Driving performance in adults with ADHD: results from a randomized, waiting list controlled trial with atomoxetine.
OBJECTIVE
To investigate effects of a 12-week treatment with atomoxetine (ATX) on driving performance in real traffic, driving-related neuropsychological performance tests and self-evaluation of driving in adult patients with ADHD compared to an untreated control group with ADHD.


METHODS
Parallel group design with an ATX and a waiting list group. At baseline and endpoint patients were evaluated with a standardized on-road driving test (SDBO), a driving-related neuropsychological test battery (Act and React Test System [ART2020]), and subjective measures of driving performance (one-week driving diary, Driver Coping Questionnaire).


RESULTS
Forty-three of the 64 included patients completed the study (n=22 ATX, n=21 controls). Mean intervention period was 11.9±3.0 weeks, mean daily ATX dosage was 71.6±14.9mg. At endpoint, 60.1% of patients treated with ATX and 0% of waiting list group had reduced ADHD symptoms by greater or equal to 30%. In SDBO, ATX group reduced driving errors in three of four driving performance categories (attention, P<0.05; risk-related self-control, P<0.005; driver skills, P<0.001), number of driving errors remained stable in control group. At endpoint, 47.6% of control group and 18.2% of ATX group (P<0.05) did not fulfil the driving fitness criteria according to German Guidelines (percentile rank less or equal to 16 in one or more subtests in ART2020). Total number of self-reported critical traffic situations decreased from 12.0 to 6.8 per week in ATX group (P<0.05) and remained stable in controls by 9.3 and 9.9 at baseline and endpoint (ns). Coping strategies with stressful traffic situations did not change within both groups.


CONCLUSIONS
Our study provides first evidence that treatment with ATX improves driving performance in real traffic in adults with ADHD.
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, J 5, 68159 Mannheim, Germany. esther.sobanski@zi-mannheim.de
E
E
Sobanski
D
D
Sabljic
B
B
Alm
R W
RW
Dittmann
P M
PM
Wehmeier
G
G
Skopp
P
P
Strohbeck-Kühner
D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D000069445:Atomoxetine Hydrochloride; D001288:Attention / Q000187:drug effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D001334:Automobile Driving; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011437:Propylamines / Q000494:pharmacology / Q000627:therapeutic use*; D011930:Reaction Time / Q000187:drug effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014850:Waiting Lists
D018759:Adrenergic Uptake Inhibitors; D011437:Propylamines; D000069445:Atomoxetine Hydrochloride