Hyperactive children as young adults: Driving abilities, safe driving behavior, and adverse driving outcomes
Abstract
ADHD has been linked to poorer driving abilities and greater adverse outcomes (crashes, citations) in clinic-referred cases of teens and adults with ADHD. No study, however, has focused systematically on ADHD children followed into adulthood. The present paper does so while measuring driving-related cognitive abilities, driving behavior, and history of adverse driving outcomes. A multi-method, multi-source battery of driving measures was collected at the young adult follow-up on hyperactive (H; N=147; mean age=21.1) and community control children (CC; N=71; mean age=20.5) followed for more than 13 years. More of the H than CC groups had been ticketed for reckless driving, driving without a license, hit-and-run crashes, and had their licenses suspended or revoked. Official driving records found more of the H group having received traffic citations and a greater frequency of license suspensions. The cost of damage in their initial crashes was also significantly greater in the H than CC group. Both self-report and other ratings of actual driving behavior revealed less safe driving practices being used by the H group. Observations by driving instructors during a behind-the-wheel road test indicated significantly more impulsive errors. Performance on a simulator further revealed 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 in the H than in the CC group. These findings suggest that children growing up with ADHD may either have fewer driving risks or possibly under-report those risks relative to clinic-referred adults with this disorder. Deficits in simulator performance and safe driving behavior, however, are consistent with clinic-referred adults with ADHD suggesting ongoing risks for such adverse driving outcomes in children growing up with ADHD.
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Driving accidents are increased in young adults with ADHD.
“Driving accidents are increased in young adults with ADHD as a result of being distracted, impulsive and having an increased need for stimulation [124-127].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [124]
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A Systematic Review of Global Publication Trends Regarding Long-Term Outcomes of ADHD
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“In the real world, persons with these histories also show more reckless driving habits (Barkley et al., 1993; Fischer et al., 2007), and are at increased risk for abuse of drugs or alcohol (Fergusson and Horwood, 1995; Fergusson et al.”
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Accident Proneness in Children and Adolescents Affected by ADHD and the Impact of Medication
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“…as significant improvement of driving performance in individuals affected by ADHD through the administration of stimulant medication (Barkley & Cox, 2007; Fischer, Barkley, Smallish, & Fletcher, 2007; Jerome, Segal, & Habinski, 2006; Reimer, Mehler, D’Ambrosio, & Fried, 2010; Verster et al., 2008).”
Childhood problem behaviors and injury risk over the life course
Jokela, M. M., Power, C., & Mika Kivimaki, B. (2009) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2009.02122.x · Cited by 49 · see citing works
“Barkley, Murphy, & Kwasnik, 1996; Fischer, Barkley, Smallish, & Fletcher, 2007; Shepherd et al., 2004).”
A brief office-based hazard perception intervention for drivers with ADHD symptoms
Poulsen, A. A., Horswill, M. S., Wetton, M. A., Hill, A., & Lim, S. M. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048671003596048 · Cited by 48 · see citing works
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“Several studies have reported that adults with ADHD are more likely to experience problems associated with driving, including more fines, accidents, drivingrelated injuries, and the suspension of their driver's license (Barkley et al., 1996, 2002; Barkley and Cox, 2007; Fischer et al., 2007).”
Chen, T., Wong, Y. D., Shi, X., & Yang, Y. (2021) · Accident Analysis & Prevention · doi:10.1016/j.aap.2021.106061 · Cited by 46 · see citing works
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“This study had subjects with above average IQ, and the HI subjects were young adults with ADHD who are known to minimize their symptoms (Fischer et al. 2007).”
Association Between Executive Function and Problematic Adolescent Driving
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“…a novice driver; and (b) for adolescents, and those with ADHD in particular, it is welldocumented that they are poor evaluators of their own behavioral weaknesses (Fischer et al., 2007; Hoza et al., 2002; Hoza et al., 2004; Knouse et al., 2005; Owens, Goldfine, Evangelista, Hoza, & Kaiser, 2007).”
BackgroundInfluentialBarraclough, P., af Wåhlberg, A. E., Freeman, J., Watson, B. C., & Watson, A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0153390 · Cited by 45 · see citing works
“An additional nine effects were identified from seven studies which compared variables created utilizing a combination of self-report and archival data and are shown in Table 4 [40,63,86,120,121,153].”
BackgroundSobanski, E., Sabljic, D., Alm, B., Dittmann, R., Wehmeier, P. M., Skopp, G., & Strohbeck-Kühner, P. (2012) · European Psychiatry · doi:10.1016/j.eurpsy.2012.08.001 · Cited by 42 · see citing works
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Young Adult Outcomes of Children with Hyperactivity: Leisure, financial, and social activities
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“Drivers with specific health problems had slower and more variable reaction times, greater errors of impulsiveness, more steering variability, and more crashes with the roads' boundaries ( Fischer et al, 2007 ).”
BackgroundCardiovascular Effects of Medications for the Treatment of Attention-Deficit Hyperactivity Disorder
Elia, J., & Vetter, V. L. (2010) · Pediatric Drugs · doi:10.2165/11532570-000000000-00000 · Cited by 35 · see citing works
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Stimulant Medication and Prefrontal Functional Connectivity During Working Memory in ADHD
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Driving With ADHD: Performance Effects and Environment Demand in Traffic
Randell, N. J. S., Charlton, S. G., & Starkey, N. J. (2016) · Journal of Attention Disorders · doi:10.1177/1087054716658126 · Cited by 34 · see citing works
“…also more likely to have their license revoked or suspended and to continue driving without a license (Barkley et al., 1993; Barkley et al., 2002; Fischer et al., 2007; Nada-Raja et al., 1997; Thompson, Molina, Pelham, & Gnagy, 2007; Woodward, Fergusson, & Horwood, 2000); are more likely to be…”
BackgroundThe Effects of ADHD in Adult Substance Abusers
Moura, H. F., Faller, S., Benzano, D., Szobot, C., von Diemen, L., Stolf, A. R., Souza-Formigoni, M. L., Cruz, M. S., Brasiliano, S., Pechansky, F., et al. (2013) · Journal of Addictive Diseases · doi:10.1080/10550887.2013.824359 · Cited by 33 · see citing works
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Pharmacological treatment of attention-deficit/hyperactivity disorder: assessing outcomes
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“Adverse outcomes on driving performance [6] and higher obesity rates have been found among male adults diagnosed with ADHD as children [7].”
BackgroundPhilip, P., Micoulaud‐Franchi, J., Lagarde, E., Taillard, J., Canel, A., Sagaspe, P., & Bioulac, S. (2015) · PLoS ONE · doi:10.1371/journal.pone.0138004 · Cited by 30 · see citing works
Driving among Adolescents with Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder
Bishop, H. J., Boe, L., Stavrinos, D., & Mirman, J. H. (2018) · Safety · doi:10.3390/safety4030040 · Cited by 29 · see citing works
“context of a driving environment have shown mixed results, with some indicating slower and more variable reaction times in adolescents with ADHD compared to typically-developing adolescents [75], and others finding no significant differences in reaction time to hazardous events [6,76,77].”
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Neurocognitive Correlates of Young Drivers' Performance in a Driving Simulator
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Brain Maturation and Risky Behavior: The Promise and the Challenges of Neuroimaging-Based Accounts
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KIP3: Robotic Companion as an External Cue to Students with ADHD
Zuckerman, O., Hoffman, G., Kopelman-Rubin, D., Klomek, A., Shitrit, N., Amsalem, Y., & Shlomi, Y. (2016) · International Conference on Tangible, Embedded, and Embodied Interaction · doi:10.1145/2839462.2856535 · Cited by 61 · see citing works
“have problems keeping jobs and stable relationships [8], and display an unhealthy lifestyle [3].”
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“Correlational and experimental studies have been conducted to assess whether adolescents and adults with ADHD have a higher propensity to risky driving, commit driving offenses, and be involved in collisions (Barkley et al. 1993, 2002; Fischer et al. 2007; Fried et al. 2006; Murphy and Barkley 1996; Nada-Raja et al. 1…”
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Emerging Adulthood and Developmental Co-ordination Disorder
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Working Memory Development and Motor Vehicle Crashes in Young Drivers
Walshe, E. A., Winston, F. K., Betancourt, L. M., Khurana, A., Arena, K., & Römer, D. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.11421 · Cited by 22 · see citing works
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“, reckless driving, hit-and-run crash) [7].”
Symptom Dimensions of Disruptive Behavior Disorders in Adolescent Drivers
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Positive Bias in Teenage Drivers With ADHD Within a Simulated Driving Task
Fabiano, G. A., Schatz, N. K., Hulme, K., Morris, K. L., Vujnovic, R. K., Willoughby, M. T., Hennessy, D. A., Lewis, K. E., Owens, J. S., & Pelham, W. E. (2015) · Journal of Attention Disorders · doi:10.1177/1087054715616186 · Cited by 20 · see citing works
“…multiple prospective studies with adolescents with ADHD and comparison adolescents without ADHD that teen drivers with ADHD have more accidents (Fischer et al., 2007; Nada-Raja et al., 1997; Thompson et al., 2007; Woodward, Fergusson, & Horwood, 2000) that result in greater costs (Fischer et…”
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Wilbertz, G., Delgado, M. R., Tebartz Van Elst, L., Maier, S., Philipsen, A., & Blechert, J. (2017) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2015.1112032 · Cited by 18 · see citing works
“Given the presence of risky behaviour in adult ADHD (Flory et al. 2006; Barkley and Cox 2007; Elkins et al. 2007; Fischer et al. 2007), we assumed the anticipation of negative outcomes to be deficient and therefore expected lower neural activation in ADHD than healthy controls during the anticipation of loss.”
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Parenting Behaviors During Risky Driving by Teens With Attention-Deficit/Hyperactivity Disorder
Schatz, N. K., Fabiano, G. A., Morris, K. L., Shucard, J., Leo, B. A., & Bieniek, C. (2013) · Behavior Therapy · doi:10.1016/j.beth.2013.08.003 · Cited by 16 · see citing works
- Authors
- Fischer, M., Barkley, R. A., Smallish, L., & Fletcher, K.
- Affiliations
- Medical College of Wisconsin (US)
- Medical University of South Carolina (US)
- University of Massachusetts Chan Medical School (US)
- Corresponding author
- Barkley, Russell A.
- Venue
- Accident Analysis & Prevention
- Publisher
- Elsevier BV
- Published
- 2007-01
- Volume
- 39
- Issue
- 1
- Pages
- 94-105
- ISSN
- 0001-4575 (ISSN-L)
- OpenAlex
- W2020136426
- Cited by
- 200
- References
- 34
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 1 · 2023: 6 · 2022: 6 · 2021: 8 · 2020: 8 · 2019: 8 · 2018: 10 · 2017: 8 · 2016: 16 · 2015: 15 · 2014: 12 · 2013: 15 · 2012: 16
- FWCI
- 7.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Accident Analysis & Prevention (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH042181, MH42181)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Physical Sciences › Engineering › Safety, Risk, Reliability and Quality › Traffic and Road Safety
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Older Adults Driving Studies
- Keywords
- attention deficit hyperactivity disorder, hyperactivity, driver behavior, traffic accidents, traffic citations, license suspension, reaction time, impulsivity, driving instructors, young adults, long-term follow-up
- MeSH terms
- Accidents, Traffic, Adolescent, Adult, Age Factors, Attention Deficit Disorder with Hyperactivity, Automobile Driving, Child, Computer Simulation, Female, Humans, Licensure, Male, Pilot Projects, Prospective Studies, Psychomotor Performance, Reaction Time, Risk Factors, Risk-Taking, Safety, Wisconsin, Case-Control Studies, Risk Assessment
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