Attention deficit disorder: not just for children

Social Cognition and Functioning in Patients With Social Anxiety Disorder and/or Attention-Deficit/Hyperactivity Disorder

ABSTRACT

In recent years, social cognition and one of its dimensions, the theory of mind, have been more commonly investigated in patients with social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD). In this study, SAD, ADHD, comorbid SAD-ADHD, and healthy control (HC) groups, each consisting of 30 participants, were included and compared in terms of social cognition and functionality. Mean global functioning assessment scores were found to be significantly higher in the HC group compared with the other three groups and in the ADHD group compared with the SAD and SAD-ADHD groups. Mean Dokuz Eylül Theory of Mind Index total scores were found to be significantly higher in the HC group compared with the other three groups and in the SAD and SAD-ADHD groups compared with the ADHD group. These findings suggest that SAD patients with or without ADHD show better social cognition but worse functioning compared with pure ADHD patients.

Differences in Psychiatric Problems and Criminality Between Individuals Treated With Central Stimulants Before and After Adulthood

OBJECTIVE

The evidence for central stimulant (CS) treatment in ADHD is strong in some respects but not with respect to unselected clinical material and long-term effects over the life course cycle. The objective of this study was to explore differences in vocational, psychiatric, and social impairment, including crime and substance abuse, among adults with ADHD, treated or not, with CS drugs before age 18.

METHOD

A clinical population of men ( N = 343) and women ( N = 129) seeking CS treatment as adults was assessed within a specific program for such treatment. Clinical information and data collected by structured instruments were available.

RESULTS

Previously CS-treated persons had a lower frequency of problems (alcohol/substance abuse, criminality), and of certain psychiatric disorders (depressive, anxiety and personality ones). Most differences were substantial.

CONCLUSION

The study supports the assumption that CS treatment during childhood/adolescence offers some protection against the development of a range of problems known to characterize adult ADHD patients.

Clinical Utility of the Korean Version of the WHO Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale Screener

OBJECTIVE

The aim of this study was to compare the performance of the 18-item Korean version of the World Health Organization adult attention-deficit/hyperactivity disorder self-report scale (ASRS) with the six-item ASRS Screener for predicting attention-deficit/hyperactivity disorder (ADHD) group.

METHODS

The study sample included 51 adult patients with ADHD and 158 normal controls. All participants completed the ASRS and were interviewed individually using the Mini-International Neuropsychiatric Interview. Receiver operating characteristic (ROC) curves were used to compare the ASRS (ASRS-18) with the ASRS Screener (ASRS-6) in Korean samples.

RESULTS

The ADHD group had higher ASRS and ASRS subscale scores than those of the control group. ROC curve analysis revealed the ASRS was more powerful to predict ADHD group than the ASRS Screener, but the ASRS Screener also had strong concordance with clinician diagnoses.

CONCLUSION

This study shows that the 18-question ASRS outperforms the six-question ASRS Screener. However, the weighted Screener is also a valid and useful screening instrument both in epidemiological surveys and in clinical settings.

Social factors affect motor and anxiety behaviors in the animal model of attention-deficit hyperactivity disorders: A housing-style factor

The present study examines whether housing style (e.g., single housing, same-strain-grouped housing, and different-strain-grouped housing) and rat strain (e.g., spontaneous hypertension rats [SHR] and Wistar-Kyoto rats [WKY]) mediate motor function and anxiety behavior in the open field task. From week 4 through week 10 following birth, the rats were measured 30min for locomotor activity and anxiety once per week in the open field task. The SHR rats exhibited hyperactivity in total distance traveled and movement time to form the animal model of ADHD. The SHR rats spent more time inside the square and crossed the inside-outside line more often than the WKY rats, indicating the SHR rats exhibited less anxiety behavior. The different-strain-grouped housing style (but neither the same-strain-grouped housing style nor the single housing style) decreased total distance traveled and facilitated anxiety behavior. The motor function was negatively correlated with anxiety behavior for SHR rats but not for WKY rats. Housing styles had a negative correlation between motor function and anxiety behavior. The present findings provide some insights regarding how social factors (such as housing style) affect motor function and anxiety behavior related to ADHD in a clinical setting.

ADHD and Hyperkinetic Disorder Symptoms in Australian Adults: Descriptive Scores, Incidence Rates, Factor Structure, and Gender Invariance

OBJECTIVE

ADHD and Hyperkinetic Disorder (HKD) have the same 18 symptoms, covering inattention (IA), hyperactivity (HYP), and impulsivity (IMP). This study was aimed at providing descriptive scores for the different symptom groups in these disorders and how these scores varied by age and gender, the percentages of individuals meeting the symptom thresholds for the different ADHD types and HKD, the factor structure, and gender invariance of these symptoms in adults.

METHOD

To accomplish this, 852 adults provided self-ratings for a scale comprising the 18 ADHD/HKD symptoms.

RESULTS

The findings showed that age and gender had minimal effects on the ADHD symptoms. Also, in terms of symptom counts, 2% had HKD and 6.3% had ADHD (inattentive = 1.6%, hyperactive-impulsive = 2.7%, and combined type = 2.0%). Confirmatory factor analysis (CFA) provided most support for the three-factor HKD model, involving separate factors for the IA, HYP, and IMP symptoms. This model showed full measurement invariance across gender.

CONCLUSION

The theoretical and clinical implications of the findings are discussed.

Attention-deficit/hyperactivity disorder symptoms in adults with self-reported epilepsy: Results from a national epidemiologic survey of epilepsy

OBJECTIVE

To assess symptoms of attention-deficit/hyperactivity disorder (ADHD) and their impact among adults with epilepsy from a large community-based survey.

METHODS

Adults who self-reported epilepsy were sent a postal survey including the Adult ADHD Self-Report Scale version 6 (ASRS-6), Physicians Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Assessment 7 (GAD-7), and questions about seizure frequency and number of antiepileptic drugs (AEDs) during the preceding 3 months. Individuals with ASRS-6 scores >14 were classified as ASRS+, and those with lower scores as ASRS-. Outcome measures included the Quality of Life in Epilepsy Inventory 10 (QOLIE-10), Quality of Life and Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and the Sheehan Disability Scale (SDS). The relationship of ADHD symptoms to quality of life outcomes was modeled hierarchically, with linear regression controlling for sociodemographic covariates, comorbid depression and anxiety, seizure frequency, and number of AEDs.

RESULTS

Among 1,361 of respondents with active epilepsy, 18.4% (n = 251) were classified as ASRS+ and at risk for ADHD. Compared to ASRS- cases, ASRS+ individuals were more likely to have elevated depression and anxiety scores as well as greater seizure frequency and more AED use (p < 0.05 for all). Modeling results comparing ASRS+ and ASRS- cases, controlling for all covariates, indicated that ASRS+ cases had lower quality of life (Beta [β] = -3.07, 95% confidence interval [CI] -4.19 to -1.96) and worse physical (β = -0.048 95% CI -0.076 to -0.020) and social functioning (β = -0.058, 95% CI -0.081 to -0.035) on the Q-LES-Q, and increases in family (β = 1.57, 95% CI 1.09-2.05), social (β = 1.68, 95% CI 1.20-2.16), and work-related disability (β-1.86, 95% CI 1.27-2.46).

SIGNIFICANCE

ADHD symptoms occur in nearly one of five adults with epilepsy, and are associated with increased psychosocial morbidity and lowered QOL. Future studies should clarify the nature and causes of ADHD symptoms in adults with epilepsy.

Impaired visuomotor adaptation in adults with ADHD

Attention-deficit hyperactivity disorder (ADHD) is a prevalent psychiatric disorder in children that often continues into adulthood. It has been suggested that motor impairments in ADHD are associated with underlying cerebellar pathology. If such is the case, individuals with ADHD should be impaired on motor tasks requiring healthy cerebellar function. To test this, we compared performance of individuals with ADHD and ADHD-like symptoms with non-ADHD controls on a visuomotor adaptation task known to be impaired following cerebellar lesions. Participants adapted reaching movements to a visual representation that was rotated by 30°. Individuals with ADHD and those with ADHD-like symptoms took longer to correct the angle of movement once the rotation was applied relative to controls. However, post-adaptation residual effect did not differ for individuals with ADHD and ADHD-like symptoms compared to the control group. These results are consistent with the hypothesis that mild cerebellar deficits are evident in the motor performance of adults with ADHD.

The impact of acute tryptophan depletion on attentional performance in adult patients with ADHD

OBJECTIVE

To date, the impact of the neurotransmitter serotonin (5-HT) on different neuropsychological functions in adults with attention deficit hyperactivity disorder (ADHD) is underinvestigated. We aimed to examine the effects of acute tryptophan depletion (ATD) and the resulting reduction in central nervous 5-HT synthesis on target/non-target discrimination ability and sustained attention in adults with ADHD using an AX-Continuous Performance Test (AX-CPT).

METHOD

Twenty male patients with ADHD (age: M = 30.25 SD = 9.37) and twenty male healthy controls (age: M = 27.90 SD = 6.01) received ATD on one day and a tryptophan-balanced control condition (BAL) on another day in a double-blind within-subject crossover design. A continuous performance test (AX-CPT) with three conditions (AX, AY, and BX) was administered on both days under depleted and sham-depleted conditions.

RESULTS

In patients omissions increased after ATD when compared with BAL. Patient's reaction time decreased after ATD when compared with BAL, which was contrasted by opposite effects in controls. Patients showed fewer correct responses (AX condition) and showed a higher rate of errors (condition AXE ) independent of ATD or BAL intake.

CONCLUSION

The present preliminary results are indicative of the contribution of serotonergic neurotransmission to attentional processes in adults with ADHD.

Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners

BACKGROUND

Compared to existing literature on childhood attention deficit hyperactivity disorder (ADHD), little published adult data are available, particularly outside of the United States. Using General Practitioner (GP) questionnaires from the United Kingdom, this study aimed to examine a number of issues related to ADHD in adults, across three cohorts of patients, adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood; adults who received ADHD drug treatment in childhood/adolescence and continued treatment into adulthood and adults who started ADHD drug treatment in adulthood.

METHODS

Patients with a diagnosis of ADHD and prescribed methylphenidate, dexamfetamine or atomoxetine were identified using data from The Health Improvement Network (THIN). Dates when these drugs started and stopped were used to classify patients into the three cohorts. From each cohort, 50 patients were randomly selected and questionnaires were sent via THIN to their GPs.GPs returned completed questionnaires to THIN who forwarded anonymised copies to the researchers. Datasets were analysed using descriptive statistics.

RESULTS

Overall response rate was 89% (133/150). GPs stated that in 19 cases, the patient did not meet the criteria of that group; the number of valid questionnaires returned was 114 (76%). The following broad trends were observed: 1) GPs were not aware of the reason for treatment cessation in 43% of cases, 2) patient choice was the most common reason for discontinuation (56%), 3) 7% of patients who stopped pharmacological treatment subsequently reported experiencing ADHD symptoms, 4) 58% of patients who started pharmacological treatment for ADHD in adulthood received pharmacological treatment for other mental health conditions prior to the ADHD being diagnosed.

CONCLUSION

This study presents some key findings relating to ADHD; GPs were often not aware of the reason for patients stopping ADHD treatment in childhood or adolescence. Patient choice was identified as the most common reason for treatment cessation. For patients who started pharmacological treatment in adulthood, many patients received pharmacological treatment for comorbidities before a diagnosis of ADHD was made.

Under diagnosis of adult ADHD: cultural influences and societal burden

OBJECTIVE

To explore the literature focusing on cultural influences in the diagnosis of adult ADHD and respective societal burden.

METHOD

A review of the literature over the past 10 years was performed using OVID.

RESULTS

Although numerous articles focused on diagnosis and burden of adult ADHD, few focused on cultural factors influencing diagnosis. Like other mental health disorders, cultural and social perspectives contribute to our understanding of adult ADHD and may play a significant role in the diagnosis and varying acceptance of the condition. Moreover, adults with ADHD may underestimate the impact of ADHD symptoms, and in many cases have learned to compensate for ADHD related impairments by choosing lifestyles that help compensate for symptoms. Some adults with ADHD may appear to function well, however they may expend excessive amounts of energy to overcome impairments; and they may be distressed by ongoing symptoms such as restlessness, mood instability and low self-esteem. Research shows that ADHD can be detrimental to many areas of life including work, daily activities, social and family relationships and psychological and physical well-being. Patient-reported impairments in productivity due to poor time management, procrastination, and distractibility can translate into significant indirect costs and decreased quality of life. ADHD in adults is also associated with increased accidents, medical resource utilization, antisocial behaviour and drug alcohol abuse.

CONCLUSION

The substantial societal burden of adult ADHD highlights the importance of providing a better understanding of the factors that contribute to accurate diagnosis and of improving the low recognition of the disorder in many world regions.

Adult ADHD and comorbid depression: A consensus-derived diagnostic algorithm for ADHD

OBJECTIVE

Many patients present to their physician with depression as their primary symptom. However, depression may mask other comorbid disorders. This article presents diagnostic criteria and treatment recommendations (and monitoring) pertaining to the diagnosis of adult attention deficit hyperactivity disorder (ADHD), which may be missed in patients who present with depressive symptoms, or major depressive disorder (MDD). Other co-occurring conditions such as anxiety, substance use, and bipolar disorder are briefly discussed.

METHODS

A panel of psychiatrist-clinicians with expertise in the area of child and adolescent ADHD and mood disorders, adult mood disorders, and adult ADHD was convened. A literature search for recommendations on the diagnosis and treatment of co-occurring conditions (MDD, anxiety symptoms, and substance use) with adult ADHD was performed. Based on this, and the panel's clinical expertise, the authors developed a diagnostic algorithm and recommendations for the treatment of adult ADHD with co-occurring MDD.

RESULTS

Little information exists to assist clinicians in diagnosing ADHD co-occurring with other disorders such as MDD. A three-step process was developed by the panel to aid in the screening and diagnosis of adult ADHD. In addition, comorbid MDD, bipolar disorder, anxiety symptoms, substance use and cardiovascular concerns regarding stimulant use are discussed.

CONCLUSION

This article provides clinicians with a clinically relevant overview of the literature on comorbid ADHD and depression and offers a clinically useful diagnostic algorithm and treatment suggestions.

Using the Attention Network Test to predict driving test scores

Driving is a complex multi-factorial task that taps underlying mechanisms of cognition and attention. Not surprisingly, therefore, many tests of cognition and attention are significantly associated with driving outcomes. In this article, we introduce driving researchers and clinicians with an interest in driving to the Attention Network Test (ANT), which to our knowledge has not previously been used in driving research. It is a recently developed test that is based on a neural network model of the human attention system. It combines elements of Posner's cuing paradigm [Posner, M.I., 1980. Orienting of attention. Quarterly Journal of Experimental Psychology 32, 3-25.] with the Eriksen & Eriksen flanker task [Eriksen, B.A., Eriksen, C.W., 1974. Effects of noise letters upon the identification of a target letter in a nonsearch task. Perception & Psychophysics 16, 143-149.], and provides measures of three distinct functions of attention: alerting, orienting, and executive function. Our results demonstrate that the ANT has very good concurrent validity with the Useful Field of View (UFOV), and that it is comparable to UFOV in its ability to predict road test scores for a simulated drive. These findings suggest that further investigation of the usefulness of the ANT as a tool for driving researchers and clinicians is merited.

Untreated ADHD in adults: are there sex differences in symptoms, comorbidity, and impairment?

OBJECTIVE

To analyze sex differences among adult, never-treated patients referred for central stimulant treatment of ADHD.

METHOD

Data for 600 consecutive patients from northern Norway referred for evaluation by an expert team during 7 years were analyzed. General background information, diagnostic and social history, and symptom profiles were compared between previously never-treated men and women.

RESULTS

The sex ratio was skewed. Of the previously untreated patients, more than 20% fell outside society's ordinary vocational activities or social benefit system. Most patients had the combined form, one third the inattentive type, and only 2% the hyperactive/impulsive subtype. Abuse and criminality were more common among men, and affective, eating, and somatization disorders were more common among women. Otherwise few sex differences were found.

CONCLUSION

AD/HD symptom intensity and subtypes did not differ between the sexes and was unrelated to age. Symptom intensity was linked with criminality, abuse, and other psychiatric problems, differentially for the two sexes.

Association study for genes at chromosome 5p13-q11 in attention deficit hyperactivity disorder

Linkage of attention deficit hyperactivity disorder (ADHD) to the short arm-centromeric region of chromosome 5 has been reported in multiple studies. The overlapping region (5p13-q11) contains a number of strong candidate genes for ADHD, based on their role in brain function or neurodevelopment. The aim of this study was to investigate some of the top candidates among these genes in relation to ADHD in a sample of 245 nuclear families from the Toronto area. We investigated the genes for the glial cell-derived neurotropic factor (GDNF), the fibroblast growth factor 10 (FGF10), islet-1 (ISL1), the hyperpolarized potassium channel (HCN1) and the integrin alpha 1 (ITGA1). In addition to these genes, we assessed the 3'region of the SLC1A3 gene, a glutamate transporter implicated in ADHD by a previous association study. A total of 36 polymorphisms were selected across the six genes. We performed family-based association and haplotype analyses. ADHD is a dimensional disorder, with symptoms of inattention and hyperactivity-impulsivity therefore, we also conducted quantitative analysis in relation to symptom scores for both dimensions. Single marker and haplotype analyses yielded little evidence of association for any of the genes tested in this study. Moreover, we were unable to replicate the positive association findings reported for SLC1A3. Our results suggest that these six genes are unlikely to be susceptibility genes in the chromosome 5p13-q11 region and other genes should now be considered for priority study.

Efficacy and safety of extended-release dexmethylphenidate compared with d,l-methylphenidate and placebo in the treatment of children with attention-deficit/hyperactivity disorder: a 12-hour laboratory classroom study

OBJECTIVE

This study compared the efficacy and safety of extended-release dexmethylphenidate (d-MPH-ER) 20 mg/day and 30 mg/day with extended-release racemic methylphenidate hydrochloride (d,l-MPH-ER) 36 mg/day and 54 mg/day, and placebo in children with attention-deficit/hyperactivity disorder (ADHD) in a laboratory classroom setting.

METHODS

This multicenter, double-blind, crossover study included children (N = 84) 6-12 years of age, stabilized on total daily doses of 40 mg to 60 mg d,l-MPH or 20 mg/day or 30 mg/day d-MPH who were randomized to different treatment sequences. Primary efficacy was measured by the change from pre-dose in Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) Rating Scale-Combined scores at 2 hours post-dose (d-MPH-ER 20 mg/day versus d,l-MPH- ER 36 mg/day). Adverse events were monitored throughout the study period.

RESULTS

Mean change in SKAMP-Combined score at 2 hours post-dose was significantly larger for d-MPH-ER 20 mg/day versus d,l-MPH-ER 36 mg/day (p < 0.001). Both doses of d-MPH-ER had a more rapid onset and greater morning effect relative to d,l-MPH-ER while d,l-MPH-ER had a greater effect at the end of the 12-hour day. All active treatments provided a significant benefit over placebo at most time points to 12 hours post-dosing. Both treatments were well tolerated.

CONCLUSIONS

d-MPH-ER and d,l-MPH-ER improved ADHD symptoms and were well tolerated. While d-MPH-ER had a faster onset of action, d,l-MPH-ER retained greater effect at the end of the 12- hour classroom day.

Treatment of adult ADHD: is current knowledge useful to clinicians?

Psychostimulant drugs have for decades been considered the cornerstone of ADHD treatment. Non-stimulant drugs have also been reported successful. However, many controlled studies exclude patients with comorbidities typical for patients seen in clinical setting. Many patients are also considered non-responders to medication. Current knowledge might not be directly useful to clinicians. The present article reviews the literature on pharmacological and psychotherapeutic treatment in adult ADHD emphasizing comorbidity and other clinically important factors, as well as ADHD specific outcomes. Thirty-three relevant studies of pharmacotherapy and three studies of psychotherapy were included. Most subjects had little current comorbidity, but some studies included subjects with substance use disorder. Significant effect of treatment on ADHD symptoms was found in most studies using pharmacotherapy and all studies of psychotherapy. Both positive and negative effects on comorbid anxiety and depression measures were reported. Pharmacotherapy did not seem to have effect on substance use disorder. Few pharmacotherapy studies conducted any long-term follow-up; two studies that did, found that most subjects had discontinued medication. A clear-cut dose-respons relationship was not substanciated. In conclusion, clinicians have good support for both pharmacological and psychotherapeutic treatment of ADHD in adults, but should take additional measures to deal with comorbidities as well as treatment adherence.

Monitoring quality of life in adults with ADHD: reliability and validity of a new measure

OBJECTIVE

To develop and evaluate a questionnaire, the ADHD Impact Module for Adults (AIM-A), to dimension quality of life for adults with attention-deficit/hyperactivity disorder (ADHD).

METHOD

Six multi-item AIM scales were developed and evaluated in 317 participants enrolled in an open-label trial. Multitrait scaling analysis and correlations between the AIM-A and the ADHD Rating Scale were evaluated. Differences in scale scores based on severity (clinician rated), subtype, previous medication experience, and sensitivity to change were examined, and F statistics were compared for the AIM-A and the ADHD Rating Scale.

RESULTS

100-80% scaling successes were observed for the AIM-A scales. Alpha coefficients were >or=.83. Significant correlations were observed (range: .494 to .200). The AIM-A discriminated based on severity, subtype, and medication experience (p <or= .01) and was sensitive to change (n = 23, p <or= .001).

CONCLUSION

Psychometric findings are encouraging. Future efforts will examine validity and responsiveness in larger clinical samples with different therapeutic interventions.

The consequences of attention-deficit/hyperactivity disorder in adults

Until recently, attention-deficit/hyperactivity disorder (ADHD) was a diagnosis reserved for children and adolescents as it was believed to dissipate before adulthood. New evidence, however, supports the persistence of ADHD beyond adolescence, and it is now recognized as a chronic neurobehavioral disorder in adults. Adults with ADHD have difficulties with school, work, family interactions, and social activities. Although treatments are available for adult ADHD, many patients never receive an accurate diagnosis that would afford them appropriate therapeutic intervention. If left untreated, adult ADHD can cause significant personal, social, and economic burdens that can have a negative impact on overall quality of life. This article discusses how ADHD presents in adults and the effects of the disorder on educational, occupational, interpersonal, and social functioning. Currently available treatments for ADHD in adults are also reviewed.

Association study of the nicotinic acetylcholine receptor alpha4 subunit gene, CHRNA4, in attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is a common childhood-onset psychiatric condition with a strong genetic component. Evidence from pharmacological, clinical and animal studies has suggested that the nicotinic system could be involved in the disorder. Previous studies have implicated the nicotinic acetylcholine receptor alpha4 subunit gene, CHRNA4, in ADHD. Particularly, a polymorphism in the exon 2-intron 2 junction of CHRNA4 has been associated with severe inattention defined by latent class analysis. In the current study, we used the transmission disequilibrium test (TDT) to investigate four polymorphisms encompassing this region of CHRNA4 for association with ADHD in a sample of 264 nuclear families from Toronto. No significant evidence of biased transmission was observed for any of the marker alleles for ADHD defined as a categorical trait (all subtypes included), although one haplotype showed marginal evidence of under-transmission. No association was found with the ADHD predominantly inattentive subtype or with symptom dimension scores of inattention. On the contrary, nominally significant evidence of association of individual markers was obtained for the ADHD combined subtype and with teacher-rated hyperactivity-impulsivity scores, with the same haplotype being under-transmitted. Based on our results and others, CHRNA4 may be involved in ADHD; however, its role in ADHD symptomatology remains to be clarified.

A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance

INTRODUCTION

Attention-Deficit/Hyperactivity Disorder (ADHD) may interfere with driving competence, predisposing those with the disorder to impaired driving performance and greater risk for adverse driving outcomes. Effective treatment may minimize the risk in those with ADHD.

METHOD

We reviewed the scientific literature on driving risks and impairments associated with ADHD and the effects of stimulants on driving performance. Several lines of evidence were considered, including longitudinal studies and community-derived sample studies. The present review is based on a weekly review (by the first author) of all journals in the behavioral and social sciences indexed in the publication Current Contents spanning the past 15 years, as well as a search of the reference section of all studies found that pertained to driving risks associated with ADHD or to the treatment of ADHD as it relates to driving difficulties.

RESULTS

The review of the scientific literature demonstrated well-documented driving risks and impairments associated with ADHD and the positive effects of stimulant medications on driving performance.

CONCLUSIONS

Clinicians should educate patients/caregivers about the increased risk of adverse outcomes among untreated individuals with ADHD and the role of medication in potentially improving driving performance.

IMPACT ON INDUSTRY

Owing to the significantly higher risk of adverse driving outcomes, the use of stimulant medications to treat people with ADHD who drive may reduce such safety risks.