My teenage son, who has Attention Deficit Hyperactivity Disorder (ADHD), will be driving our car very soon. I have read that teenagers with this diagnosis are at risk for car accidents. Is this true? How concerned should I be?
Motor Vehicle Collisions (MVCs) are the main cause of death among children, adolescents, and young adults. It is considered a major cause of premature death and long-term disability.
It is indeed true that patients with the diagnosis of ADHD are more prone not only to automobile accidents; they are also more likely to get speeding tickets and other traffic citations. Patients with ADHD tend to be impulsive and easily distracted; they are also more likely to take risks such as speeding, following too close, driving while under the influence of alcohol, and not consistently using seatbelts.
These patients are also more likely to have issues with anger, aggression, and antisocial behavior. So called co-morbid conditions such as Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) are also more frequent in patients with ADHD. All of these mental health challenges add up and put these patients at risk. Some experts argue that boys with ADHD, more so than girls, do even worse.
This is the bad news. The good news is that with the correct interventions, one can reduce these risks.
The World Health Organization designated 2004 as Road Safety Year in recognition of the public health issue of an epidemic of MVCs. Their logo was “Road safety is no accident”. In the same year, Health Canada and Transport Canada made a decision to work toward a 30% reduction in serious injuries and fatalities by the year 2010.
It is interesting that the association of accident proneness with unintentional driving injury was first described in 1949 by two Canadian psychiatrists, Dr. Tillman and Dr. Hobbes, from the University of Western Ontario. The literature on this topic continues to expand as more and more clinicians and families understand its importance.
Initial studies were not very well done. But experts in the area, such as Dr. Barkley and Dr. Cox, have improved the quality of gathering accurate information. For example, instead of relying on questionnaires and self-reported data, researchers are using hidden cameras in the cockpits of cars and simulators to study patients more accurately.
The patients are put in situations which require rapid decision-making. Differences between teens with ADHD and a non-ADHD group consistently show up. Teens with ADHD take more risks, are more impulsive, tend to lose focus, and become forgetful. Things only get worse when there are more passengers in their cars. Distractions such as cell phones, texting while driving, and putting CDs in the CD player only compounds matters, which creates what some say is “an accident waiting to happen”. The bottom line of all this can be summed up in the following saying: A man (woman) drives as he (she) lives.
The solution is not entirely clear. A novel idea for improving road safety is to install in-car speed governors when teens are prone to speeding.
Current research suggests medication makes a huge difference. Initially, a short-acting stimulant medication was all that doctors had to offer. It worked, but only up to a point, as expected. When the longer acting stimulant medications came on the market, it became clear they worked better.
There are mainly two types of longer acting stimulants: methylphenidate and dexamphetamine. In one study, a researcher (Dr. Cox) looked at what would happen when these two stimulants were used in a head-to-head placebo controlled fashion. The longer acting stimulant methylphenidate may have had a small advantage; it led to a slightly better driver performance. Yet, both medications worked far better than the placebo.
One other type of medication, known as a non-stimulant, was also studied. It also made a difference. However, the quality of the study drew a lot of criticism, thus leading to a predictable request for further studies before drawing more conclusions.
Knowing that many teenagers are night owls and do much of their driving later in the evening is a problem in itself. The majority of long-acting medications are given in the morning, and at best may last only 15 hours, if that long. Taking these products later in the day can lead to insomnia and subsequent struggles to be on one’s best game at school the next day.
Insurance companies and lawyers are sitting on the sidelines at this point, eager for more research. Insurance premiums for patients who have ADHD and who fail to take their medication (compliance is a common challenge for many teens) may be increasing.
Medico-legal liabilities are increasingly discussed. This is why some doctors will clearly note in the patient’s charts that the benefits of these medications, in reducing driver errors and in improving driving behavior, were discussed in depth with the family. Should families still refuse to use the medications, and sadly should their teen with ADHD crash a car or kill someone else, they may not be able to blame the doctor by pleading ignorance.
Access www.healthykids.ca for a terrific new resource in helping families raise healthy children - HealthyKids with Dr. Nieman will optimize your child's complete health.
An informed parent is ... an empowered parent.