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J Am Acad Child Adolesc Psychiatry. 2019 Aug 22. pii: S0890-8567(19)31458-3. doi: 10.1016/j.jaac.2019.08.007. [Epub ahead of print]

Effects of Childhood and Adult Persistent Attention-Deficit/Hyperactivity Disorder on Risk of Motor Vehicle Crashes: Results From the Multimodal Treatment Study of ADHD.



Determine crash risk in adults with a history of childhood attention-deficit/hyperactivity disorder (ADHD) and persistent ADHD symptoms.


Participants with (n = 441) and without (n = 239; local normative comparison group, LNCG) childhood ADHD from the Multimodal Treatment Study of ADHD (MTA) were included. Participants provided self-reports on the total number of motor vehicle crashes (MVCs) they had been involved in and the time of licensure. Driving experience was estimated as the number of months since licensure. Total number of MVCs by adulthood was regressed on baseline ADHD status adjusting for sex, age at follow-up, driving experience, baseline oppositional defiant disorder (ODD)/conduct disorder (CD) comorbidity, baseline household income level, adult ODD/CD symptoms, adolescent and adult substance use, and adult antisocial personality disorder symptoms. We repeated the analysis using adult ADHD status (persistent vs. desistant vs. LNCG) and symptom level as the predictor variable. Results are presented as incidence rate ratios (IRR) and confidence intervals.


Childhood ADHD was associated with a higher number of crashes (IRR = 1.45, CI = 1.15 to 1.82) and adult ADHD symptom persistence was associated with more crashes than desistence (IRR = 1.46, CI = 1.14 to 1.86). ADHD desistence was not associated with a significantly increased risk for crashes compared to the LNCG (IRR = 1.24, CI = 0.96 to 1.61). Concurrent symptoms of inattention and hyperactivity/impulsivity predicted MVC risk.


Adult ADHD persistence is a stronger predictor of motor vehicle crash risk than childhood-limited ADHD.


ADHD persistence; attention-deficit/hyperactivity disorder (ADHD); comorbidity; driving; motor vehicle crashes


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