Author
Abstract
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<p>&nbsp;</p>

<p><strong>What is already known on this topic?</strong></p>

<p id="p-2">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.<a class="xref-bibr" href="#ref-1" id="xref-ref-1-1">1</a> 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.<a class="xref-bibr" href="#ref-2" id="xref-ref-2-1">2</a><br>
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<p><strong>What does this paper add?</strong></p>

<p>This landmark population-based study is the first to quantify an almost 50% increased risk of serious crash injuries among adults with ADHD.</p>
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<p id="p-3">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.</p>
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<p id="p-4">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.</p>
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<p id="p-5">Among women with ADHD, no evidence of reduction in crashes with medication was found.</p>
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<p><strong>Limitations</strong></p>
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<p id="p-6">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.</p>
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<p id="p-7">The minimum age of participants in this study was 18 years; therefore, the population at highest risk of crashes, teen drivers, was not included.</p>
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<p id="p-8">Length of licensure was not included as a cofounder, precluding examination of the contribution of inexperience and ADHD, separately and synergistically, on crash risk.</p>
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<p id="p-9">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.</p>
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<p><strong>What next in research</strong></p>

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<p>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.</p>
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<p id="p-11">Priority should be given to developing effective strategies to assessing and managing driving, especially among women and adolescents with ADHD.<a class="xref-bibr" href="#ref-3" id="xref-ref-3-1">3</a></p>
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<p><strong>Could these results change your practices and why</strong></p>
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<p id="p-12">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.</p>
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<p id="p-21">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.</p>
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<p>&nbsp;</p>
Year of Publication
2014
Journal
Evidence Based Mental Health
Date Published
08/2014
Type of Article
journal
URL
http://ebmh.bmj.com/content/early/2014/08/27/eb-2014-101860.full
DOI
10.1136/eb-2014-101860