Sunday, November 3, 2002
October 28, 2002 10:30 AM ET
By Paula Moyer
SAN FRANCISCO (Reuters Health) - The already-steep learning curve for adolescent drivers is a mountain for those who live with attention-deficit/hyperactivity disorder (ADHD), according to Dr. Daniel J. Cox, speaking here at the 49th annual meeting of the American Academy of Child and Adolescent Psychiatry.
"Motor vehicle accidents are the leading cause of death in adolescents, and the rate for such deaths is four times higher for adolescent drivers with ADHD," Cox told Reuters Health. "The key ADHD-related problem that interferes with safe driving is inattention. However, when treated with stimulant therapy, adolescents with ADHD drive as well as those without this condition." He is a professor of psychiatric medicine at the University of Virginia in Charlottesville.
People with ADHD have difficulty focusing their attention and controlling their behavior. A mainstay in the treatment of ADHD is stimulant medication, typically methylphenidate (Ritalin, Adderall, Concerta). One issue that can affect the safety of a driver with ADHD may be the type of stimulant therapy he or she is taking and the timing of the dose, Cox said. Because the most common forms of stimulants for ADHD wear off quickly, an evening dose may be appropriate for a teenager with ADHD who will be driving in the evening.
In a study presented here, Cox and colleagues compared the effects of an immediate release version of methylphenidate with a sustained-release version taken once daily (Concerta). In particular, the investigators wanted to see the different effects these medications had on the driving performance throughout the day among adolescent drivers who had ADHD.
They recruited six male adolescents who had ADHD and who drive routinely. Cox and colleagues measured driving performance four times throughout two different days, at 2 PM, 5 PM, 8 PM and 11 PM, in simulated driving performances. On one day the participant was on the immediate-release version of methylphenidate and on the other day the participant was on the sustained-release version, taken once daily.
The investigators found that the driving score worsened throughout the day when the participants took the immediate-release medication but remained stable when they took the sustained-release medication.
Because stimulant therapy greatly improves driving safety for teens with ADHD, Cox urged parents to stress that ADHD medication is non-negotiable. "Stimulant medication for the person with ADHD is like glasses for the person who needs a vision correction," he said. "You don't drive without them. If you have ADHD, you don't drive without your medication on board."
For young people who are on an immediate-release medication, an extra dose in the evening may be appropriate. The parent can then gently remind the young person to take the medication if he or she is planning to drive. For those on a once-daily formulation, it would be important not to skip that daily dose.
The study was funded by McNeil Consumer & Specialty Pharmaceuticals, the manufacturers of Concerta.