- The Washington Times - Monday, February 19, 2007

Arlington resident Alison O’Brien knows she must take her medication every day to keep the symptoms of attention-deficit (hyperactivity) disorder, or ADHD, at bay.

One day three years ago, the then-16-year-old didn’t, and it led to a head-on collision.

ADHD is a neurobehavioral disorder in which those afflicted show frequent inattention or behave impulsively. According to the Centers for Disease Control and Prevention, about 4.4 million children ages 4 to 17 have been diagnosed with ADHD. Symptoms may include fidgeting, excessive talking and an inability to follow instructions or complete tasks.

Driving requires concentration, something ADHD can diminish.

Miss O’Brien, 19 and a sophomore at Marymount University, says she was diagnosed with ADHD at about 6 years of age.

“My parents had known, kind of, that I had something wrong with me. It was pretty obvious. They were trying to not believe what was really there,” she says.

Years later, when she neared driving age, her parents made her watch educational videos about safe driving.

But one fateful drive sans medication taught her an indelible lesson.

“I started to feel a little woozy,” she says, looking back at how she felt before the accident. No one was seriously hurt in the accident, but Miss O’Brien took a court-ordered driver’s education course afterward, along with her father, who was there for support. She now keeps extra medication in her car just in case, although lethargy isn’t a typical concern for ADHD teens behind the wheel.

One Virginia-based researcher has been studying ADHD and teen drivers for years in a flurry of projects.

Daniel Cox, professor with the University of Virginia’s Department of Psychiatry, says his studies have shown both the effect ADHD has on teen drivers and the role medication can play in keeping them safer.

“Kids are dying each and every day in car accidents,” Mr. Cox says, and a portion of them have ADHD.

Mr. Cox’s studies typically use a driving-simulator program. In his initial study, Mr. Cox examined how teens concentrated on driving challenges and how various medications affected their performance. Later work uncovered that slower-acting medications better served teen ADHD drivers, for the most part, than faster-acting pills.

Even ADHD teens who took several doses of Ritalin, a fast-acting, fast-metabolizing medication, couldn’t match the driving skills shown by those who took a longer-acting pill such as Concerta.

In the latter study, tests were conducted at 2, 5, 8 and 11 p.m.

“What’s so significant about that is that teens are four times more accidental in the evening than during the day,” Mr. Cox says. Their driving skills eroded further the later it got, he says.

A subsequent study came about when Mr. Cox learned of an ADHD teen who began driving a car with manual transmission after wrecking three vehicles with automatic transmissions.

With an automatic transmission, “I don’t need to think about what I’m doing,” she told him. “It allows me to be inattentive.”

As a result, he set up a test to measure how ADHD and non-ADHD teens fared when driving simulators featuring both automatic and manual transmission types.

“It turned out ADHD individuals drove significantly better on manual transmissions,” he says, echoing the findings of two previous studies (one conducted in Italy, the other in Israel).

“The more the driving environment allows you to not pay attention, the worse off you are,” he says. “Cruise control is probably a bad thing for ADHD drivers.”

His latest study, which he hopes to start in the coming weeks, will install cameras in the cars of teens with ADHD who aren’t on medication to capture their daily driving habits. The first part of the test will be drug-free, but the second half will have the teens take ADHD medication.

All of this assumes that a parent knows definitively that his or her child suffers from ADHD.

Lourdes Griffin, executive director for the Washington Hospital Center’s behavioral health service, says ADHD is typically overdiagnosed — and she understands why.

“Look at any factors influencing things in their life at the moment. It could be a divorce or the child is just distraught and anxious. … These children can’t pay attention,” Ms. Griffin says, adding that children who have been abused are often misdiagnosed as having ADHD.

Doctors sometimes miss children who suffer from attention deficit disorder without the hyperactivity, or ADD.

“They’re not behavioral problems. They’re kids who can’t focus, but they may be caught staring into space,” she says.

Sometimes a parent will hurt a child’s chances of being diagnosed correctly.

Ms. Griffin recalls working with a child whose parents insisted she had ADHD because she didn’t want to do her homework. The doctor talked with the girl and checked with her teacher but didn’t find solid grounds to diagnose her as ADHD.

“This mother was determined [her daughter] had this problem, but she wouldn’t change certain things that made [the girl] act out at home,” Ms. Griffin says.

When it comes to ADHD and teen drivers, Ms. Griffin says extra precautions should be taken.

ADHD drivers need more practice than their peers; they should shelve common distractions such as cell phones and consider not driving around town with a bevy of pals in the car who could distract them — good advice for any teens who drive, in fact.

Evelyn Polk Green, vice president of the New Jersey-based Attention Deficit Disorder Association, says she is well aware of driving issues concerning her two sons, both of whom have ADHD.

Ms. Green’s 21-year-old son lives in Chicago and has never applied for a driver’s license, she says, something she admits gives her peace.

Her younger son, who turns 15 soon, “cannot wait to be behind the wheel,” she says.

“I’m also a little more comfortable with him. He’s not quite as distractible as his brother, but I’m still worried,” says Ms. Green, who also suffers from ADHD.

She alleviated some of her concerns by talking with her younger son about the responsibilities associated with driving.

“We’re going to have a contract,” she says, with provisions including no cell phone usage and no driving with the car full of his friends.

Miss O’Brien knows how lucky she was to survive her crash, but she says she’s also fortunate to have parents who have been diligent in training her properly about driving with ADHD.

“I don’t think as many parents are as active as mine are, which is kind of scary,” she says. “There are consequences [to having ADHD].”

Miss O’Brien keeps her cell phone off while driving and does all she can to drive safely.

“Having ADHD puts us in a disadvantage in nearly every aspect of life. It’s manageable, but you have to be responsible,” she says.

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