Research In Action

My colleague Thomas J. Power, PhD, director of the Center for Management of ADHD at Children’s Hospital of Philadelphia (CHOP), and I were invited by the Journal of the American Academy of Child & Adolescent Psychiatry to contribute a commentary on recent research conducted by Arunima Roy, et al: “Effects of Childhood and Adult Persistent Attention-Deficit/Hyperactivity Disorder on Risk of Motor Vehicle Crashes.”

Dr. Roy and her team sought to determine crash risk in adults with a history of diagnosed childhood ADHD, including those who persisted with the diagnosis into adulthood and those who did not. To do so, the team leveraged data from the longitudinal Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA). Particularly notable is the study found that the rate of crash involvement among 220 participants who continued to meet criteria for ADHD diagnosis as adults was an estimated 1.46 times as high as the rate among 221 participants who no longer met the criteria for ADHD diagnosis.

The study findings highlight the importance of assessing ADHD status and symptoms concurrently with crash risk, instead of relying on past diagnoses or symptoms. As a substantial proportion of individuals diagnosed with childhood ADHD do not meet full diagnostic criteria as adults, limiting crash risk studies to the population of individuals with a history of ADHD may provide an incomplete understanding of adverse driving outcomes.

Where Should ADHD-Driving Research Go From Here?

In our commentary, Dr. Power and I offer several important considerations on how future research efforts can advance our current knowledge of the relationship between ADHD and driving outcomes.

A recent body of research has established that teens and young adults with ADHD are at moderately increased risk of crashes and other negative driving outcomes. Now, we must focus research to better understand why. As we do, it is important to consider the following:

• Capitalizing on novel methods, such as in-vehicle naturalistic driving technology, will provide important insight on behaviors and actions occurring in the moments just before a crash.
• Rarely, if ever, is there a single “cause” of a crash; but, instead, a chain of events that ultimately results in a crash.
• It is important to study whether potential protective factors, such as parental involvement and school engagement, reduce crash risk.
• Studies should adopt a rigorous approach to capture key variables with needed accuracy and quality. This includes current ADHD symptomatology, as demonstrated by Roy et al., but also ADHD medication use during driving and driving outcomes themselves.

We also need to make the most of opportunities to guide families as they approach the learning to drive process with their children. It’s important to encourage clinicians to have transportation-related conversations with families well before their adolescents with ADHD reach driving age to determine readiness to drive and to address any concerns, such as attention, impulse control, responsibility, decision making, or communication issues. Managing ADHD symptoms and associated impairments are key to helping adolescents with ADHD get behind the wheel safely. It may also be helpful to add driving goals to the teen with ADHD’s individualized education plan (IEP) and to follow up with school personnel.

Clinicians should also be encouraged to share evidence-based resources to support parent-supervised practice driving, following Graduated Driver Licensing (GDL) laws, and setting house rules for independent driving.

Finally, given the complexity of the issues involved in traffic safety and ADHD, advancing our knowledge of how to keep teens with ADHD safe on the road will need to involve multidisciplinary teams with collective expertise in multiple disciplines. It will also be key for researchers to partner with other researchers, advocates, and community groups to support this effort. We see this as a critical component, and one of the most rewarding aspects, of our own collaborative work on this issue.

Click here to read the commentary.

Click here to learn more about ADHD and driving.