A neglected risky behavior among children and adolescents: underage driving and injury in New South Wales,Australia

PROBLEM: Among different causes of injury, roads and traffic-related incidents contributed most to all child deaths. The majority of childhood and adolescent traffic-related deaths are young people killed as pedestrians or bicyclists. Underage driving is a particular risky behavior much neglected. This study aimed to describe some characteristics related to motor-vehicle crashes and crash-related injury in which the vehicle was driven by a young person who was under the legal age of obtaining a learner license in New South Wales, Australia. METHODS: Data used in this study were made available from the Roads and Traffic Authority of NSW for the period between 1996 and 2000. Crash information was collected and reported by NSW police at the scene of these motor-vehicle crash incidents. RESULTS: There were 526 crashes involving an underage driver recorded within the study period. The majority (79.5%) of these underage drivers were males with slightly more than half (58.0%) aged 15 years, and nearly 30% aged 14 years. Among these, 83.6% involved the driver of the vehicle being killed or injured. Among the injured or killed passengers, 128 (73.6%) were nonadult passengers under the age of 18 years. Seventy of these crashes occurred while the car was in pursuit by police. The adjusted relative risk of injury to at least one occupant in the vehicle should a crash occur for female underage drivers was two times (OR=2.01, 95% CI=1.27-3.20) as compared to male underage drivers. DISCUSSION: Underage driving poses a serious problem in terms of crash outcomes. Experimental driving and late-night outings for adolescents should be discouraged. Well-designed studies are required to further investigate the relationship between underage driving and on road risk-taking behavior among licensed adolescents. IMPACT ON INDUSTRY: Data obtained from this study indicate that adults, particularly parents, should discourage underage adolescents from experimenting driving and should actively cultivate a positive attitude toward driving.     

The effects of minimum legal drinking age 21 laws on alcohol-related driving in the United States

Objective

To examine trends in alcohol consumption and alcohol-related crashes among people younger than 21 in the United States and to review evidence on the effects of minimum legal drinking age (MLDA) laws.

Methods

Trends in alcohol-related crashes and alcohol consumption among young people were examined, and studies on the effects of lowering and raising the drinking age were reviewed.

Results

MLDA laws underwent many changes during the 20th century in the United States. Since July 1988, the MLDA has been 21 in all 50 states and the District of Columbia. Surveys tracking alcohol consumption among high school students and young adults found that drinking declined since the late 1970 s, and most of the decline occurred by the early 1990 s. These were the years when states were establishing, or reinstating, a MLDA-21. Among fatally injured drivers ages 16-20, the percentage with positive BACs declined from 61% in 1982 to 31% in 1995, a bigger decline than for older age groups; declines occurred among the ages directly affected by raising MLDAs (ages 18-20) and among young teenagers not directly affected (ages 16-17). Almost all studies designed specifically to gauge the effects of drinking age changes show MLDAs of 21 reduce drinking, problematic drinking, drinking and driving, and alcohol-related crashes among young people. Yet many underage people still drink, many drink and drive, and alcohol remains an important risk factor in serious crashes of young drivers, especially as they progress through the teenage years. Stepped-up enforcement of MLDA and drinking and driving laws can reduce underage drinking. Recent efforts to lower MLDAs to 18 and issue licenses to drink upon completion of alcohol education have gained local and national media attention. There is no evidence that alcohol education can even partially replace the effect of MLDA-21.

Conclusions

The cause and effect relationship between MLDAs of 21 and reductions in highway crashes is clear. Initiatives to lower the drinking age to 18 ignore the demonstrated public health benefits of MLDAs of 21.

Impact on Industry

Lowering the drinking age to 18 will increase highway crash deaths among young people.     

Adolescent, and their parents, attitudes towards graduated driver licensing and subsequent risky driving and crashes in young adulthood

Problem

Although Graduated Driver Licensing Systems (GDLS) have helped reduce young driver crash rates, they remain significantly over-represented in crash statistics. To be effective GDLS rely heavily on support for the legislation by those directly involved; parents to enforce the restrictions and adolescents to comply. There is some evidence that practices regarding GDLS restrictions influence adolescent driving outcomes in the early stage of licensure. However there has been no examination undertaken on the influence of parent and adolescent attitudes toward GDLS on adolescents’ driving behavior and crash experiences as they move into their young adult years. The aim of this research was to examine these relationships.

Method

This investigation was based on a longitudinal study of a birth cohort, and uses data collected when the cohort members were aged 15, 18, and 21 years. At age 15 both adolescent and their parent attitudes toward GDLS were measured. At age 18 adolescent GDLS attitudes were measured again. The association between these measures and self-reported risky driving behavior and crash involvement at age 21 were examined.

Results

Negative attitudes toward the learner supervisor restriction for males, and negative attitudes toward a GDLS for females were strongly associated with risky driving and crash involvement as young adults.

Impact on industry

Targeting interventions to improve adolescents and parents understanding of the reasons for graduated licensing and the specific restrictions may improve attitudes and views and thereby contribute to a reduction in risky driving behaviors and crash risk among young adults.     

Changes in risky driving behavior from age 21 to 26 years

Aim: The aim of this study was to determine whether the prevalence of risky driving behavior changed between ages 21 and 26 years, among a cohort of young people. Method: This study was part of the Dunedin Multidisciplinary Health and Development Study, which is a longitudinal study of a birth cohort. This study involved examining changes in the prevalence of risky driving behavior among young adults at ages 21 and 26 years. At both ages, 936 members of the cohort were administered face-to-face interviews, using a structured questionnaire that included items on a range of risky driving and thrill-seeking activities. Results: The results showed that risky driving was predominantly a male activity, but by 26 years of age, many had “matured out” of this behavior. At the same time, the desire for thrill-seeking increased among the males. Among the females, there were few significant changes between ages 21 and 26 years, but at both ages, the prevalence of risky driving and thrill-seeking was relatively low. Impact on industry: These results show that the main target population for road safety interventions aimed at reducing risky driving behavior should be young, male drivers.     

Young driver risk in relation to parents' retrospective driving record

PROBLEM: Parents are an important potential influence on the driving safety of their children. This study examined the relationship of parental driving record on male and female offspring's at-fault collision risk. METHOD: Drivers aged 16-21 on the date of full licensure were selected from driver records and a matching process was used to identify putative parents in two-parent households. Poisson regression models were developed to predict at-fault collisions of male and female youth in the three years following full licensure from parents' at-fault collisions, speeding offenses, and other moving offenses in the four years prior to children's licensure. One set of models examined the relative risk associated with increasing numbers of maternal and paternal at-fault collisions and offenses. Other models examined the joint versus separate maternal and parental contributions. RESULTS: Controlling for region of residence, both mothers' and fathers' at-fault collisions were associated with an increased risk in both male and female youth at-fault collisions. Mothers' and fathers' speeding offenses were also associated with increased relative risk of at-fault collisions for both sons and daughters, while fathers' other moving offenses increased collision risk for sons but not daughters. DISCUSSION: Further research is required to identify how parental driving risk is transmitted to children. IMPACT ON INDUSTRY: (a) Parents of young children should be informed of their role in influencing their children's future driving risk; (b) The results identify risk factors that could be of interest to licensing authorities and the insurance industry.     

Young drivers' determinants of driving under the influence of cannabis: Findings from the Youth Cannabis and Driving Survey (YouCanDS)

Introduction: Driving under the influence of cannabis (DUIC) is proven to increase the risk of collisions and is most common among young drivers (ages 16 to 24). However, little is known about the specific determinants of DUIC behavior among youth, which limits the capacity to develop evidence-based prevention and intervention efforts. This study developed and evaluated a youth DUIC questionnaire, which was used to establish the DUIC determinants of young drivers. Method: The questionnaire was based on the theoretical framework of general deterrence and general prevention. Data obtained included: demographics, past cannabis use and DUIC experiences, DUIC intention, experiences riding as a passenger with someone DUIC, knowledge and credibility of the law, attitudes towards DUIC, and social controls. The resulting questionnaire was validated for a sample of 426 young drivers in the province of Ontario, Canada. An ordinal regression was conducted to examine the relationships between questionnaire items and DUIC intention. Results: The questionnaire displayed good construct validity and internal consistency across four out of five domains (KMO and Cronbach α values ≥ 0.70). Of the 426 respondents (52.6% female), 356 (83.6%) reported previous cannabis use, with 296 (69.5%) doing so in the past year, and 142 (33.3%) reporting DUIC. Furthermore, 179 (42%) study participants indicated at least a slight chance of DUIC in the next year. The regression analysis identified six variables predictive of DUIC intention: past DUIC incidence, perceived percent of those convicted that receive the penalty, moral awareness, perceived dangerousness, minor accident risk, and vicarious punishment avoidance. Conclusions: Preventive efforts should emphasize these determinants when designing targeted strategies and interventions. Practical Applications: These efforts should focus on educating the dangers and risk of a vehicle collision, that law enforcement has the capacity to apprehend and appropriately punish individuals DUIC, and that DUIC is wrong and socially unacceptable.     

Deconstructing a gender difference: driving cessation and personal driving history of older women

PROBLEM: The purpose of this study is to understand the reasons behind older women's driving cessation by comparing the driving histories of Finnish women who either gave up or renewed their drivers license at the age of 70. METHOD: A mail survey was sent to all Finnish women born in 1927 who gave up their license in 1997 (N=1,476) and to a corresponding random sample of women who renewed their license (N=1,494). The total response rate was 42.1%. RESULTS: The length and level of activity of personal driving history were strongly associated with driving cessation and continuation. Ex-drivers tended to have an inactive driving career behind them, whereas drivers had a more active personal driving history. In addition, those women with an active, "male-like" driving history who had decided to stop driving gave reasons for driving cessation that were similar to what is known about older men's reasons to give up driving. The results suggest that the decision to stop driving is related to driving habits rather than gender.     

Predictability of clinical assessments for driving performance

PROBLEM: As the number of older drivers grows, it is increasingly important to accurately identify at-risk drivers. This study tested clinical assessments predictive of real-time driving performance. METHOD: Selected assessment tools considered important in the identification of at-risk older drivers represented the domains of vision, cognition, motor performance, and driving knowledge. Participants were administered the battery of assessments followed by an on-road test. A univariate analysis was conducted to identify significant factors (<.05) to be included in a multivariate regression model. RESULTS: Assessments identified as independently associated with driving performance in the regression model included: FACTTM Contrast sensitivity slide-B, Rapid Pace Walk, UFOV rating, and MMSE total score. DISCUSSION: The domains of vision, cognitive, and motor performance were represented in the predictive model. SUMMARY: Due to the dynamic nature of the driving task, it is not likely that a single assessment tool will identify at risk drivers. IMPACT ON INDUSTRY: By standardizing the selection of clinical assessments used in driving evaluations, practitioners should be able to provide services more efficiently, more objectively, and more accurately to identify at-risk drivers.     

Changes in driving performance after first and second eye cataract surgery: A driving simulator study

Introduction: This study investigated the separate impact of first eye and second eye cataract surgery on driving performance, as measured on a driving simulator. Method: Forty-four older drivers with bilateral cataract aged 55+ years, awaiting first eye cataract surgery participated in a prospective cohort study. They completed a questionnaire, visual tests and a driving simulator assessment at three time points: before first eye, after first eye, and after second eye cataract surgery. Generalized Estimating Equation Poisson or linear regression models were undertaken to examine the change in four driving outcomes of interest after adjusting for cataract surgery and other potential confounders. Results: The rate of crashes/near crashes decreased significantly by 36% (incidence rate ratio (IRR) 0.64, 95% CI 0.47–0.88, p = 0.01) after first eye surgery and 47% (IRR 0.53, 95% CI 0.35–0.78, p < 0.001) after second eye surgery, compared to before first eye cataract surgery, after accounting for confounders. The rate of crashes/near crashes also decreased with better contrast sensitivity (IRR 0.69, 95% CI 0.48–0.90, p = 0.041). A separate model found that time spent speeding 10 kilometers per hour or more over the limit after second eye surgery was significantly less (0.14 min, p = 0.002), compared to before first eye surgery, after accounting for confounders. As contrast sensitivity improved, the duration of speeding also decreased significantly by 0.46 min (p = 0.038). There were no statistically significant changes in lane excursions or speed variation. Practical applications: The findings highlight the importance of timely first and second eye cataract surgery to ensure driver safety, especially as older drivers wait for second eye cataract surgery. It also provides further evidence that contrast sensitivity is probably a better predictor of driving ability in older drivers with cataract than visual acuity, the measure on which driver licensing requirements are currently based, and should also be used when assessing fitness to drive.     

On-road and simulated driving: concurrent and discriminant validation

Introduction

A converging pair of studies investigated the validity of a simulator for measuring driving performance/skill.

Study 1

A concurrent validity study compared novice driver performance during an on-road driving test with their performance on a comparable simulated driving test.

Results

Results showed a reasonable degree of concordance in terms of the distribution of driving errors on-road and errors on the simulator. Moreover, there was a significant relationship between the two when driver performance was rank ordered according to errors, further establishing the relative validity of the simulator. However, specific driving errors on the two tasks were not closely related suggesting that absolute validity could not be established and that overall performance is needed to establish the level of skill.

Study 2

A discriminant validity study compared driving performance on the simulator across three groups of drivers who differ in their level of experience - a group of true beginners who had no driving experience, a group of novice drivers who had completed driver education and had a learner's permit, and a group of fully licensed, experienced drivers.

Results

The findings showed significant differences among the groups in the expected direction -- the various measures of driving errors showed that beginners performed worse than novice drivers and that experienced drivers had the fewest errors. Collectively, the results of the concurrent and discriminant validity studies support the use of the simulator as a valid measure of driving performance for research purposes.

Impact on industry

These findings support the use of a driving simulator as a valid measure of driving performance for research purposes. Future research should continue to examine validity between on-road driving performance and performance on a driving simulator and the use of simulated driving tests in the evaluation of driver education/training programs.     

A challenge to the assumed generalizability of prediction and countermeasure for risky driving: different factors predict different risky driving behaviors

In road safety, it may be debated whether all risky behaviors are sufficiently similar to be explained by similar factors. The often assumed generalizability of the factors that influence risky driving behaviors has been inadequately tested. Study 1 (N=116) examined the role of demographic, personality and attitudinal factors in the prediction of a range of risky driving behaviors, for young drivers. Results illustrated that different driving behaviors were predicted by different factors (e.g., speeding was predicted by authority--rebellion, while drink driving was predicted by sensation seeking and optimism bias). Study 2 (N=127) examined the generalizability of these results to the general driving population. Study 1 results did not generalize. Predictive factors remained behavior-specific, but different predictor-behavior relationships were observed in the community sample. Overall, results suggest that future research and practice should focus on a multi-factor framework for specific risky driving behaviors, rather than assuming generalizability across behaviors and driving populations.     

Difficulties in emotion regulation and risky driving among Lithuanian drivers

Background: Risky driving is a common cause of traffic accidents and injuries. However, there is no clear evidence of how difficulties in emotion regulation contribute to risky driving behavior, particularly in small post-Soviet countries. The present study aimed to investigate the relationship between difficulties in emotion regulation and self-reported risky driving behavior in a sample of Lithuanian drivers.

Methods: A total of 246 nonprofessional Lithuanian drivers participated in a cross-sectional survey. Difficulties in emotion regulation were assessed using the Difficulties in Emotion Regulation Scale (DERS; Gratz and Roemer 2004), and risky driving behavior was assessed using the Manchester Driver Behaviour Questionnaire (DBQ; Lajunen et al. 2004).

Results: Males scored higher than females in aggressive violations and ordinary violations. Females scored higher for the nonacceptance of emotional responses, whereas males had more difficulties with emotional awareness than females. More difficulties in emotion regulation were positively correlated with driving errors, lapses, aggressive violations, and ordinary violations for both males and females. Structural equation modeling showed that difficulties in emotion regulation explained aggressive and ordinary violations more clearly than lapses and errors. When controlling for interactions among the distinct regulation difficulties, difficulties with impulse control and difficulties engaging in goal-directed behavior predicted risky driving. Furthermore, nonacceptance of emotional responses and limited access to emotion regulation strategies were related to less violations and more driving errors.

Conclusion: Emotion regulation difficulties were associated with the self-reported risky driving behaviors of Lithuanian drivers. This provides useful hints for improving driver training programs in order to prevent traffic injuries.     

Higher cue utilization in driving supports improved driving performance and more effective visual search behaviors

IntroductionOnce qualified, drivers rarely receive objective feedback concerning their performance. This is especially the case in the context of cognitive skills such as situation assessment. The aim of this study was to test the construct validity of an online assessment of motor-vehicle driver cue utilization that forms the foundation for situation assessment. Method: Seventy-one undergraduate Psychology students with broadly comparable driving experience completed a motor-vehicle driving version of EXPERTise 2.0, an online tool that enables inferences concerning the utilization of cues based on responses to task-related stimuli. They also completed a simulated driving task while fitted with an eye tracking device, during which a range of hazards were presented with participants’ responses recorded. Results: The results indicated that higher cue utilization was associated with fewer driving errors and collisions, fewer visual fixations, and fewer saccades in comparison to participants with lower cue utilization. Conclusion: The results provide support for the construct validity of EXPERTise 2.0 as an effective measure of cue utilization in the context of driving.Practical applicationsProviding comparative feedback to drivers concerning their development of situation assessment skills may provide opportunities for further training and development, thereby reducing the likelihood of motor-vehicle accidents.     

女性驾驶人特性与行为机制研究现状及展望

为系统地认识女性驾驶人的驾驶特性,分析其驾驶行为,从女性驾驶人交通事故数据统计、致因和心理、生理、“药驾”等因素,梳理国内外女性驾驶人驾驶特性及行为机制的研究成果,总结主流研究角度、方法和内容,并展望其未来研究趋势。对文献的梳理和分析表明:导致女性驾驶人交通事故的因素主要包括人格、认知等心理特征和视觉能力、应激反应等生理特征,同时“药驾”也影响着驾驶特性与行为。剖析了女性驾驶人特性及行为机制研究目前存在的不足之处,对未来的研究提出了建议。并针对女性驾驶人群体在各种道路交通环境中开展有效的模拟驾驶培训和教育,进而全面提升中国女性驾驶人的交通安全水平。     

Pediatrician attitudes, knowledge, and practice behavior regarding teen driving safety

Problem

Each year about 4,000 teens ages 16-19 die on U.S. roads. Injury prevention counseling is recommended as a valuable and cost-effective part of routine health supervision. This study describes pediatrician knowledge and practice regarding teen driving safety.

Methods

A 31-item self-administered survey was mailed to pediatricians.

Results

160 of 392 pediatricians (41%) completed the survey. During a health supervision visit 93% of pediatricians reported discussing seat belt use, 89% impaired driving, 54% teen licensing laws, and 16% parent teen contract. Half reported having a teen in their practice killed in a crash.

Conclusions

A majority surveyed report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduated driver licensing laws or related issues. Impact on Industry: Broadly adopted, this inexpensive counseling approach, could lead to reductions in teen motorvehicle crash injuries.     

Evaluating impaired drivers confidence and intention to "(Please) drink responsibly"

Introduction

Currently, alcohol industry-sponsored advertisements subsume traditional designated driver and don't drink and drive messages within responsible drinking campaigns. Yet, to date, there remains a dearth of literature specifically examining the attitudinal beliefs impaired drivers attach to the responsible drinking message.

Objective

This investigation sought to examine the responsible drinking attitudes and beliefs of impaired drivers, specifically examining their confidence and intention to drink responsibly the next time they consumed alcohol.

Methods

A random sample of 729 students attending a large, public Texas university completed a web-based administration of the Characteristic of Responsible Drinking Survey (CHORDS).

Results

Participants in this sample who had driven while impaired by alcohol exhibited significantly less confidence in refraining from drinking and driving and reported significantly lower intentions to designate a driver, take a taxi, or use a safe-ride program the next time they consumed alcohol. Additionally, they also reported less confidence, and lower intentions, to ensure their blood alcohol concentrations remained below the legal limit (0.08%) the next time they consumed alcohol.

Conclusions

Drivers who had driven while impaired significantly differed in their confidence and intention to drink responsibly the next time they consumed alcohol. Logistic regression results indicate that by increasing one's confidence in responsible drinking, and increasing their intention to drink responsibly, the likelihood of impaired driving can be decreased.

Impact on industry

Results from this investigation demonstrate one’s responsible drinking attitudinal beliefs accounts for a significant amount of the variance associated with one’s alcohol-related behaviors. Thus, further research should examine and establish how individuals conceptualize and practice responsible drinking.     

Identifying the impact of the COVID-19 pandemic on driving behavior using naturalistic driving data and time series forecasting

Introduction: COVID-19 has disrupted daily life and societal flow globally since December 2019; it introduced measures such as lockdown and suspension of all non-essential movements. As a result, driving activity was also significantly affected. Still, to-date, a quantitative assessment of the effect of COVID-19 on driving behavior during the lockdown is yet to be provided. This gap forms the motivation for this paper, which aims at comparing observed values concerning three indicators (average speed, speeding, and harsh braking), with forecasts based on their corresponding observations before the lockdown in Greece. Method: Time series of the three indicators were extracted using a specially developed smartphone application and transmitted to a back-end platform between 01/01/2020 and 09/05/2020, a time period containing normal operations, COVID-19 spreading, and the full lockdown period in Greece. Based on the collected data, XGBoost was employed to identify the most influential COVID-19 indicators, and Seasonal AutoRegressive Integrated Moving Average (SARIMA) models were developed for obtaining forecasts on driving behavior. Results: Results revealed the intensity of the impact of COVID-19 on driving, especially on average speed, speeding, and harsh braking per 100 km. More specifically, speeds were found to increase by 2.27 km/h on average compared to the forecasted evolution, while harsh braking/100 km increased to almost 1.51 on average. On the bright side, road crashes in Greece were reduced by 49% during the months of COVID-19 compared to the non-COVID-19 period.     

Covariability in three dimensions of teenage driving risk behavior: impaired driving,risky and unsafe driving behavior,and secondary task engagement

Objective: This research examined the extent to which teenagers who engaged in one form of risky driving also engaged in other forms and whether risky driving measures were reciprocally associated over time.

Methods: The data were from waves 1, 2, and 3 (W1, W2, and W3) of the NEXT Generation study, with longitudinal assessment of a nationally representative sample starting with 10th graders starting in 2009–2010. Three measures of risky driving were assessed in autoregressive and cross-lagged analyses: driving while alcohol/drug impaired (DWI), Checkpoints Risky Driving Scale (risky and unsafe driving), and secondary task engagement while driving.

Results: In adjusted autoregression models, the risk variables demonstrated high levels of stability, with significant associations observed across the 3 waves. However, associations between variables were inconsistent. DWI at W2 was associated with risky and unsafe driving at W3 (β = 0.21, P < .01); risky and unsafe driving at W1 was associated with DWI at W2 (β = 0.20, P < .01); and risky and unsafe driving at W2 is associated with secondary task engagement at W3 (β = 0.19, P < .01). Over time, associations between DWI and secondary task engagement were not significant.

Conclusions: Our findings provide modest evidence for the covariability of risky driving, with prospective associations between the Risky Driving Scale and the other measures and reciprocal associations between all 3 variables at some time points. Secondary task engagement, however, appears largely to be an independent measure of risky driving. The findings suggest the importance of implementing interventions that addresses each of these driving risks.     

The effects of personality and gender on risky driving behaviour and accident involvement

The present study investigates the effects of personality traits and gender on risky driving behaviour and accident involvement. A sample of Norwegian adolescents in two Norwegian counties participated (n = 1356). Anxiety was significantly correlated to excitement-seeking and risky driving behaviour, and excitement-seeking was significantly correlated to risky driving behaviour and collisions. Through a regression analysis, personality traits and gender were found to explain 37.3% of the variance in risky driving behaviour. However, the relations were not very strong, and the personality traits did only explain a moderate part of the variance. Possible explanations for this as well as methodological considerations are discussed. Directions for further research are suggested.     

A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance

INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) may interfere with driving competence, predisposing those with the disorder to impaired driving performance and greater risk for adverse driving outcomes. Effective treatment may minimize the risk in those with ADHD. METHOD: We reviewed the scientific literature on driving risks and impairments associated with ADHD and the effects of stimulants on driving performance. Several lines of evidence were considered, including longitudinal studies and community-derived sample studies. The present review is based on a weekly review (by the first author) of all journals in the behavioral and social sciences indexed in the publication Current Contents spanning the past 15 years, as well as a search of the reference section of all studies found that pertained to driving risks associated with ADHD or to the treatment of ADHD as it relates to driving difficulties. RESULTS: The review of the scientific literature demonstrated well-documented driving risks and impairments associated with ADHD and the positive effects of stimulant medications on driving performance. CONCLUSIONS: Clinicians should educate patients/caregivers about the increased risk of adverse outcomes among untreated individuals with ADHD and the role of medication in potentially improving driving performance. IMPACT ON INDUSTRY: Owing to the significantly higher risk of adverse driving outcomes, the use of stimulant medications to treat people with ADHD who drive may reduce such safety risks.