Center for Injury Research and Prevention

Medication Reduces Crash Risk Among Men With ADHD

TitleMedication Reduces Crash Risk Among Men With ADHD
Publication TypeJournal Article
Year of Publication2014
AuthorsWinston FK, Romer D
JournalEvidence Based Mental Health
Date Published08/2014
Type of Articlejournal


What is already known on this topic?

Safe driving requires ‘situation awareness’, a combined implementation of skills and traits that include attending to the driving task, focusing on relevant hazards, and being aware of traffic and road conditions and responding appropriately.1 Deficits in attention and impulse control put patients with attention-deficit hyperactivity disorder (ADHD) at increased crash risk. Consistent ADHD medication use, ensuring therapeutic levels while driving, has the potential to reduce this risk.2

What does this paper add?

This landmark population-based study is the first to quantify an almost 50% increased risk of serious crash injuries among adults with ADHD.

  • For adult men, injuries were 58% less likely when on-medication compared with when off-medication; for motorcyclists alone, on -medication injuries were 90% less likely.

  • Only 57.5% of men with ADHD had been prescribed ADHD medication. At the end of the study period, only 37.2% were on medication.

  • Among women with ADHD, no evidence of reduction in crashes with medication was found.


  • The observational study design may have resulted in unmeasured confounding associated with non-random treatment selection. For example, two unmeasured variables—motivation for treatment and accuracy of symptom self-assessment—might have been associated with both whether a participant was on medication (and compliant with it) and with his/her crash likelihood.

  • The minimum age of participants in this study was 18 years; therefore, the population at highest risk of crashes, teen drivers, was not included.

  • Length of licensure was not included as a cofounder, precluding examination of the contribution of inexperience and ADHD, separately and synergistically, on crash risk.

  • For auto crashes, drivers and passengers could not be differentiated, likely resulting in a conservative estimate of the risk of ADHD on drivers and precluding examination of differences due to driving alone versus driving with passengers.

What next in research

  • Future prospective studies of ADHD and crashes among adult men between the ages of 18 and 45 years should be considered unethical if a non-treatment control group is included.

  • Priority should be given to developing effective strategies to assessing and managing driving, especially among women and adolescents with ADHD.3

Could these results change your practices and why

Based on these findings and given the high burden of crashes, I would change my practice (FKW) to further prioritise assessment and management of driving among all of my patients with ADHD. Although this study did not examine adolescents, I would ensure that all men with ADHD were optimally treated with medication. I will also share these important results with my colleagues in psychiatry, paediatrics, family practice and internal medicine.

When they were not taking medication (HR=0.42, 95% CI 0.23 to 0.75). For women, no significant difference was found between medication and non-medication periods. Population-attributable fractions estimated that 41% of accidents in men with ADHD could be attributed to non-medication.