Novice drivers with attention-deficit hyperactivity disorder

The recent CMAJ lead editorial on the high rate of injuries and deaths among youthful drivers is long overdue.¹ It focuses our attention on potentially modifiable human factors in this important public health epidemic.² The latest edition of the CMA driver's guide includes changes concerning the safety of drivers with attention-deficit hyperactivity disorder (ADHD).²

ADHD was first mentioned as a reportable condition in the previous edition of the handbook.³ In the 2006 edition, physicians are advised to consider treating novice drivers with ADHD with long-acting stimulants, on the basis of a recent meta-analysis examining the effects of a variety of medications used to treat ADHD.⁴ The conclusion from this meta-analysis was that young drivers with ADHD show a normalization of dysfunctional driving behaviours on a driving simulator and during on-the-road driving when they receive treatment with long-acting methylphenidate compared with treatment with other stimulants and nonstimulants.

To our knowledge this is the first time that clinical research has demonstrated that medications improve driving performance in a vulnerable psychiatric population. We applaud the CMA's decision to incorporate evidence-based findings in their new handbook; recommendations in previous editions were based on the consensus opinion of an expert panel. The new recommendation leads the way for the international public health community to reduce the risks associated with driving for youth with ADHD.