ATTENTION DEFICIT HYPERACTIVITY DISORDER:
SAFETY ISSUES

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MORE ACCIDENTS... MORE SERIOUS INJURIES, TOO?

Not only is there some indication that children with ADHD may be more 'accident prone,' but it appears that they are also likely to experience more serious injuries than their non-ADHD peers. ADHD children are also significantly more likely to be injured when walking (as pedestrians) and as bicyclists than their non-ADHD peers. In fact, well over half of all accidents among the ADHD children noted in one study were transportation related: involving either walking, motor vehicles, or bicycling.

Somewhat alarmingly, children with ADHD are also more likely to sustain injuries to multiple body regions, to sustain head injuries, and to be severely injured (as measured by the investigators injury severity indices). Children with ADHD tended to have longer hospital stays, and while there was no significant difference in the percent of children requiring surgery (40%), the ADHD children were admitted more frequently to the intensive care unit. Injuries sustained led to disability in 53% of the children with ADHD in contrast to 48% of the children who didn't have ADHD, and those who had any disability and ADHD were twice as likely to be discharged to rehabilitation or extended care facilities than their non-ADHD peers.

THE ADHD STUDENT AND DRIVING

One of the things parents of all teenagers worry about is driving safety, and a series of reports by Russell Barkley, PhD and his colleagues suggest that there is good reason to be extra concerned about a teen with ADHD. Barkley (1993, 1996) reported that while knowledge of driving was not affected by ADHD, teens and young adults with ADHD were more likely to have had automobile accidents, to have had more crashes than their non-ADHD peers, to be at fault for more crashes than control subjects, and to have had more physical injuries associated with the accidents. They are also more likely to have received traffic citations and more of them than control subjects (particularly for speeding). Teenagers with ADHD who had comorbid oppositional defiant disorder and conduct disorder symptoms were at highest risk for problems. When compared to non-ADHD young adults, those with ADHD had more crashes, scrapes, and erratic steering during the computer-simulated driving task.

In their most recent published report, Barkley and his colleagues (2002) compared 105 young adults with ADHD (age 17-28) to 64 community control (CC) adults on five domains of driving ability and a battery of executive function tasks. The ADHD group self-reported significantly more traffic citations, particularly for speeding, vehicular crashes, and license suspensions than the CC group [most of these differences were corroborated by the official DMV records obtained by the investigators]. Cognitively, the ADHD group was less attentive and made more errors during a visual reaction task under rule-reversed conditions than the CC group. In some contrast to previous findings, the ADHD group also obtained lower scores on a test of driving rules and decision-making, although their performance on a simple driving simulator was not significantly different than CC adults. The results, then, support previous findings that young adults with ADHD may be at increased risk of driving problems.

Does severity of ADHD correlate with increased risk? Richards et al. (2002) looked at driving anger and other driving-related behaviors in college students with ADHD. For their sample of 59 introductory psychology students, those with high ADHD symptom severity experienced more driving anger, displayed driving-related anger in more hostile or aggressive ways, were more aggressive and took greater risks on the road, experienced more crash-related outcomes, and were generally angrier and more inappropriate as to how they expressed their anger than peers with low ADHD symptom severity.  

WOULD MEDICATION HELP?

Would taking a stimulant medication reduce any of the safety risks while driving? Preliminary data from Cox et al. suggest that it might. In their study, adults with ADHD and non-ADHD controls were each tested in a driving simulator under placebo and methylphenidate (Ritalin) conditions. While adults with ADHD in their study had more career driving accidents and more motor vehicle violations than their non-ADHD peers and while they performed significantly worse in the simulator under placebo conditions, they demonstrated significant improvement under the Ritalin condition.

NOW WHAT?

Safety first. Many high schools or secondary schools offer drivers' education training programs to students. I have never seen a school district factor in ADHD to the training protocols or even inform their driving instructor that a particular student has ADHD and may require additional training and experience as part of the program. In general, driver's education programs seem to be a "one size fits all" approach. The teenager who has completed the course -- and the worried parents -- may have a false sense of security because the course was taken and completed. Educators who are aware of the safety risks might wish to share some of this information with parents and encourage them to arrange for additional supervised training or restriction to daytime driving until the teen gets more successful experiences under their (seat)belt.

Safety first!