Evidence-Based Review on Interventions and Determinants of Driving Performance in Teens with Attention Deficit Hyperactivity Disorder or Autism Spectrum Disorder

Abstract

Objective: We conducted an evidence-based review of intervention studies and predictor studies related to driving outcomes in teens with attention deficit–hyperactivity disorder (ADHD) or autism spectrum disorder (ASD).

Methods: Ten primary studies were classified using the American Academy of Neurology's criteria (class I–IV, I = highest level of evidence). We provided recommendations including Level A: intervention/factors are effective/predictive or not; Level B: probably effective/predictive or not; Level C: possibly effective/predictive or not; Level U: no recommendations.

Results: For the intervention studies we identified 1 Class II and 1 Class III study; for predictor studies, we identified 7 ADHD studies consisting of 1 Class II and 6 Class III studies. Only 1 Class III ASD study was found. In synopsizing the evidence, the following recommendations are made for the intervention studies pertaining to on-road performance in teens with ADHD: a multimodal intervention is possibly effective in improving driving performance (Level C); stimulants possibly do not affect driving negatively (Level C); no recommendations can be made for hazard perception training in ADHD or ASD (Level U). Consider the following recommendations useful for simulated driving performance: Stimulants possibly improve driving performance (Level C); ADHD diagnosis and being unmedicated possibly worsen driving performance (Level C); no recommendations for driving in low-stimulus conditions (Level U). From self-/proxy report, no recommendations can be made related to gender or ADHD subtype affecting adverse driving outcomes (Level U).

Conclusion: Class I studies with Level A recommendations, currently lacking in the literature, are urgently needed to make clear the mechanism underlying driving performance outcomes in ADHD and ASD.

Supplementary materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention for the following supplemental resource: Table: Evidence-based Synopsis of ADHD, ASD and Driving Performance: Variables, Sample, Findings & Rationale

Keywords:

• evidence-based practice
• adolescents
• attention deficit disorder with hyperactivity
• pervasive disorders
• automobile driving

Acknowledgments

This study was funded by the 2011–2012 UF&Shands Quasi Endowment Fund (principal investigator: Classen). The Institute for Mobility, Activity and Participation provided infrastructure and support.