Characterizing Impaired Driving in Adults With Attention-Deficit/Hyperactivity Disorder: A Controlled Study

Ronna Fried, Ed.D.; Carter R. Petty, M.A.; Craig B. Surman, M.D.; Bryan Reimer, Ph.D.; Megan Aleardi, B.A.; Jessica M. Martin, M.A.; Joseph F. Coughlin, Ph.D.; and Joseph Biederman, M.D.

Objective: We sought to confirm previously documented findings that individuals with
attention-deficit/hyperactivity disorder (ADHD) demonstrate impaired driving behavior when compared with controls.

Method: Subjects were adults with (N = 26) and without (N = 23) DSM-IV ADHD ascertained through clinical referrals to an adult ADHD program and through advertisements in the local
media. Driving behavior was assessed using the Manchester Driving Behavior Questionnaire (DBQ) and 10 questions from a driving history questionnaire. Neuropsychological testing and structured interviews were also administered to all subjects.

Results: Substantially more ADHD subjects had been in an accident on the highway (35%
vs. 9%, p = .03) or had been rear-ended (50% vs. 17%, p = .02) compared with controls. Analysis of the DBQ findings showed that ADHD subjects had significantly higher mean ± SD scores than control subjects on the total DBQ (34.1 ± 15.2 vs. 18.0 ± 8.6, p < .001) and in all 3 subscales of the DBQ: errors (9.3 ± 5.4 vs. 4.6 ± 3.5, p < .001), lapses (12.4 ± 6.2 vs. 6.1 ± 3.5, p < .001), and violations (12.4 ± 5.2 vs. 7.4 ± 4.1, p < .001). Using the score that separated ADHD from control drivers on the DBQ as a cutoff, ADHD drivers at high risk for poor driving outcomes had more severe rates of comorbidity and exhibited more impaired scores on neuropsychological testing.

Conclusions: Our results confirm and extend previous work documenting impaired driving behavior in subjects with ADHD. Results also suggest that ADHD individuals at high risk for poor driving behavior might be distinguishable from other ADHD individuals on DBQ scores, neuropsychological deficits, and patterns of comorbidities.

(J Clin Psychiatry 2006;67:567-574)

Received April 7, 2005; accepted Sept. 15, 2005. From the Pediatric Psychopharmacology Department, Massachusetts General Hospital, Boston (Drs. Fried, Surman, Reimer, and Biederman and Mr. Petty and Mss. Aleardi and Martin); Department of Psychiatry, Harvard Medical School, Boston, Mass. (Drs. Fried, Surman, and Biederman); and AgeLab, Massachusetts Institute of Technology, Cambridge (Drs. Reimer and Coughlin).

This study was supported by the Johnson & Johnson Center at Massachusetts General Hospital.

Dr. Biederman receives research support from Shire, Eli Lilly, McNeil, and Cephalon and serves on the speakers/advisory boards of Shire, Eli Lilly, McNeil, Janssen, Novartis, and Cephalon. Drs. Fried, Surman, Reimer, and Coughlin and Mr. Petty and Mss. Aleardi and Martin report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Ronna Fried, Ed.D., Massachusetts General Hospital, Pediatric Psychopharmacology Research, 15 Parkman St., Warren 705, Boston, MA 02114 (e-mail: rfried@partners.org).