Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes | Attention Deficit/Hyperactivity Disorders | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.239.150.57. Please contact the publisher to request reinstatement.
1.
World Health Organization.  Global Status Report on Road Safety 2015. Geneva, Switzerland: World Health Organization Press; 2015.
2.
National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS), 2016. http://www.cdc.gov/injury/wisqars/overview/key_data.html. Accessed September 16, 2016.
3.
Fenelon  A, Chen  LH, Baker  SP.  Major causes of injury death and the life expectancy gap between the United States and other high-income countries.  JAMA. 2016;315(6):609-611.PubMedGoogle ScholarCrossref
4.
Willcutt  EG.  The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review.  Neurotherapeutics. 2012;9(3):490-499.PubMedGoogle ScholarCrossref
5.
Asherson  P, Buitelaar  J, Faraone  SV, Rohde  LA.  Adult attention-deficit hyperactivity disorder: key conceptual issues.  Lancet Psychiatry. 2016;3(6):568-578.PubMedGoogle ScholarCrossref
6.
Barkley  RA, Cox  D.  A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance.  J Safety Res. 2007;38(1):113-128.PubMedGoogle ScholarCrossref
7.
Jerome  L, Habinski  L, Segal  A.  Attention-deficit/hyperactivity disorder (ADHD) and driving risk: a review of the literature and a methodological critique.  Curr Psychiatry Rep. 2006;8(5):416-426.PubMedGoogle ScholarCrossref
8.
Vaa  T.  ADHD and relative risk of accidents in road traffic: a meta-analysis.  Accid Anal Prev. 2014;62:415-425.PubMedGoogle ScholarCrossref
9.
Dalsgaard  S, Nielsen  HS, Simonsen  M.  Five-fold increase in national prevalence rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a Danish register-based study.  J Child Adolesc Psychopharmacol. 2013;23(7):432-439.PubMedGoogle ScholarCrossref
10.
Visser  SN, Danielson  ML, Bitsko  RH,  et al.  Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011.  J Am Acad Child Adolesc Psychiatry. 2014;53(1):34-46.e2.PubMedGoogle ScholarCrossref
11.
Banaschewski  T, Coghill  D, Santosh  P,  et al.  Long-acting medications for the hyperkinetic disorders: a systematic review and European treatment guideline.  Eur Child Adolesc Psychiatry. 2006;15(8):476-495.PubMedGoogle ScholarCrossref
12.
Castells  X, Ramos-Quiroga  JA, Rigau  D,  et al.  Efficacy of methylphenidate for adults with attention-deficit hyperactivity disorder: a meta-regression analysis.  CNS Drugs. 2011;25(2):157-169.PubMedGoogle ScholarCrossref
13.
Gobbo  MA, Louzã  MR.  Influence of stimulant and non-stimulant drug treatment on driving performance in patients with attention deficit hyperactivity disorder: a systematic review.  Eur Neuropsychopharmacol. 2014;24(9):1425-1443.PubMedGoogle ScholarCrossref
14.
Gibson  JE, Hubbard  RB, Smith  CJ, Tata  LJ, Britton  JR, Fogarty  AW.  Use of self-controlled analytical techniques to assess the association between use of prescription medications and the risk of motor vehicle crashes.  Am J Epidemiol. 2009;169(6):761-768.PubMedGoogle ScholarCrossref
15.
Gibbons  RD, Amatya  AK, Brown  CH,  et al.  Post-approval drug safety surveillance.  Annu Rev Public Health. 2010;31:419-437.PubMedGoogle ScholarCrossref
16.
Gibbons  RD, Amatya  AK.  Statistical Methods for Drug Safety. Boca Raton, FL: Chapman & Hall/CRC; 2015.
17.
Chang  Z, Lichtenstein  P, D’Onofrio  BM, Sjölander  A, Larsson  H.  Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study.  JAMA Psychiatry. 2014;71(3):319-325.PubMedGoogle ScholarCrossref
18.
Zoëga  H, Furu  K, Halldórsson  M, Thomsen  PH, Sourander  A, Martikainen  JE.  Use of ADHD drugs in the Nordic countries: a population-based comparison study.  Acta Psychiatr Scand. 2011;123(5):360-367.PubMedGoogle ScholarCrossref
19.
Zuvekas  SH, Vitiello  B.  Stimulant medication use in children: a 12-year perspective.  Am J Psychiatry. 2012;169(2):160-166.PubMedGoogle ScholarCrossref
20.
Molina  BS, Pelham  WE  Jr.  Attention-deficit/hyperactivity disorder and risk of substance use disorder: developmental considerations, potential pathways, and opportunities for research.  Annu Rev Clin Psychol. 2014;10:607-639.PubMedGoogle ScholarCrossref
21.
Hansen  L.  MarketScan White Paper: The MarketScan Databases for Life Sciences Researchers. Ann Arbor, MI: Truven Health Analytics; 2016.
22.
Allison  PD.  Fixed Effects Regression Models. Thousand Oaks, CA: SAGE Publications; 2009.
23.
Sjölander  A. Attributable fractions. In:  Wiley StatsRef: Statistics Reference Online. Hoboken, NJ: John Wiley & Sons, Ltd; 2014. http://onlinelibrary.wiley.com/doi/10.1002/9781118445112.stat07873/abstract. Published February 15, 2016. Accessed April 5, 2017.
24.
Fuermaier  AB, Tucha  L, Evans  BL,  et al.  Driving and attention deficit hyperactivity disorder.  J Neural Transm (Vienna). 2017;124(suppl 1):55-67.PubMedGoogle Scholar
25.
Barkley  RA, Murphy  KR, Dupaul  GI, Bush  T.  Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning.  J Int Neuropsychol Soc. 2002;8(5):655-672.PubMedGoogle ScholarCrossref
26.
Fabiano  GA, Schatz  NK, Morris  KL,  et al.  Efficacy of a family-focused intervention for young drivers with attention-deficit hyperactivity disorder.  J Consult Clin Psychol. 2016;84(12):1078-1093.PubMedGoogle ScholarCrossref
27.
Cornforth  C, Sonuga-Barke  E, Coghill  D.  Stimulant drug effects on attention deficit/hyperactivity disorder: a review of the effects of age and sex of patients.  Curr Pharm Des. 2010;16(22):2424-2433.PubMedGoogle ScholarCrossref
28.
Chang  Z, Lichtenstein  P, Halldner  L,  et al.  Stimulant ADHD medication and risk for substance abuse.  J Child Psychol Psychiatry. 2014;55(8):878-885.PubMedGoogle ScholarCrossref
29.
Redelmeier  DA, Chan  WK, Lu  H.  Road trauma in teenage male youth with childhood disruptive behavior disorders: a population based analysis.  PLoS Med. 2010;7(11):e1000369.PubMedGoogle ScholarCrossref
30.
Asherson  P, Akehurst  R, Kooij  JJ,  et al.  Under diagnosis of adult ADHD: cultural influences and societal burden.  J Atten Disord. 2012;16(5)(suppl):20S-38S.PubMedGoogle ScholarCrossref
31.
Fayyad  J, De Graaf  R, Kessler  R,  et al.  Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder.  Br J Psychiatry. 2007;190:402-409.PubMedGoogle ScholarCrossref
32.
Simon  V, Czobor  P, Bálint  S, Mészáros  A, Bitter  I.  Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis.  Br J Psychiatry. 2009;194(3):204-211.PubMedGoogle ScholarCrossref
33.
Dalsgaard  S, Østergaard  SD, Leckman  JF, Mortensen  PB, Pedersen  MG.  Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study.  Lancet. 2015;385(9983):2190-2196.PubMedGoogle ScholarCrossref
Original Investigation
June 2017

Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes

Author Affiliations
  • 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  • 2Center for Health Statistics, The University of Chicago, Chicago, Illinois
  • 3Department of Psychological and Brain Sciences, Indiana University, Bloomington
  • 4School of Medical Sciences, Örebro University, Örebro, Sweden
JAMA Psychiatry. 2017;74(6):597-603. doi:10.1001/jamapsychiatry.2017.0659
Key Points

Question  Is the use of attention-deficit/hyperactivity disorder medication associated with a reduced risk of motor vehicle crashes in patients with the disorder?

Findings  In a national cohort study of 2 319 450 patients with attention-deficit/hyperactivity disorder, the use of medication for the disorder was associated with a significant reduction in the risk of motor vehicle crashes in male and female patients.

Meaning  Attention-deficit/hyperactivity disorder medication use may lower the risk of motor vehicle crashes, a prevalent and preventable cause of mortality and morbidity among patients with the disorder.

Abstract

Importance  Motor vehicle crashes (MVCs) are a major public health problem. Research has demonstrated that individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to experience MVCs, but the effect of ADHD medication treatment on the risk of MVCs remains unclear.

Objective  To explore associations between ADHD medication use and risk of MVCs in a large cohort of patients with ADHD.

Design, Setting, and Participants  For this study, a US national cohort of patients with ADHD (n = 2 319 450) was identified from commercial health insurance claims between January 1, 2005, and December 31, 2014, and followed up for emergency department visits for MVCs. The study used within-individual analyses to compare the risk of MVCs during months in which patients received ADHD medication with the risk of MVCs during months in which they did not receive ADHD medication.

Exposures  Dispensed prescription of ADHD medications.

Main Outcomes and Measures  Emergency department visits for MVCs.

Results  Among 2 319 450 patients identified with ADHD, the mean (SD) age was 32.5 (12.8) years, and 51.7% were female. In the within-individual analyses, male patients with ADHD had a 38% (odds ratio, 0.62; 95% CI, 0.56-0.67) lower risk of MVCs in months when receiving ADHD medication compared with months when not receiving medication, and female patients had a 42% (odds ratio, 0.58; 95% CI, 0.53-0.62) lower risk of MVCs in months when receiving ADHD medication. Similar reductions were found across all age groups, across multiple sensitivity analyses, and when considering the long-term association between ADHD medication use and MVCs. Estimates of the population-attributable fraction suggested that up to 22.1% of the MVCs in patients with ADHD could have been avoided if they had received medication during the entire follow-up.

Conclusions and Relevance  Among patients with ADHD, rates of MVCs were lower during periods when they received ADHD medication. Considering the high prevalence of ADHD and its association with MVCs, these findings warrant attention to this prevalent and preventable cause of mortality and morbidity.

×