Automobile crashes are one of the leading causes of deaths in adolescents.  Accidents are three to four times more frequent in persons with Attention Deficit Hyperactivity Disorder.  The Attention Deficit Hyperactivity Disorder driver is three to four times more likely to be at fault.  The Attention Deficit Hyperactivity Disorder driver is six to eight times more likely to loose their license.  The treatment of Attention Deficit Hyperactivity Disorder with stimulants improves the performance of the driver.  There is a serious lack of attention being given to the impact of Attention Deficit Hyperactivity Disorder on driver’s performance in relation to accidents in Ireland.  Unfortunately adult Attention Deficit Hyperactivity Disorder is not uncommonly missed as a psychiatric diagnosis.

Adults with Attention Deficit Hyperactivity Disorder have difficulties tending to tasks and activities and inhibiting their impulses. They have a poor ability to sustain attention over long periods, and are unable to concentrate on short, focussed work. They act without thinking, often resulting in reckless and impetuous behaviour.  Indeed, impulsiveness may be an important defining characteristic of Attention Deficit Hyperactivity Disorder in adulthood.  Although they do not necessarily present with the overactive behaviour frequently seen in children they feel restless.  As a result an individual may act without reflection or consideration for the consequences of action.  They may be disorganised, forgetful, and have planning deficits and poor time management skills.  Impetuous novelty-seeking behaviour may result in criminal acts, substance misuse and dependence according to Susan Young a psychologist who focuses on adult Attention Deficit Hyperactivity Disorder.  About 4.4% of adults in the community have adult Attention Deficit Hyperactivity Disorder.  Unfortunately there is an error in DSM-IV diagnosis for Attention Deficit Hyperactivity Disorder. Particularly with adults the age seven cut off is unsatisfactory and it is likely in future that onset in primary school or before the age of 12 will be accepted rather than onset before the age of seven.  In making the diagnosis multiple informants are very helpful or information from parents of a person with adult Attention Deficit Hyperactivity Disorder or school records to improve diagnosis.  It is more common in males than females.  Clearly there is a great deal of comorbidity particularly in the area of Antisocial Personality Disorder, substance misuse, and depression.  They have often poor occupational histories and considerable breakdown in the long term in interpersonal relationships, marriages etc. They often feel socially isolated and misunderstood.  This is unfortunate since there is relatively good treatment available.  Nevertheless they can be successful particularly in the artistic areas.  John Osbourne, Clark Gable, Jesse James, George Carman, and Kenneth Tynan had adult Attention Deficit Hyperactivity Disorder.  Doctors can also have adult Attention Deficit Hyperactivity Disorder and the following questions are often worth considering:

(1)       Do you have difficulty concentrating or focussing your attention on one thing?

(2)       Do you often start multiple projects at the same time, but rarely finish them?

(3)       Do you have trouble with organisation?

(4)       Do you procrastinate on projects that take a lot of attention to detail?

(5)       Do you have problems remembering appointments or obligations?

(6)       Do you have trouble staying seated during meetings or other activities?

(7)       Are you restless or fidgety?

(8)       Do you often loose or misplace things?

In terms of driving behaviour Methylphenidate (Ritalin / Ritalin LA) significantly reduces inattentive driving errors.  It would appear that for those driving in the early evening including during the day Concerta XL (Methylphenidate) which lasts for 12 hours would be more relevant.  This is also a form of slow release Methylphenidate and is off label in Ireland for adults.  Of course accidents do occur in the evening and so good attention is particularly required at this time.  There is also a new medication the first non-stimulant medication available in Ireland for Attention Deficit Hyperactivity Disorder on a named patient basis called Atomoxetine (Strattera) which is active over the 24 hours. This has slow onset and has to be taken seven days a week. This would seem to have a place when you are particularly focussing on wanting to have a person on continuous treatment as it does not wear off.  It would particularly appear to be important for late evening / night, the time of maximum danger for accidents.  Adolescents with Attention Deficit Hyperactivity Disorder also benefit from cognitive / behavioural therapy which focuses on the inhibition of impulses, time management, organisational skills, problem solving skills, anger management, decision-making skills, social skills training, and improved social perception.  Persons with Attention Deficit Hyperactivity Disorder need to be educated about it.  Once the diagnosis is given to them it can suddenly make sense of their lives and sometimes of the chaos of their lives.  It is difficult to get a chaotic life into order if one doesn’t understand what the problem is.  Genetic factors play a major role in Attention Deficit Hyperactivity Disorder.  The problem of adult Attention Deficit Hyperactivity Disorder and accidents is a matter that should be taken up by professional psychiatric bodies and by consultants in Accident and Emergency Departments who are often on the receiving end of problems with Attention Deficit Hyperactivity Disorder.  Organisations involved in road safety should also examine this issue.

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