Review article
Driving impairments in teens and adults with attention-deficit/hyperactivity disorder

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Driving risks associated with attention-deficit/hyperactivity disorder

Until a decade ago, one domain of major life activity for teens and adults that had not been explored well in ADHD research was driving, or the independent operation of a motor vehicle. Driving is often an underappreciated domain of self-sufficiency and major life activity for adults. Yet it is one that facilitates most other adaptive domains, including employment, family care, responsibilities, and overall functioning, education, social engagements, shopping, and entertainment, among others,

Current models of driving performance: implications for drivers with attention-deficit/hyperactivity disorder

The author's initial findings and those from the New Zealand epidemiological studies strengthened the conclusion that ADHD somehow was associated with increased risks for various adverse outcomes related to driving. Such studies did little to reveal the basis for this association, however. The process or mechanisms by which ADHD disrupts driving to result in these adversities remained unknown. To get a clearer picture of the means by which ADHD was disrupting driving the author and his

Exploring the basis for elevated driving risks in drivers with attention-deficit/hyperactivity disorder

Using Michon's model, the author and colleagues have conducted several studies exploring the impact of ADHD at the operational and tactical levels of driving. They also have examined driving knowledge in addition to operational skills. Strategic driving, however, has not been evaluated in these studies, leaving open the issue of the impact of ADHD on driving at this level and suggesting an avenue for future research.

In the author's initial pilot study, the research team [45] compared 25 young

The potential impact of alcohol and drug use on driving in adults with attention-deficit/hyperactivity disorder

The results of the author's previous studies found that the teens and young adults with ADHD consumed more alcohol in an average week than the control group and had gotten drunk more times in the past 3 months than control subjects. In the author's largest, most recent study [48], both the number of drinks per week (r = 0.28, N = 129, P = 0.002) and the number of times the participant got drunk in the past 3 months (r = 0.30, N = 129, P = 0.001) correlated significantly with the self-reports of the number

Self-evaluation of driving performance in adults with attention-deficit/hyperactivity disorder

Research shows that children with ADHD show a positive illusory bias in their self-perceptions of competence in multiple domains such as academic competence, athletic competence, social acceptance, and physical appearance [53]. In addition, ADHD children often overestimate their performance on laboratory tasks immediately after completing the tasks [54], [55]. The benefit of laboratory studies is that children's self-perceptions of performance can be compared directly to their actual

Driving-related anger, hostility, and aggression (road rage)

Recent studies have documented a significant relationship between driver emotional status, aggressive driving, and risks for various adverse driving outcomes such as citations and crashes. For instance, Porter and Berry [58] used a US probability sample of 880 drivers to survey them about various driving behaviors. Level of frustration was associated with the likelihood of most risky driving behaviors such as speeding, tailgating, weaving in and out of traffic, and gesturing angrily at other

Driving in adults diagnosed with attention-deficit/hyperactivity disorder as children

All of the aforementioned studies of driving in ADHD have been done with clinically referred teens and adults known to have the disorder or, in the case of Richards' studies on anger, hostility, and aggression, with college students manifesting high symptom levels of ADHD. This raises the related question of whether children diagnosed with ADHD are more prone to driving impairments and adverse outcomes when they reach driving age than are control children followed over the same time period.

Implications of research findings for treatment

In view of the pervasive adversities established at all levels of driving performance studied (operational, tactical) and negative driving outcomes resulting from ADHD, it is imperative that adults with ADHD and parents of adolescents with ADHD be counseled about the driving risks now reasonably well-documented as accruing from this disorder. The author and colleagues would even go so far as to propose a more graduated, restrictive licensing system for teens about to begin their driving careers

Summary

Available research provides compelling evidence that ADHD is associated with significantly increased risks for various adverse outcomes while driving, including increased traffic citations (particularly speeding), motor vehicle crashes for which the driver is at fault, repeated crash occurrences, and more severe crashes as determined from dollar damage and likelihood of bodily injuries from the crash. Not surprisingly, teens and adults with ADHD are more likely to have their licenses suspended

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