1. Adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) experienced higher rates of crashes compared to adolescents without ADHD, including at-fault, single-vehicle, injury, and alcohol-related crashes.
2. Rates of traffic and moving violations were also higher among adolescents with ADHD, and differences in crash and violation rates were more pronounced in the first year after licensure.
Evidence Rating Level: 2 (Good)
Study Rundown: Adolescent drivers with ADHD were found to have an increased crash risk in prior epidemiological studies; however, little is known about the behavioral mechanisms underlying this risk. In this retrospective cohort study, researchers linked electronic health records to licensing, crash, and violation databases to compare rates of crashes and violations between young drivers with and without a diagnosis of ADHD. After adjusting for demographic factors, young drivers with ADHD had significantly higher crash rates than those without ADHD, especially in the first year after licensure. Drivers with ADHD also had double the rate of alcohol-related crashes, and higher rates of at-fault, single-vehicle, and injury crashes, as well as higher rates of traffic and moving violations.
These findings are limited by diagnosis of ADHD by primary care providers and lack of information regarding driving exposure. Nonetheless, the study is strengthened by its longitudinal nature, objective outcomes measures, and large community cohort. For physicians, these findings highlight the importance of developing strategies to address preventable risky driving behaviors in order to reduce elevated crash risk among adolescent drivers with ADHD.
In-Depth [retrospective cohort]: Researchers linked electronic health records from the New Jersey primary care locations of the Children’s Hospital of Philadelphia to licensing, crash, and violation databases covering 2004-2014 in New Jersey. A total of 14 936 young drivers born in 1987-1997 were indentified, and 1769 of them had a diagnosis of ADHD. Subjects were followed-up for 48 months, until death, or until the end of the study period. Monthly per-driver rates of crashes and violations were calculated and defined a priori by the nature of the crash or violation. Generalized estimating equation models were used to compare rates of crashes and violations between young drivers with and without ADHD.
Young drivers with ADHD had a 62% higher crash rate in the first month after licensure than drivers without ADHD (adjusted RR [adjRR]: 1.62; 95% confidence interval [CI]: 1.18-2.23), and 37% higher in the first 4 years after licensure (95% CI: 1.26-1.48). Drivers with ADHD also experienced higher rates of crashes involving passengers and at-fault, single-vehicle, injury (adjRR: 1.62; 95% CI: 1.23-2.14), and alcohol-related crashes (adjRR: 2.09; 95% CI: 1.16-3.76) in the first 4 years after licensure. Rates of traffic and moving violations were higher among drivers with ADHD.
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