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Information
Section: Conditions
Condition:
ADHD
Article: ADHD: Safety
Source: Leslie E. Packer,
PhD
This File Last
Updated: December
27, 2004
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Article
Page 1
2
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MORE
ACCIDENTS... MORE SERIOUS INJURIES,
TOO?
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Not only is
there some indication that children with
ADHD may be more 'accident prone,' but it
appears that they are also likely to
experience more serious injuries than
their non-ADHD peers. ADHD children are
also significantly more likely to be
injured when walking (as pedestrians) and
as bicyclists than their non-ADHD peers.
In fact, well over half of all accidents
among the ADHD children noted in one study
were transportation related: involving
either walking, motor vehicles, or
bicycling.
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Being a
pedestrian was the single biggest source
of accidents in children with ADHD but
bicycle accidents were also a major
contributor.
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Somewhat alarmingly,
children with ADHD are also more likely to sustain
injuries to multiple body regions, to sustain head
injuries, and to be severely injured (as measured
by the investigators injury severity indices).
Children with ADHD tended to have longer hospital
stays, and while there was no significant
difference in the percent of children requiring
surgery (40%), the ADHD children were admitted more
frequently to the intensive care unit. Injuries
sustained led to disability in 53% of the children
with ADHD in contrast to 48% of the children who
didn't have ADHD, and those who had any disability
and ADHD were twice as likely to be discharged to
rehabilitation or extended care facilities than
their non-ADHD peers.
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DAD, CAN
I HAVE THE CAR KEYS?
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One of the things
parents of all teenagers worry about is driving
safety, and a series of reports by Russell Barkley,
PhD and his colleagues suggest that there is good
reason to be extra concerned about a teen with
ADHD. Barkley (1993, 1996) reported that while
knowledge of driving was not affected by ADHD,
teens and young adults with ADHD were more likely
to have had automobile accidents, to have had more
crashes than their non-ADHD peers, to be at fault
for more crashes than control subjects, and to have
had more physical injuries associated with the
accidents. They are also more likely to have
received traffic citations and more of them than
control subjects (particularly for speeding).
Teenagers with ADHD who had comorbid oppositional
defiant disorder and conduct disorder symptoms were
at highest risk for problems. When compared to
non-ADHD young adults, those with ADHD had more
crashes, scrapes, and erratic steering during the
computer-simulated driving task.
Barkley and his
colleagues (2002) compared 105 young adults with
ADHD (age 17-28) to 64 community control (CC)
adults on five domains of driving ability and a
battery of executive function tasks. The ADHD group
self-reported significantly more traffic citations,
particularly for speeding, vehicular crashes, and
license suspensions than the CC group [most of
these differences were corroborated by the official
DMV records obtained by the investigators].
Cognitively, the ADHD group was less attentive and
made more errors during a visual reaction task
under rule-reversed conditions than the CC group.
In some contrast to previous findings, the ADHD
group also obtained lower scores on a test of
driving rules and decision-making, although their
performance on a simple driving simulator was not
significantly different than CC adults. The
results, then, support previous findings that young
adults with ADHD may be at increased risk of
driving problems.
Does severity of ADHD
correlate with increased risk? Richards et al.
(2002) looked at driving anger and other
driving-related behaviors in college students with
ADHD. For their sample of 59 introductory
psychology students, those with high ADHD symptom
severity experienced more driving anger, displayed
driving-related anger in more hostile or aggressive
ways, were more aggressive and took greater risks
on the road, experienced more crash-related
outcomes, and were generally angrier and more
inappropriate as to how they expressed their anger
than peers with low ADHD symptom severity.
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WOULD
MEDICATION HELP?
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Would taking a
stimulant medication reduce any of the safety risks
while driving? Preliminary data from Cox et al.
suggest that it might. In their study, adults with
ADHD and non-ADHD controls were each tested in a
driving simulator under placebo and methylphenidate
(Ritalin) conditions. While adults with ADHD in
their study had more career driving accidents and
more motor vehicle violations than their non-ADHD
peers and while they performed significantly worse
in the simulator under placebo conditions, they
demonstrated significant improvement under the
Ritalin condition.
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NOW
WHAT?
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Safety first. Many
high schools or secondary schools offer drivers'
education training programs to students. I have
never seen a school district factor in ADHD to the
training protocols or even inform their driving
instructor that a particular student has ADHD and
may require additional training and experience as
part of the program. In general, driver's education
programs seem to be a "one size fits all" approach.
The teenager who has completed the course -- and
the worried parents -- may have a false sense of
security because the course was taken and
completed. Educators who are aware of the safety
risks might wish to share some of this information
with parents and encourage them to arrange for
additional supervised training or restriction to
daytime driving until the teen gets more successful
experiences under their (seat)belt.
Safety
first!
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POSTSCRIPT
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This article was originally
written in 1998, and I have continued to update it
as research becomes available.
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Information
Section: Conditions
Condition:
ADHD
Article: ADHD: Safety
Source: Leslie E. Packer,
PhD
This File Last
Updated: December
27, 2004
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Article
Page 1
2
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Tourette
Syndrome "Plus" © Copyright 1998 - 2005 Leslie
E. Packer, PhD. except as noted.
All rights reserved
This page last updated January 7, 2005.
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