Controlled-Release Methylphenidate Improves Attention During On-Road Driving by Adolescents with Attention-Deficit/Hyperactivity Disorder

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with a 3-to 4-fold increase in both driving-related accidents and associated injuries. Methylphenidate (MPH) is the most commonly prescribed psychostimulant medication for ADHD. It has been demonstrated to improve performance on a driving simulator. This study investigated whether a once-daily, long-acting, osmotic, controlledrelease MPH formulation improves the driving performance of ADHD adolescents while driving their own car on an actual road segment.Methods: Twelve ADHD-diagnosed male adolescent drivers (mean age, 17.8 years) prescribed a standard dose of 1.0 mg/kg (if they were not already taking methylphenidate) of controlled-release MPH participated in this repeated-measures crossover study. On 2 separate occasions (off/on medication randomized), participants drove a standard 16-mile road course incorporating rural, highway, and urban streets. A rater, blind to medication conditions, sat in the back seat and rated impulsive (eg, "cutting off" another driver) and inattentive (eg, drove past designated turn) driving errors.Results: Impulsive driving errors were observed to occur rarely under both medication and no medication conditions. Inattentive driving errors were more common and were significantly reduced while the subject was on medication (4.6 versus 7.8; P < .01). The improvement in driving performance (change in number of errors recorded) from first to second testing was positively correlated with medication dosage (r ‫؍‬ 0.60; P < .01). Conclusions

Using self-reported data to assess the validity of driving simulation data

“…Surveys have found an increased probability of driving accidents among those with conditions ranging from, for example, attention deficit hyperactivity disorder (ADHD; Barkley, Guevremont, Anastopoulos, DuPaul, & Shelton, 1993;Murphy & Barkley, 1996), to diabetes (Cox et al, 2003), to dementia (Carr, Duchek, & Morris, 2000;Zuin, Ortiz, Boromei, & Lopez, 2002), to heart disease (McGwin, Sims, Pulley, & Roseman, 2000), to arthritis (McGwin et al, 2000), and to emotional stress (Lagarde et al, 2004). Yet studies with such populations using on-road methods to measure driving behaviors may place both participants and researchers at increased risk for harm (Cox, Humphrey, Merkel, Penberthy, & Kovatchev, 2004). On-road behavior evaluations also lack the replicability, control, efficiency, safety, and ease of use associated with simulated driving experiments, in turn making inferences about the impact of experimental manipulations on driving behavior more difficult (Godley, Triggs, & Fildes, 2002).…”

The Pharmacologically Enhanced Physician

“…Preliminary data is emerging in nonmedical categories of performance. Methylphenidate has been shown to decrease errors from inattentive driving in adolescents with attention-deficit hyperactivity disorder [5]. Whether methylphenidate or other stimulants could decrease performance errors by those without the disorder or by physicians is an untested question.…”

Quantifying the Benefits of Enhancing Medications on Driving Performance: Comparing OROS ® MPH vs. se-AMPH ER ® in Driving Safety of ADHD Teenagers as Case Example

“…Five controlled studies have found that active treatment of ADHD with stimulant medications significantly improved on-road and simulator driving performance (Barkley, Murphy, O'Connell, & Connor, submitted;Cox, Merkel, Kovatchev, & Seward, 2000;Cox, Humphrey, Merkel, Penberthy, & Kovatchev, 2004;Cox, Merkel, Penberthy, Kovatchev, & Hankin, 2004). Ganz and colleagues found that driving reaction time on a driving simulator worsened 1 week after total hip arthroplasty but then subsequently improved, leading them to recommend patients wait 4 to 6 weeks after surgery before resuming driving (Ganz, Levin, Peterson, & Ranawat, 2003).…”