Do Pharmaceuticals Improve Driving in Individuals with ADHD? A Review of the Literature and Evidence for Clinical Practice
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Attention-deficit/hyperactivity disorder (ADHD) is defined as a disorder of impaired attention and/or behavioral control. Studies suggest that the condition can dispose individuals to a higher risk of automobile accidents. ADHD symptoms respond to pharmacotherapy in a majority of uncomplicated cases. Evidence on how pharmacotherapies for ADHD impact driving behavior or outcomes could allow clinicians to support on-road safety rationally. We therefore undertook a review to identify the evidence base to date indicating positive or negative effects of pharmacotherapies on driving behavior in individuals with ADHD. Further, we evaluated the level of evidence for these effects, their specificity to ADHD, and how they may inform clinical care. We identified studies involving pharmacotherapy for ADHD that evaluated driving-related activities or outcomes. We then categorized these studies by the mode of measurement used and by the ADHD specificity of the driving behaviors measured. Finally, we extracted themes of interest to clinical practice in pharmacologic intervention. In total, 14 studies, involving 2–61 subjects diagnosed with ADHD, looked at computer-measured, observer-measured, or self-reported driving behavior correlates of pharmacotherapy during simulation or on-road driving. Of these studies, 13 involved psychostimulant agents and two used atomoxetine. All but three investigations (one of methylphenidate, one of mixed amphetamine salts, and one of atomoxetine) found favorable changes in measures such as steering and braking behaviors or reaction to unexpected events. One study found adverse effects on driving at hour 17 following mixed amphetamine salt administration. Four studies compared two pharmacotherapies, and each found differences in measured driving behavior between the therapies. One study explored impact on ADHD-specific driving impairments, and the same study was the only one to explore correlation of clinical measures (ADHD symptoms and self-reported driving behavior) with medication-associated changes—finding dissociation between changes in ADHD symptoms and changes in measured driving measures. While data to date are limited on the ADHD-specific effects of pharmacotherapies used for ADHD on driving, it is clear from our review that these agents have effects on driving-relevant behaviors. Further research is urgently needed to develop an evidence base for clinically predictable effects of pharmacotherapy on driving safety in individuals with ADHD. If possible, clinicians should evaluate the positive and negative effects of pharmacotherapy on driving in their clients.
Compliance with Ethical Standards
No sources of funding were used to prepare this manuscript.
Conflict of interest
Craig Surman, MD, reports the following conflicts in his lifetime. Speaking/education: Arbor, McNeil, Janssen, Janssen-Ortho, Novartis, Shire, and Reed/MGH Academy. Global medical education: funded by multiple companies. Research Support: MGH Adult ADHD Program: National Institutes of Health, Abbot, Cephalon, Hilda and Preston Davis Foundation, Eli Lilly, Magceutics, J & J/McNeil, Merck, Magceutics/Neurocentria, Nordic Naturals, Nestle/Pamlab, Pfizer, Organon, Shire, Takeda. Consulting: McNeil, Nutricia/Dannone, Rhodes, Takeda, Shire, Somaxon. Book royalties: Fast Minds: How to Thrive if you have ADHD (Or Think you Might), ADHD in Adults: A Practical Guide to Evaluation and Management. Ronna Fried, EdD, Lauren Rhodewalt, and Heidi Boland have no conflicts of interest.
- 1.World Health Organization. World Health Statistics 2016. Road traffic injuries. Geneva: World Health Organization; 2016. http://www.who.int/gho/publications/world_health_statistics/2016/whs2016_annexa_roadtraffic.pdf?ua=1&ua=1. Accessed 16 Nov 2016
- 3.Kessler RC. Prevalence of adult ADHD in the United States: results from the national comorbidity survey replication (NCS-R). Paper presented at: Annual Meeting of the American Psychiatric Association: New York; May 1–6, 2004.Google Scholar
- 4.Faraone SV. Adult ADHD: A family-genetic perspective. Paper presented at: 157th Annual Meeting of the American Psychiatric Association; New York; May 1–6, 2004.Google Scholar
- 5.Biederman J, Faraone SV, Mick E. Psychiatric and functional outcome of adolescent females with ADHD: a large, controlled, five-year longitudinal follow-up study. Paper presented at: 158th Annual meeting of the American Psychiatric Association: Atlanta; May 21–26, 2005.Google Scholar
- 15.Chang Z, Quinn PD, Hur K. Association between medication use for attention-deficit/hyperactivity disorder and risk of motor vehicle crashes. JAMA. 2017;74(6):597–603.Google Scholar
- 23.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.CrossRefPubMedGoogle Scholar
- 24.Bjørkli CA, Flø M, Jenssen GD, Ryum T, Zeiner P. Assessment of fitness to drive among patients with learning difficulties. SINTEF. 2005;STF50:A05027.Google Scholar
- 27.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.CrossRefPubMedGoogle Scholar
- 31.Barkley RA, Murphy KR, Dupaul GJ, 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.Google Scholar
- 35.Rizzo M, Kellison IL. The Brain on the Road. In: Marcotte TD, Grant I, editors. Neuropsychology of everyday functioning (the science and practice of neuropsychology). New York: Guilford Press; 2009. p. 168–208.Google Scholar
- 36.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.CrossRefPubMedGoogle Scholar
- 38.Biederman J, Fried R, Monuteaux MC, Reimer B, Coughlin JF, Surman CB, Aleardi M, Dougherty M, Schoenfeld S, Spencer TJ, Faraone SV. A laboratory driving simulation for assessment of driving behavior in adults with ADHD: a controlled study. Ann Gen Psychiatry. 2007;6:4. doi: 10.1186/1744-859X-6-4.