Presented by the. National Resource Center on ADHD

Transcription

1 Presented by the National Resource Center on ADHD

2 (800)

3 Daniel Cox, PhD Director of the Virginia Driving Safety Laboratory Professor of Psychiatric & Internal Medicine, University of Virginia School of Medicine

4 Ask A Question

5

6 Daniel Cox, PhD Director of the Virginia Driving Safety Laboratory Professor of Psychiatric & Internal Medicine, University of Virginia School of Medicine

7 Reducing the Risk of Driving Mishaps Among ADHD Drivers Daniel J. Cox, PhD, ABPP University of Virginia Professor, Department of Psychiatry Director, Virginia Driving Safety Laboratory

8 Bad News

9 Looking beyond the classroom Functional Impairment in Individuals with ADHD Repeat a grade < high school ADHD Normal Teen pregnancy STD Substance abuse Accident prone Serious car accident Arrested Incarcerated Fired from job 0% 10% 20% 30% 40% 50% 60% Subjects (%) 1. Barkley. Attention-deficit hyperactivity disorder. A handbook for diagnosis and treatment, 1998; 2. Barkley et al. JAACAP 1990; 3. Biederman et al. Arch Gen Psych 1996; 4. Weiss et al. JAACAP 1985; 5. Satterfield, Schell. JAACAP 1997; 6. Biederman et al. Am J Psych 1995.

10 Core symtp0oms of ADHD` 1.Inattention 2.Impulsivity 3.Hyperactivity 4.(Distractable) Driving Safety

11 ADHD and Driving: A Dangerous Mix Motor vehicle accidents are the leading cause of death in adolescents, and ADHD is a major contributor. 1 Young drivers with ADHD are 2 to 4 times more likely to have traffic accidents times as likely to have injuries. 3 4 times as likely to be at fault. 2 6 to 8 times more likely to have their license suspended. 2,3 This extends to females as well as males National Highway Traffic Safety Administration. Ann Emerg Med. 1997;29: Barkley RA et al. Pediatrics. 1993;92: Barkley RA et al. Pediatrics. 1996;98: Cox DJ et al. J Nerv Ment Dis. 2000;188: Nada-Raja S et al. JAACAP. 1997;36:

12 Our Studies to Assess the Effect of ADHD and Interventions on Driving Safety STUDY 1: Simulated driving study of RITALIN vs placebo1 among college students with and without ADHD STUDY 2: Simulated driving study of CONCERTA vs RITALIN2 STUDY 3: Simulated and on-road driving study of CONCERTA vs ADDERALL XR vs Placebo4 Study 4: On-road assessment of ADHD adolescents study of CONCERTA vs ADDERALL XR vs Placebo4 Study 5: On-road assessment of ADHD young adults on and off Daytrana Study 6: Simulator study- ADHD driving a manual vs automatic transmission 1Cox DJ Current Psychiatry Reports 13(5):345-50

13 Real World Driving Observations: DriveCam.com Inattention/distraction and Impulsive over correction

14 Good News

15 Virtual Reality Driving Simulator 165 degree visual field Updates every 60 msec Performance feedback Auditory Kinesthetic Visual Tracks 120 performance variables

16 Impaired Driving Score STUDY 1: RITALIN vs Placebo Impaired Driving Score ADHD Placebo Control Placebo ADHD RITALIN Control RITALIN Average driving Placebo ADHD improvement, P<0.05. RITALIN Lower score denotes better driving performance. Cox DJ et al. J Nerv Ment Disord. 2000;188:

17 Concentration (ng/ml) Plasma Profiles Following Ritalin tid and CONCERTA XL 20 IR MPH 10 mg tid (n=15) CONCERTA XL 36 mg qd (n=15) Time (h) Swanson J et al. Arch Gen Psychiatry 2003;60:

18 Impaired Driving Score STUDY 2: CONCERTA vs RITALIN Impaired Driving Score Equivalent performance to male drivers 80+ yrs CONCERTA qd RITALIN tid Average driving -2-3 P<0.01 (8:00 PM). Equivalent performance to male drivers yrs 2:00 PM 5:00 PM 8:00 PM 11:00 PM Time Cox DJ et al. J Am Acad Child Adolesc Psychiatry. 2004;43(3)

19 Impaired Driving Score STUDY 3: CONCERTA vs ADDERALL XR Impaired Driving Score Equivalent performance to male drivers yrs CONCERTA ADDERALL XR Placebo Equivalent performance to male drivers yrs -2 Contrasts Medication vs. placebo; P=.01 Concerta vs. placebo; Time P=.001 Adderall XR vs. placebo; P=.24 Concerta vs. Adderall XR ; P=.03 5:00 PM 8:00 PM 11:00 PM Contrasts: Medication vs placebo P=0.01; CONCERTA vs placebo P=0.001; ADDERALL XR vs placebo P=0.24; CONCERTA vs ADDERALL XR P=0.03. Cox DJ et al. Poster presented at APA 2005; manuscript in preparation.

20 Subjective ratings (0-5) of driving ability post drive CONCERTA Adderall XR Placebo 5:00 PM 8:00 PM 11:00 PM

21 Impaired Neuro-Cognitive Score CONCERTA vs Adderall XR Impaired Neuro-Cognitive Score (Distractibility and Visual Memory) Contrasts OROS MPH vs. Plcebo; P<.001 Adderall XR vs. placebo; P=.042 Plcebo Adderall XR CONCERTA q 0 1 a 5:00 PM 8:00 PM 11:00 PM Average driving 2 3 Academy of Clinical Neuropsychology, 2006, Nov. (In Press) Time

22 Inattention Composite Score STUDY 4: CONCERTA vs. Adderall XR On- Road Driving Inattention Composite Score = Across Midline + Running Stop Signs + No signaling (p =.01) p=.04 p= Placebo Adderall XR CONCERTA Cox DJ, J. Child & Adolescent Psychopharmacology, 18(1), 1-10

23 Study 5: Routine ADHD driving off and on long acting MPH (Daytrana) 20 young adult (18-25) drivers with ADHD who routinely do not take medication Three months off and the on medication Two-camera DriveCam.com video system

24 Real World Benefits Driving Errors Female Male ox, et al, Archives of Pediatrics & Adolescent Medicine. 2008, 162 (8)

25 3 months on and off of Daytrana Collisions No Medication Daytrana No Medication Daytrana Cox DJ, The Journal of Clinical Psychopharmacology. 32(2):

26 What to look for in a medication Medications can be extremely helpful 1. Optimal dose 1.Greatest symptom relief: inattention & impulsivity 2. None to tolerable side effects 2. Driver recognizes benefits 3. Long acting 4. No rebound effects

27 Study 6: Non Pharmacological Interventions: Automatic Vs. Manual transmission Manual Automatic IDS :00 23: Cox et al, J Atten Disord. 2006;10(2):

28 What are non-medication strategies? Anything that enhances engagement and reduces distraction 1. Enhance engagement/attention to driving 1. Manual transmission 2. Back-up obstacle alert system 3. No cruise control Minimize distractions 1. Minimal passenger conversations 2. No teen passengers 3. No pets 4. Put cellphone in trunk/deactivate cell phone 5.?

29 Ask A Question

30 Daniel Cox, PhD Director of the Virginia Driving Safety Laboratory Professor of Psychiatric & Internal Medicine, University of Virginia School of Medicine

31 Let us know how we re doing Suggest topics and presenter Help us better meet your needs Survey appear on your screen immediately following Webcast!

32 (800)

33 The information provided in this episode of Ask the Expert is supported by Cooperative Agreement Number 5U38DD from the Centers for Disease Control and Prevention (CDC). The Ask the Expert webinars contents are solely the responsibility of the invited guest Expert and do not necessarily represent the official views of CDC. Neither CHADD and the National Resource Center on ADHD, nor the CDC endorses, supports, represents or guarantees the accuracy of any material or content presented in the Ask the Expert webinars, nor endorses any opinions expressed in any material or content of the webinars. CHADD and the National Resource Center on ADHD offer webinars for educational purposes only; the information presented should not be regarded as medical advice or treatment information.