Current Psychiatry Reports

, Volume 8, Issue 5, pp 416–426 | Cite as

Attention-deficit/hyperactivity disorder (ADHD) and driving risk: A review of the literature and a methodological critique

  • Laurence Jerome
  • Liat Habinski
  • Alvin Segal


This article examines the literature on attention-deficit/ hyperactivity disorder (ADHD) and unintentional driving injury. This literature has emerged over the last decade as part of the burgeoning epidemic of road traffic death and injury, which is the number-one cause of death among young adults in North America. The available literature on observational outcome studies and experimental pharmacologic interventions is critically reviewed. A meta-analysis of behavioral outcomes and a review of effect size of pharmacologic studies are presented. Current data support the utility of stimulant medication in improving driving performance in younger ADHD drivers. A conceptual model of risk factors in young ADHD drivers is offered. The current state of screening instruments for identifying high-risk subjects within this clinical group is summarized along with a final section on emerging trends and future prospects for intervention.


Atomoxetine Acad Child Adolesc Psychiatry Continuous Performance Test Dexamphetamine Driving Risk 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Barkley RA, Cox D: A review of driving performance and adverse outcomes in adolescents and adults with attentionde ficit/hyperactivity disorder. J Safety Res 2006, In press. An excellent review of the association between problem driving and ADHD by two of the prominent researchers in the field.Google Scholar
  2. 2.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  3. 3.
    World Health Organization: The Injury Chartbook: A Graphical Overview of the Global Burden of Injuries. Geneva: World Health Organization; 2002.Google Scholar
  4. 4.
    World Health Organization: World Report on Road Traffic Injury Prevention. Geneva: World Health Organization; 2004.Google Scholar
  5. 5.
    World Health Organization: Injury: A Leading Cause of the Global Burden of Disease, 2000. Geneva: World Health Organization; 2002.Google Scholar
  6. 6.
    National Highway Traffic Safety Administration: 2020 Report: People Saving People “On the Road to a Healthier Future.” Washington, DC: National Highway Traffic Safety Administration; 1997.Google Scholar
  7. 7.
    United States General Accounting Office: Research Continues on a Variety of Factors That Contribute to Motor Vehicle Crashes. Washington, DC: General Accounting Office; 2003.Google Scholar
  8. 8.
    Blows S, Ameratunga S, Ivers RQ, et al.: Risky driving habits and motor vehicle driver injury. Accid Anal Prev 2005, 37:619–624.PubMedCrossRefGoogle Scholar
  9. 9.
    Jonah BA: Accident risk and risk taking behavior among young drivers. Accid Anal Prev 1986, 18:255–271.PubMedCrossRefGoogle Scholar
  10. 10.
    McKnight AJ, McKnight AS: The behavioural contributors to crashes of youthful drivers. Annu Proc Assoc Adv Automot Med 2000, 44:321–333.PubMedGoogle Scholar
  11. 11.
    Turner D, McClure R: Age and gender differences in risk taking behaviours as an explanation for high incidence of motor vehicle crashes in young males. Inj Control Saf Promot 2003, 10:123–130.PubMedCrossRefGoogle Scholar
  12. 12.
    Williams AF, Shabanova VI: Responsibility of drivers, by age and gender, for motor-vehicle crash deaths. J Safety Res 2003, 34:527–531.PubMedCrossRefGoogle Scholar
  13. 13.
    Preusser DF, Williams AF, Ferguson SA, et al.: Fatal crash risk for older drivers. Accid Anal Prev 1998, 30:151–159.PubMedCrossRefGoogle Scholar
  14. 14.
    Zhang J, Fraser S, Lindsay J, et al.: Age-specific patterns of factors related to fatal motor vehicle traffic crashes: focus on young and elderly drivers. Public Health 1998, 112:289–295.PubMedCrossRefGoogle Scholar
  15. 15.
    Hasselberg M, Laflamme L: Socioeconomic background and road traffic injuries: a study of young car drivers in Sweden. Traffic Inj Prev 2003, 4:249–254.PubMedCrossRefGoogle Scholar
  16. 16.
    Murray A: The home and school background of young drivers involved in traffic accidents. Accid Anal Prev 1998, 30:169–182.PubMedCrossRefGoogle Scholar
  17. 17.
    Tillman WA, Hobbs GE: The accident-prone automobile driver. Am J Psychiatry 1949, 106:321–331.Google Scholar
  18. 18.
    Tsuang MT: Psychiatric aspects of traffic accidents. Am J Psychiatry 1985, 142:538–546.PubMedGoogle Scholar
  19. 19.
    Jonah BA: Sensation seeking, risky driving and behavioural adaptation. Accid Anal Prev 2001, 33:679–684.PubMedCrossRefGoogle Scholar
  20. 20.
    Deffenbacher JL, Deffenbacher DM, Lynch RS, Richards TL: Anger, aggression and risky behaviour: a comparison of high and low anger drivers. Behav Res Ther 2003, 41:701–718.PubMedCrossRefGoogle Scholar
  21. 21.
    Lagarde E, Chastang JF, Gueguen A, et al.: Emotional stress and traffic accidents: the impact of separation and divorce. Epidemiology 2004, 15:762–766.PubMedCrossRefGoogle Scholar
  22. 22.
    Shope JT, Waller PF, Raghunathan TE, Patil SM: Adolescent antecedents of high-risk driving behaviour into young adulthood: substance use and parental influences. Accid Anal Prev 2001, 33:649–658.PubMedCrossRefGoogle Scholar
  23. 23.
    Shope JT, Raghunathan TE, Patil SM: Examining trajectories of adolescent risk factors as predictors of subsequent high-risk driving behaviour. J Adolesc Health 2003, 32:214–224.PubMedCrossRefGoogle Scholar
  24. 24.
    Treat JR, McDonald NS, Shinar D, et al.: Tri-level Study of the Causes of Traffic Accidents, vol I: Causal Factor Tabulations and Assessment. Washington, DC: National Highway Traffic Safety Administration; 1977. [Report no. DOT-HS-805-085.]Google Scholar
  25. 25.
    Ryb GE, Dischinger PC, Kufera JA, Read KM: Risk perception and impulsivity: association with risky behaviours and substance abuse disorders. Accid Anal Prev 2006, 38:567–573.PubMedCrossRefGoogle Scholar
  26. 26.
    McKnight AJ, McKnight AS: The effect of cellular phone use upon driver attention. Accid Anal Prev 1993, 25:259–265.PubMedCrossRefGoogle Scholar
  27. 27.
    Blakemore SJ, Choudhury S: Development of the adolescent brain: implications for executive function and social cognition. J Child Psychol Psychiatry 2006, 47:296–312.PubMedCrossRefGoogle Scholar
  28. 28.
    Cohen J: Statistical Power Analysis for the Behavioural Sciences, edn 2. Hillsdale, NJ: Erlbaum; 1988.Google Scholar
  29. 29.
    Thalheimer W, Cook S: How to calculate effect sizes from published research articles: a simplified methodology. Available at: Accessed April 1, 2006.Google Scholar
  30. 30.
    Truls V: Impairment, diseases, and their relative risks of accident involvement: results from meta-analysis. IMMORTAL; 2003. A meta-analysis of published research on disease and RR of accident involvement, including RR for psychiatric disorder. Available on the Web at Scholar
  31. 31.
    Weiss G, Hechtman L, Perlman T, et al.: Hyperactives as young adults: a controlled prospective ten-year follow-up of 75 children. Arch Gen Psychiatry 1979, 36:675–681.PubMedGoogle Scholar
  32. 32.
    Barkley RA, Guevremont DC, Anastopoulos AD, et al.: 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, 92:212–218.PubMedGoogle Scholar
  33. 33.
    Barkley RA, Murphy KR, Kwasnik D: Motor vehicle driving competencies and risks in teens and young adults with attention deficit hyperactivity disorder. Pediatrics 1996, 98:1089–1095.PubMedGoogle Scholar
  34. 34.
    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, 8:655–672.PubMedCrossRefGoogle Scholar
  35. 35.
    Richards TL, Deffenbacher JL, Rosen LA: Driving anger and other driving-related behaviors in high and low ADHD symptom college students. J Atten Disord 2002, 6:25–38.PubMedCrossRefGoogle Scholar
  36. 36.
    Murphy K, Barkley RA: Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr Psychiatry 1996, 37:393–401.PubMedCrossRefGoogle Scholar
  37. 37.
    Fischer M, Barkley RA, Smallish L, Fletcher K: Hyperactive children as young adults: driving abilities, safe driving behaviours and adverse driving outcomes. Accid Anal Prev 2006, In press.Google Scholar
  38. 38.
    Lambert NM: Analysis of Driving Histories of ADHD Subjects. Washington, DC: Department of Transportation, National Highway Traffic Safety Administration; 1995:1–21. [Publication no. DOT-HS-808-417.]Google Scholar
  39. 39.
    Fried R, Petty CR, Surman CB, et al.: Characterizing impaired driving in adults with attention-deficit/hyperactivity disorder: a controlled study. J Clin Psychiatry 2006, 67:567–574.PubMedGoogle Scholar
  40. 40.
    Nada-Raja S, Langley JD, McGee R, et al.: Inattentive and hyperactive behaviors and driving offenses in adolescence. J Am Acad Child Adolesc Psychiatry 1997, 36:515–522.PubMedCrossRefGoogle Scholar
  41. 41.
    Woodward LJ, Fergusson DM, Horwood LJ: Driving outcomes of young people with attentional difficulties in adolescence. J Am Acad Child Adolesc Psychiatry 2000, 39:627–634.PubMedCrossRefGoogle Scholar
  42. 42.
    Reimer B, D’Ambrosio LA, Gilbert J, et al.: Behavior differences in drivers with attention deficit hyperactivity disorder: the driving behavior questionnaire. Accid Anal Prev 2005, 37:996–1004.PubMedCrossRefGoogle Scholar
  43. 43.
    Schwartz N, Oyserman D: Asking questions about behaviour: cognition, communication and questionnaire construction. Am J Eval 2001, 22:127–160.Google Scholar
  44. 44.
    Wilson KH, Cox DJ, Merkel RL, et al.: Effect of extended release stimulant-based medications on neuropsychological functioning among adolescents with attention deficit hyperactivity disorder. Arch Clin Neuropsychol 2006, In press. Evidence for differential effects of MPH and dexamphetamine on neurocognitive performance.Google Scholar
  45. 45.
    Cox DJ, Punja M, Powers K, et al.: Manual transmission enhances attention and driving performance of ADHD adolescent males: pilot study. J Atten Disord 2006, In press. A pilot study of an intriguing nonpharmacologic measure for improving driving performance in young ADHD drivers.Google Scholar
  46. 46.
    Zeier H: Concurrent physiological activity of driver and passenger when driving with and without automatic transmission in heavy city traffic. Ergonomics 1979, 22:799–810.PubMedGoogle Scholar
  47. 47.
    Arnett JJ, Offer D, Fine MA: Reckless driving in adolescence: ‘state’ and ‘trait’ factors. Accid Anal Prev 1997, 29:57–63.PubMedCrossRefGoogle Scholar
  48. 48.
    Deffenbacher JL, Huff ME, Lynch RS, et al.: Characteristics and treatment of high anger drivers. J Couns Psychol 2000, 47:5–17.CrossRefGoogle Scholar
  49. 49.
    Malta LS, Blanchard EB, Freidenberg BM: Psychiatric and behavioral problems in aggressive drivers. Behav Res Ther 2005, 43:1467–1484.PubMedCrossRefGoogle Scholar
  50. 50.
    Barkley RA, Fischer M, Edelbrock CS, Smallish L: The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry 1990, 29:546–557.PubMedCrossRefGoogle Scholar
  51. 51.
    Whalen CK, Jamner LD, Henker B: The ADHD spectrum and everyday life: experience sampling of adolescent moods, activities, smoking and drinking. Child Dev 2002, 73:209–227.PubMedCrossRefGoogle Scholar
  52. 52.
    Ramirez CA, Rosen LA, Deffenbacher JL, et al.: Anger and anger expression in adults with high ADHD symptoms. J Atten Disord 1997, 2:115–128.CrossRefGoogle Scholar
  53. 53.
    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, 188:230–234.PubMedCrossRefGoogle Scholar
  54. 54.
    Cox DJ, Merkel RL, Penberthy JK, et al.: Impact of methylphenidate delivery profiles on driving performance of adolescents with attention-deficit/hyperactivity disorder: a pilot study. J Am Acad Child Adolesc Psychiatry 2004, 43:269–275.PubMedCrossRefGoogle Scholar
  55. 55.
    Cox DJ, Humphrey JW, Merkel RL, et al.: Controlledrelease methylphenidate improves attention during on-road driving by adolescents with attention-deficit/hyperactivity disorder. J Am Board Fam Pract 2004, 17:235–239.PubMedCrossRefGoogle Scholar
  56. 56.
    Bjorkli C, Flo M, Jenssen GD, et al.: Assessment of fitness to drive among patients with learning difficulties. IMMORTAL; 2004.Google Scholar
  57. 57.
    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, 36:121–131.PubMedCrossRefGoogle Scholar
  58. 58.
    Cox DJ, Merkel RL, Moore M, et al.: Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended-release in improving the driving performance of adolescent drivers with ADHD. Pediatrics 2006, In press. A “head-to-head” study of the effects of extended-release MPH and dexamphetamine on driving performance on the road and in a simulator finding effects up to 15 hours after ingestion. This study found evidence of the superiority of MPH to dexamphetamine.Google Scholar
  59. 59.
    Jerome L, Segal A: Benefit of long term stimulants on driving in adults with ADHD. J Nerv Ment Dis 2001, 189:63–64.PubMedCrossRefGoogle Scholar
  60. 60.
    Barkley RA, Anderson DL, Kruesi M: A pilot study of atomoxetine on driving performance in adults with attention deficit hyperactivity disorder (ADHD). J Atten Disord 2006, In press. The first publication looking at the effect of a nonstimulant medication on improving driving in ADHD populations. The authors draw attention to the public health implications of the problem. Their findings encourage replication, although effect sizes are less robust than stimulants and restricted to self-report measures.Google Scholar
  61. 61.
    Fillmore MT: Drug abuse as a problem of impaired control: current approaches and findings. Behav Cogn Neurosci Rev 2003, 2:179–197.PubMedCrossRefGoogle Scholar
  62. 62.
    Barkley RA, Murphy KR, O’Connell T, Anderson D: Effects of two doses of alcohol on simulator driving performance in adults with attention-deficit/hyperactivity disorder. Neuropsychology 2006, 20:77–87.PubMedCrossRefGoogle Scholar
  63. 63.
    Zador PL: Alcohol-related relative risk of fatal driver injuries in relation to driver age and sex. J Stud Alcohol 1991, 52:302–310.PubMedGoogle Scholar
  64. 64.
    Sackett DL: Bias in analytic research. J Chronic Dis 1979, 32:51–63.PubMedCrossRefGoogle Scholar
  65. 65.
    Sowell ER, Thompson PM, Leonard CM: Longitudinal mapping of cortical thickness and brain growth in normal children. J Neurosci 2004, 24:8223–8231.PubMedCrossRefGoogle Scholar
  66. 66.
    Barkley RA: ADHD and the Nature of Self-Control. New York: Guilford Press; 1997.Google Scholar
  67. 67.
    Stein MA, Szumowski E, Blondis TA, Roizen NJ: Adaptive skills dysfunction in ADD and ADHD children. J Child Psychol Psychiatry 1995, 36:663–670.PubMedCrossRefGoogle Scholar
  68. 68.
    Jerome L, Segal AU: Prediction of driving accident risk in novice drivers in Ontario: the development of a screening instrument. In Driver Behavior and Training, vol 2: Human Factors in Road and Rail Transport. Edited by Dorn L. Aldershot, UK: Ashgate Publishing; 2005:207–222.Google Scholar
  69. 69.
    Kweon YJ, Kockelman KM: Overall injury risk to different drivers: combining exposure, frequency and severity models. Accid Anal Prev 2003, 35:441–450.PubMedCrossRefGoogle Scholar
  70. 70.
    Jerome L, Segal AU: ADHD, executive function and problem driving. ADHD Report 2000, 8:7–11.Google Scholar
  71. 71.
    Jamson S: Would those who need it use it? Investigating the relationship between drivers speed choice and their use of a voluntary ISA system. Transportation Res Part F 2006, 9:195–206.Google Scholar
  72. 72.
    Hechtman L, Weiss G, Perlman T: Young adult outcome of hyperactive children who received long-term stimulant treatment. J Am Acad Child Psychiatry 1984, 23:261–269.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.University of Western OntarioLondonCanada

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