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A Solution to Driving with ADHD? Don't Drive, Ever

More kids are being diagnosed with attention deficit hyperactivity disorder, or ADHD, than ever before -- an impressive 66 percent more than 10 years ago, to be exact, according to "a new study":http://www.northwestern.edu/newscenter/stories/2012/0...
March 27, 2012, 3:28pm

More kids are being diagnosed with attention deficit hyperactivity disorder, or ADHD, than ever before — an impressive 66 percent more than 10 years ago, to be exact, according to a new study — and those kids are still learning how to drive cars. The leading cause of death among American teens is the auto accident. But combined with cell phones, iPods, and dashboard noises, say scientists in the Times, an ADHD teen and a steering wheel is an even deadlier combination.

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In a 2007 study by Russell A. Barkley of the Medical University of South Carolina and Daniel J. Cox of the University of Virginia Health System, young drivers with ADHD were found to be two to four times as likely as those without the condition to have an accident. That means they are at a higher risk of wrecking the car than an adult who is legally drunk.

This make sense, since the single leading cause of crashes among all drivers is inattention. Drivers who take their eyes off the road for a second double the risk of a crash.

A driving with ADHD public service announcement, produced by McNeil Pediatrics, makers of the stimulant Concerta.

And then there’s the problem of “impulsiveness,” a trait often linked to high levels of risk-taking. In other words, ADHD drivers tend to overestimate their abilities and drive fast.

As one study put it, drivers with ADHD showed, during a test, “slower and more variable reaction times, greater errors of impulsiveness (false alarms, poor rule following), more steering variability, and more scrapes and crashes of the simulated vehicle against road boundaries.” This isn’t even to mention the dangers of driving with "sluggish cognitive tempo," or SCT, which Dr. Barkley says includes “daydreaming, being ‘spacey’ or easily confused, mental fogginess, or being slow-moving, lethargic or less active than usual” – a disorder that overlaps with ADHD in about 20 percent of cases.

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Another driving with ADHD PSA. (Source unknown.)

The number of studies of ADHD and driving that have emerged in recent years has even prompted a meta critique. The results aren’t always so clear: one study that tested drunk adults with ADHD and those without the disorder found no significant difference: both were bad drivers.

Doctors like Barkley have answers: More learning experience, installing a temporary passenger side brake, using a stick shift (“gives the attention less time to wander,” which sounds like a brilliant idea), parent-kid contracts, logbooks, and, of course, drugs like Ritalin or Adderall (if they can get their hands on them).

See also, Anatomy of the Great Adderall Drought.

The attention drug industry is booming, thanks in part to strong Internet marketing, and those cozy relationships between the drug makers and doctors. As Dr. Lawrence Diller put it to Frontline, “the makers of Adderall have presented what I consider to be . . . the most disingenuous, elaborate campaign I’ve ever experienced. . . . I’ve been offered $100 if I will sit and listen to someone talk about ADHD, funded by Adderall, for 15 minutes on the telephone, and then fill out a five-minute questionnaire…”

But there’s another option, say the experts: kids with ADHD should consider not driving at all. Not ever.

It’s a sign of the times. Of course, in an unrelenting digital environment, where the alerts come not only from mobile phones but from places formerly thought to be relatively sacrosanct — the car, for instance, or inside our brains — attention is at a higher premium than ever, and harder to keep fixed where it needs to be.

Speaking of which, there are still good questions being raised about ADHD and its rapidly rising incidence. Dr. Diller derisively calls the medicine of ADHD “cosmetic psychopharmacology”, your eleven dollar phrase of the day. It’s not hard to wonder if telling a kid he or she will have a hard time driving because of ADHD (but most likely he, because boys are much more likely to be diagnosed with ADHD) would add to the kind of anxiety that leads to accidents. As a person not diagnosed with ADHD (not yet!), and yet to earn a driver’s license (I know, I know!), warnings like this can be nerve-withering. Could knowing you have ADHD make you a less confident and more dangerous driver? I’m not sure, but that seems like another question worthy of whatever attention we have.

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