Download Emad Farrag - The UK ADHD Partnership

ADHD & Driving
DR Emad Farrag
MBBCh, MRCPsych
Consultant Child & Adolescent PSychiatrist
A bit of humour
My favourite Quote
• ADHD, driving and texting; A deadly combination
A Car Story
Unintentional Injury
• Growing global concern
• In 2000, approx. 5 million died worldwide due to injuries
• 2/3 were unintentional, most were due to RTAs
• 50 million worldwide injured in RTAs
• Leading cause of death in Children, adolescents & young adults in
affluent countries
• Recent figures show approx. 6 million RTAs in USA  above 40 million
deaths + 3 million injuries
• It was estimated in 2004 alone US economy cost in excess of $200
billion
Other costs to consider
• Personal mental health trauma
• Physical mortality and disability
• Economic rehabilitation of injured or disabled
• Days off work
• Loss of driving licence
• Possible custodial sentence
DVLA & ADHD
• You may need to tell DVLA if you have attention deficit/hyperactivity
disorder (ADHD).
• You can be fined up to £1,000 if you don’t tell DVLA about a medical
condition that affects your driving. You may be prosecuted if you’re
involved in an accident as a result.
‘Accident proneness’
A man drives as he lives (Tillman & Hobbes 1949)
Personal Attributes other than ADHD
• Being male
• Anger management problems
• Drug and alcohol use and abuse
• Antisocial tendencies
• Risk taking behaviour
• Non conformity
• Occupation & educational status inversely proportionate to RTAs
Theories
Psychosocial theory
Problem behaviour theory
• Model of high risk driving
related to states of high stress
• Emphasis on lifestyle factors
• Reduced parental involvement
• Negative parental or peer
influence
•  related to risky driving and
negative driving outcomes
Cognitive abilities
• Inattention and distractibility (1/4 of RTAs)
• Poor risk perception
• Reduced judgement & reasoning while driving
• Normal brain maturational immaturities in the young (areas of the
brain responsible for executive function + Inexperience driving 
Contribute to increased risky driving behaviours
Do studies show a relationship?
• Yes but data differs and controlling for variables change the strength
of the relationship; but there is an established relationship
• Some use ADHD status (severity) alone
• Others used categorical diagnosis (more here)
• Using both showed even higher rates
Observational Studies
• Significantly increased driving citations in ADHD vs. control group
• Speeding, suspensions, driving without licence, tail gaiting
• Increased citations for those with comorbid ODD/CD in males
• In one study looked at ADHD & age vs. effect on driving (Driving
Behaviour Questionnaire):
• >40 years old  Normalised error scores
• >30 years old  Normalised violation scores
• Better driving with experience OR better avoidance of detection?
Simulator Studies
• Increase scrapes
• Increased steering variability
• Poor steering control
•  may reflect poor motor control
and coordination
Cognitive abilities related to driving
• Inattentiveness (especially visual) late response counter measures
• Impulsiveness  speeding & inability to disengage from risky
manoeuvres
• Slow processing
• Distractibility
• Problem with visual memory
Treatment effect?
IR-MPH
• Wears off and has implications
for night drivers
• Better response inhibition and
improving visual memory than
dexamphetamine
XL-MPH
• Longer availability (advantage)
How does it help?
• Treatment mediates the improved driving by:
• Improving executive functioning
• Particularly tasks of complex attention
• Response inhibition
What next?
• Do we screen for risky behaviours? Implications?
• Reporting ADHD drivers deemed to be at risk of problem driving?
• No law to say ADHD sufferers must take medication? Would that be
discriminatory?
• Is there a role for motivational interviewing (modify change especially
around compliance?)
• Issue of drug driving and stimulant treatment?
• Road safety is a public health problem so do we need a public health
approach?
Thank you for listening
&
Drive safely