S, Ringeisen H, Casanueva C, Stambaugh L (2016) DSM-5 changes: implications for child serious emotional disturbance. 73. This is an updated DSM-5 guideline. Google Scholar
  13. 13.
    •• Koisaari T, Michelsson K, Holopainen JM, Maksimainen R, Päivänsalo J, Rantala K, et al. Traffic and criminal behavior of adults with attention deficit–hyperactivity with a prospective follow-up from birth to the age of 40 years. Traffic Inj Prev. 2015;16:824–30. study assesses how road rage and ADHD are related. CrossRefPubMedGoogle Scholar
  14. 14.
    • Boonstra AM, Oosterlaan J, Sergeant JA, Buitelaar JK. Executive functioning in adult ADHD: a meta-analytic review. Psychol Med. 2005;35:1097–108. This review summarizes the functioning impairment in adult ADHD patients. CrossRefPubMedGoogle Scholar
  15. 15.
    • Classen S, Monahan M, Brown KE, Hernandez S. Driving indicators in teens with attention deficit hyperactivity and/or autism spectrum disorder: indicateurs de la conduite automobile chez les jeunes ayant un deficit de l’attention avec hyperactivite ou un trouble du spectre autistique. Can J Occup Ther. 2013;80:274–83. study explains how driving is affected in teens with ADHD. CrossRefPubMedGoogle Scholar
  16. 16.
    • Barkley RA, Murphy KR, Dupaul GI, Bush T. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. J Int Neuropsychol Soc. 2002;8:655–72. study explains how driving is affected in young adults with ADHD. CrossRefPubMedGoogle Scholar
  17. 17.
    Cox DJ, Madaan V, Cox BS. Adult attention-deficit/hyperactivity disorder and driving: why and how to manage it. Curr Psychiatry Rep. 2011;13:345–50. Scholar
  18. 18.
    •• Groom MJ, van Loon E, Daley D, Chapman P, Hollis C. Driving behaviour in adults with attention deficit/hyperactivity disorder. BMC Psychiatry. 2015;15:175. study assesses driving behavior in adults with ADHD. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Mannuzza S, Klein RG. Long-term prognosis in attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am. 2000;9:711–26. Scholar
  20. 20.
    Winston FK, Senserrick TM. Competent independent driving as an archetypal task of adolescence. Inj Prev. 2006. Scholar
  21. 21.
    Johnson SB, Blum RW, Giedd JN. Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy. J Adolesc Heal. 2009;45:216–21. Scholar
  22. 22.
    Romer D. Adolescent risk taking, impulsivity, and brain development: implications for prevention. Dev Psychobiol. 2010;52:263–76. Scholar
  23. 23.
    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. Scholar
  24. 24.
    Ahmed SP, Bittencourt-Hewitt A, Sebastian CL. Neurocognitive bases of emotion regulation development in adolescence. Dev Cogn Neurosci. 2015;15:11–25. Scholar
  25. 25.
    Theurel A, Gentaz E. The regulation of emotions in adolescents: age differences and emotion-specific patterns. PLoS One. 2018. Scholar
  26. 26.
    •• Narad M, Garner AA, Brassell AA, Saxby D, Antonini TN, O’Brien KM, et al. Impact of distraction on the driving performance of adolescents with and without attention-deficit/hyperactivity disorder.[Summary for patients in JAMA Pediatr. 2013 Oct;167(10):984; PMID: 24100395]. JAMA Pediatr, This study evaluates and compares driving performance in patients with and without ADHD. 2013;167:933–8. Scholar
  27. 27.
    Kingery KM, Narad M, Garner AA, Antonini TN, Tamm L, Epstein JN. Extended visual glances away from the roadway are associated with ADHD- and texting-related driving performance deficits in adolescents. J Abnorm Child Psychol. 2015;43:1175–86. Scholar
  28. 28.
    Weiss G, Hechtman L, Perlman T, Hopkins J, Wener A. Hyperactives as young adults: a controlled prospective ten-year follow-up of 75 children. Arch Gen Psychiatry. 1979;36:675–81. Scholar
  29. 29.
    Murphy K, Barkley RA. Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr Psychiatry. 37:393–401. Scholar
  30. 30.
    Hechtman L, Weiss G, Perlman T, Tuck D. Hyperactives as young adults: various clinical outcomes. Adolesc Psychiatry (Hilversum). 1981;9:295–306.Google Scholar
  31. 31.
    Kastrup M, Dupont A, Bille M, Lund H. Traffic accidents involving psychiatric patients: characteristics of accidents involving drivers who have been admitted to danish psychiatric departments. Acta Psychiatr Scand. 1978;58:30–9. Scholar
  32. 32.
    Noyes R. Motor vehicle accidents related to psychiatric impairment. Psychosomatics. 1985;26:569–72, 575–6, 579–80. Scholar
  33. 33.
    • Vaa T. ADHD and relative risk of accidents in road traffic: a meta-analysis. Accid Anal Prev. 2014;62:415–25. meta-analysis explains how road accidents are associated with ADHD. CrossRefPubMedGoogle Scholar
  34. 34.
    •• Curry AE, Metzger KB, Pfeiffer MR, Elliott MR, Winston FK, Power TJ. Motor vehicle crash risk among adolescents and young adults with attention-deficit/hyperactivity disorder. JAMA Pediatr. 2017;171:756–63. study evaluates the possibility of road accidents in young adults with ADHD. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    • Shaw FA, Park SJ, Bae JI, Becerra Z, Corso GM, Rodgers MO, et al. Effects of roadside distractors on performance of drivers with and without attention deficit tendencies. Transp Res Part F Traffic Psychol Behav. 2019;61:141–51. study evaluates how ADHD patients get easily distracted by roadside distractors. CrossRefGoogle Scholar
  36. 36.
    Bioulac S, Sagaspe P, Micoulaud-Franchi J-A, Altena E, Taillard J, Schröder C, et al. Objective level of alertness and inhibitory control predict highway driving impairment in adults with ADHD. J Atten Disord. 2016.
  37. 37.
    Reimer B, Mehler B, D’Ambrosio LA, Fried R. The impact of distractions on young adult drivers with attention deficit hyperactivity disorder (ADHD). Accid Anal Prev. 2010;42:842–51. Scholar
  38. 38.
    Lam LT. Distractions and the risk of car crash injury: the effect of drivers’ age. J Safety Res. 2002;33:411–9. Scholar
  39. 39.
    •• El Farouki K, Lagarde E, Orriols L, Bouvard MP, Contrand B, Galéra C, et al. The increased risk of road crashes in attention deficit hyperactivity disorder (ADHD) adult drivers: driven by distraction? Results from a responsibility case-control study. PLoS One. 2014. study establishes that there is an augmented risk of driving accidents in patients with ADHD. CrossRefGoogle Scholar
  40. 40.
    Tillmann WA, Hobbs GE. The accident-prone automobile driver; a study of the psychiatric and social background. Am J Psychiatry. 1949;106:321–31. Scholar
  41. 41.
    Nada-Raja S, Langley JD, McGee R, Williams SM, Begg DJ, Reeder AI. Inattentive and hyperactive behaviors and driving offenses in adolescence. J Am Acad Child Adolesc Psychiatry. 1997;36:515–22. Scholar
  42. 42.
    Das D, Cherbuin N, Butterworth P, Anstey KJ, Easteal S. A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults. PLoS One. 2012;7:e31500. Scholar
  43. 43.
    Biederman J, Faraone SV, Monuteaux MC, Bober M, Cadogen E. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol Psychiatry. 2004;55:692–700. Scholar
  44. 44.
    Ginsberg Y, Hirvikoski T, Lindefors N. Attention deficit hyperactivity disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder. BMC Psychiatry. 2010.
  45. 45.
    Philipsen A, Graf E, Jans T, Matthies S, Borel P, Colla M, et al. A randomized controlled multicenter trial on the multimodal treatment of adult attention-deficit hyperactivity disorder: enrollment and characteristics of the study sample. ADHD Atten Deficit Hyperact Disord. 2014;6:35–47. Scholar
  46. 46.
    Spencer T, Biederman J, Wilens T, Doyle R, Surman C, Prince J, et al. A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005;57:456–63. Scholar
  47. 47.
    Richards T, Deffenbacher J, Rosén L. Driving anger and other driving-related behaviors in high and low ADHD symptom college students. J Atten Disord. 2002;6:25–38. Scholar
  48. 48.
    •• Richards TL, Deffenbacher JL, Rosén LA, Barkley RA, Rodricks T. Driving anger and driving behavior in adults with ADHD. J Atten Disord. 2006;10:54–64. study evaluates the driving behavior in adults with ADHD. CrossRefPubMedGoogle Scholar
  49. 49.
    •• Merkel RL, Nichols JQ, Fellers JC, Hidalgo P, Martinez LA, Putziger I, et al. Comparison of on-road driving between young adults with and without ADHD. J Atten Disord. 2016;20:260–9. study reports that young adults with ADHD have increased likelihood of being in an accident while driving. CrossRefPubMedGoogle Scholar
  50. 50.
    Fischer M, Barkley RA, Smallish L, Fletcher K. Hyperactive children as young adults: driving abilities, safe driving behavior, and adverse driving outcomes. Accid Anal Prev. 2007;39:94–105. Scholar
  51. 51.
    •• Curry AE, Yerys BE, Metzger KB, Carey ME, Power TJ. Traffic crashes, violations, and suspensions among young drivers with ADHD. Pediatrics. 2019. study reports that patients with ADHD have increased traffic violations and accidents. CrossRefGoogle Scholar
  52. 52.
    Barkley RA, Murphy KR, Kwasnik D. Motor vehicle driving competencies and risks in teens and young adults with attention deficit hyperactivity disorder. Pediatrics. 1996;98:1089–95 DOI: Scholar
  53. 53.
    Ougrin D, Chatterton S, Banarsee R. Attention deficit hyperactivity disorder (ADHD): review for primary care clinicians. London J Prim Care (Abingdon). 2010;3:45–51. Scholar
  54. 54.
    Cox DJ, Davis M, Mikami AY, Singh H, Merkel RL, Burket R. Long-acting methylphenidate reduces collision rates of young adult drivers with attention-deficit/hyperactivity disorder. J Clin Psychopharmacol. 2012;32:225–30. Scholar
  55. 55.
    • Sobanski E, Sabljic D, Alm B, Dittmann RW, Wehmeier PM, Skopp G, et al. Driving performance in adults with ADHD: results from a randomized, waiting list controlled trial with atomoxetine. Eur Psychiatry. 2013;28:379–85. study reports beneficial effects of atomoxetine in adults with ADHD. CrossRefPubMedGoogle Scholar
  56. 56.
    Cox DJ, Merkel RL, Kovatchev B, Seward R. Effect of stimulant medication on driving performance of young adults with attention-deficit hyperactivity disorder: a preliminary double-blind placebo controlled trial. J Nerv Ment Dis. 2000;188:230–4. Scholar
  57. 57.
    Fabiano GA, Schatz NK, Morris KL, Willoughby MT, Vujnovic RK, Hulme KF, et al. Efficacy of a family-focused intervention for young drivers with attention-deficit hyperactivity disorder. J Consult Clin Psychol. 2016;84:1078–93. Scholar
  58. 58.
    Markham PT, Porter BE, Ball JD. Effectiveness of a program using a vehicle tracking system, incentives, and disincentives to reduce the speeding behavior of drivers with ADHD. J Atten Disord. 2013;17:233–48. Scholar
  59. 59.
    • Kay GG, Michaels MA, Pakull B. Simulated driving changes in young adults with ADHD receiving mixed amphetamine salts extended release and atomoxetine. J Atten Disord. 2009;12:316–29. study reports beneficial effects of atomoxetine and amphetamine salts in adults with ADHD. CrossRefPubMedGoogle Scholar
  60. 60.
    • Cox DJ, Moore M, Burket R, Merkel RL, Mikami AY, Kovatchev B. Rebound effects with long-acting amphetamine or methylphenidate stimulant medication preparations among adolescent male drivers with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2008;18:1–10. study reports effects of atomoxetine in adults with ADHD. CrossRefPubMedGoogle Scholar
  61. 61.
    Cox DJ, Merkel RL, Moore M, Thorndike F, Muller C, Kovatchev B. Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder. Pediatrics. 2006;118:e704–10. Scholar
  62. 62.
    Barkley RA, Murphy KR, O’Connell T, Connor DF. Effects of two doses of methylphenidate on simulator driving performance in adults with attention deficit hyperactivity disorder. J Safety Res. 2005;36:121–31. Scholar
  63. 63.
    Cox DJ, Humphrey JW, Merkel RL, Penberthy JK, Kovatchev B. Controlled-release methylphenidate improves attention during on-road driving by adolescents with attention-deficit/hyperactivity disorder. J Am Board Fam Pract. 17:235–9. Scholar
  64. 64.
    Biederman J, Fried R, Hammerness P, Surman C, Mehler B, Petty CR, et al. The effects of lisdexamfetamine dimesylate on the driving performance of young adults with ADHD: a randomized, double-blind, placebo-controlled study using a validated driving simulator paradigm. J Psychiatr Res. 2012;46:484–91. Scholar
  65. 65.
    Kapoor M, Lyon M, Juneja L. The effects of L-theanine on objective sleep quality in boys with attention deficit hyperactivity disorder. Altern Med Rev. 2011;16:348–54.PubMedGoogle Scholar
  66. 66.
    Dvoráková M, Sivonová M, Trebatická J, Skodácek I, Waczuliková I, Muchová J, et al. The effect of polyphenolic extract from pine bark, Pycnogenol on the level of glutathione in children suffering from attention deficit hyperactivity disorder (ADHD). Redox Rep. 2006;11:163–72. Scholar
  67. 67.
    • Trebatická J, Kopasová S, Hradecná Z, et al. Treatment of ADHD with French maritime pine bark extract, Pycnogenol. Eur Child Adolesc Psychiatry. 2006;15:329–35. study reports beneficial effects of Pycnogenol for the treatment of ADHD. CrossRefPubMedGoogle Scholar
  68. 68.
    • Mitchell JT, Zylowska L, Kollins SH. Mindfulness meditation training for attention-deficit/hyperactivity disorder in adulthood: current empirical support, treatment overview, and future directions. Cogn Behav Pract. 2015;22:172–91. study reports how meditation is helpful for the management of ADHD. CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Schoenberg PLA, Hepark S, Kan CC, Barendregt HP, Buitelaar JK, Speckens AEM. Effects of mindfulness-based cognitive therapy on neurophysiological correlates of performance monitoring in adult attention-deficit/hyperactivity disorder. Clin Neurophysiol. 2014;125:1407–16. Scholar
  70. 70.
    Zylowska L, Ackerman DL, Yang MH, Futrell JL, Horton NL, Hale TS, et al. Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study. J Atten Disord. 2008;11:737–46. Scholar
  71. 71.
    • van de Weijer-Bergsma E, Formsma AR, de Bruin EI, Bögels SM. The effectiveness of mindfulness training on behavioral problems and attentional functioning in adolescents with ADHD. J Child Fam Stud. 2012;21:775–87. study reports how meditation is helpful for patients with ADHD. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Balanced Wellbeing LLCOxfordUSA

Personalised recommendations