title: Influence of stimulant and non-stimulant drug treatment on driving performance in patients with attention deficit hyperactivity disorder: a systematic review.
abstract: Adults with Attention Deficit Hyperactivity Disorder (ADHD), especially teenagers and young adults, show important car driving impairments, including risky driving, accidents, fines and suspension of driver׳s license. We systematically reviewed the efficacy of stimulant and non-stimulant drugs on driving performance of ADHD patients. We searched several databases for randomized controlled trials (RCTs) published through March, 2013. Fifteen RCTs (the majority with crossover design) evaluated methylphenidate (MPH) immediate-release (MPH-IR), MPH osmotic-controlled oral system (MPH-OROS), MPH transdermal system (MTS), extended-release mixed amphetamine salts (MAS-XR); atomoxetine (ATX) and lisdexamfetamine (LDX). Methods varied widely; including simulators and/or cars and different courses and scenarios. Various outcomes of driving performance, including a 'composite' or 'overall' driving score were considered. In general, stimulants improved driving performance in ADHD patients (either in RCTs conducted in simulators and/or cars). MPH-OROS improved driving performance compared with MAS-XR, placebo, or no-drug conditions. Although MPH-OROS and MPH-IR produced similar improvements during the day, MPH-IR lost its efficacy in the evening. MAS-XR also improved driving performance, but worsened driving performance in the evening. MTS (one study) showed a positive effect, but drug compliance varied widely across patients. LDX had positive effect on driving (two studies with the same sample). Studies with ATX report conflicting results. Improvement was more consistent in teenagers and young adults. In general, treatment with psychostimulants or ATX in therapeutic dosages had no negative impact on driving performance of ADHD patients. To conclude, treatment with stimulants in therapeutic doses improves driving performance in ADHD patients, especially teenagers and young adults.
authors.affiliation: Instituto de Psiquiatria do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Rua Dr. Ovídio Pires de Campos, 785, 05403-010 São Paulo, Brazil. Electronic address: magobbo51@hotmail.com.
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Gobbo
authors.affiliation: Instituto de Psiquiatria do Hospital das Clinicas da FMUSP, São Paulo, Brazil.
authors.forename: Mario R
authors.initials: MR
authors.lastname: Louzã
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000188:drug therapy; D001334:Automobile Driving; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D006801:Humans; D011596:Psychomotor Disorders / Q000188:drug therapy* / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000697:Central Nervous System Stimulants
keywords: Atomoxetine; Attention deficit hyperactivity disorder; Driving; Psychostimulants; Treatment