ADHD AND DRIVING What should we be telling adolescents? Dr N N Onugha Dr F Finlay Royal United Hospital, Bath RCPCH Conference May 2012

immature judgement inattention impaired Executive Function skills thrill-seeking tendencies need for peer acceptance impulsivity

ADHD ‘a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at a comparable level of development’ DSM IV

METHODS Search term “ADHD AND DRIVING” PUBMED EMBASE 90 papers Limit “All Child: 0-18 years” 42 papers Search term “Adolescents” 40 papers 12 irrelevant 28 papers

What does the literature tell us?

DRIVING OUTCOMES AND PERFORMANCE Behviour rating scales Driving simulators more driving violations driving without a licence Meta analysis motor vehicle collisions

DISTRACTIONS WHEN DRIVING 80% MVAs involve distractions Teenage passengers Reimer et al, 2000

DRIVING ANGER Richards et al, 2002

Does anything make a difference?

MEDICATION Stimulant medication Methylphenidate Sustained release methylphenidate Cox et al, 2004 Other studies Dexamphetamine Cox et al, 2006 Atomoxetine Kay et al, 2009

MANUAL TRANSMISSIONS Cox et al, 2006

WHAT SHOULD WE BE TELLING ADOLESCENTS? In summary…. Discussions about safe driving behaviours should include parents, should start before driving age and should continue through all subsequent outpatient visits.  Teenage drivers with ADHD should be advised of the need to inform the DVLA of their diagnosis on application for a provisional driving licence. 

WHAT SHOULD WE BE TELLING ADOLESCENTS? Advice……..

Drive carefully on your way home….!! Bring list of references in handout Drive carefully on your way home….!!