Abstract
BackgroundLittle is known about the impact of cognitive impairments on driving in adults with ADHD. The present study compared the performance of adults with and without ADHD in a driving simulator on two different routes: an urban route which we hypothesised would exacerbate weak impulse control in ADHD and a motorway route, to challenge deficits in sustained attention.MethodsAdults with (n = 22, 16 males) and without (n = 21, 18 males) ADHD completed a simulated driving session while eye movement data were recorded simultaneously. Participants also completed the Manchester Driving Behaviour Questionnaire (DBQ) and the Conners Adult ADHD Rating Scale (CAARS). Measures of driving performance included average speed, proportion distance travelled over speed limit (speeding) and lane deviation. These variables and the eye movement measures (spread of fixations, mean fixation duration) were compared between groups and routes. Also, driving behaviours, including responses to programmed events, were categorised and the frequencies within categories were compared between groups. Finally, speech analysis was performed to compare emotional verbal expressions during driving between groups.ResultsADHD participants reported significantly more Violations and Lapses on the DBQ than control participants and significantly more accidents. Average speed and speeding were also higher but did not interact with route type. ADHD participants showed poorer vehicle control, greater levels of frustration with other road users (including greater frequencies of negative comments) and a trend for less safe driving when changing lanes/overtaking on the motorway. These effects were predicted by hyperactive/impulsive CAARS scores. They were also more likely to cause a crash/near miss when an event occurred on the urban route.ConclusionsThe results suggest that difficulty regulating and controlling impulsive behavior, reflected in speeding, frustration with other road users, less safety when changing lanes on the motorway and a greater likelihood of an accident following an unexpected event, underlie impaired driving in ADHD. Hyperactivity/impulsivity symptoms correlated with these indices. Deficits in sustained attention seemed to play a lesser role in this particular study, although further research is needed to determine whether effects on attention emerge over longer periods of time and/or are influenced by the novelty of the simulator environment.
Highlights
Little is known about the impact of cognitive impairments on driving in adults with Attention deficit hyperactivity disorder (ADHD)
The cognitive impairments associated with ADHD in childhood continue into adulthood [2] but relatively little is known about the impact of these difficulties on activities of daily living in adulthood such as driving
Current and lifetime ADHD diagnosis was established by conducting the Diagnostic Interview for ADHD in Adults (DIVA 2.0 [33]), childhood developmental history and comprehensive psychiatric assessment.Scores were obtained from the Conners Adult ADHD Rating Scales (CAARS self- and observer-report) [34] and Autism Quotient (AQ) [35]
Summary
Little is known about the impact of cognitive impairments on driving in adults with ADHD. Increased rates of driving accidents (including those for which the driver was liable) and driving prosecutions have been reported in adults diagnosed with ADHD (reviewed in [3,4,5]). These adults are more likely to exceed the speed limit, have poorer vehicle control [6], express frustration and anger with other road users [7, 8] and be distracted when driving [9] than adults without ADHD and experience greater deterioration in driving performance when under the influence of alcohol [10, 11]. It seems likely that these factors will prove important during driving in individuals with ADHD and that they might predict different aspects of driving performance
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