Effect of stimulant medication on driving performance of young adults with attention-deficit hyperactivity disorder: a preliminary double-blind placebo controlled trial. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. Long-Acting Methylphenidate Reduces Collision Rates of Young Adult Drivers With Attention-Deficit/Hyperactivity Disorder The effects of lisdexamfetamine dimesylate on the driving performance of young adults with ADHD: a randomized, double-blind, placebo-controlled study using a validated driving simulator paradigm. Motor vehicle driving competencies and risks in teens and young adults with attention deficit hyperactivity disorder. Effects of two doses of methylphenidate on simulator driving performance in adults with attention deficit hyperactivity disorder. Relative Benefits of Stimulant Therapy With OROS Methylphenidate Versus Mixed Amphetamine Salts Extended Release in Improving the Driving Performance of Adolescent Drivers With Attention-Deficit/Hyperactivity Disorder Controlled-release methylphenidate improves attention during on-road driving by adolescents with attention-deficit/hyperactivity disorder. Rebound effects with long-acting amphetamine or methylphenidate stimulant medication preparations among adolescent male drivers with attention-deficit/hyperactivity disorder. Impact of methylphenidate delivery profiles on driving performance of adolescents with attention-deficit/hyperactivity disorder: a pilot study. Methylphenidate significantly improves driving performance of adults with attention-deficit hyperactivity disorder: a randomized crossover trial Simulated Driving Changes in Young Adults With ADHD Receiving Mixed Amphetamine Salts Extended Release and Atomoxetine Sex Differences in Effectiveness of Extended-Release Stimulant Medication among Adolescents with Attention-Deficit/Hyperactivity Disorder The effects of lisdexamfetamine dimesylate on driving behaviors in young adults with ADHD assessed with the Manchester driving behavior questionnaire. The Effects of Coffee and Napping on Nighttime Highway Driving Erratum to: Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies A Randomized, Double-Blind, Sham-Controlled Trial of Transcranial Direct Current Stimulation in Attention-Deficit/Hyperactivity Disorder
Driving performance of adult males with attention-deficit hyperactivity disorder ( ADHD ) was compared with matched controls in a double-blind ( Ritalin vs. placebo ) cross-over design , using a high-fidelity driving simulator . Seven ADHD and six non-ADHD drivers ( mean age 22 ) were screened to rule out comorbidity and assess for ADHD , and then admitted to the General Clinical Research Center to control diet and sleep before testing . At 0800 and 1530 , subjects consumed either a placebo or Ritalin pill in a counter-balanced manner , and at 0930 and 1700 , subjects drove the simulator . After both drives , subjects rated their driving performance . Compared with non-ADHD subjects , ADHD subjects had more career driving accidents ( p < .04 ) and motor vehicle violations ( p = .059 ) , drove worse on the simulator under placebo condition ( p < .05 ) , demonstrated significant improvement under the Ritalin condition ( p < .05 ) , rated themselves as driving poorer during the placebo condition ( p = .05 ) , and tended to perceive their driving to be better during the Ritalin condition ( p = .07 ) . This would suggest that individuals with ADHD should have the therapeutic benefit of a stimulant medication when operating a vehicle Past studies find that attention deficit hyperactivity disorder ( ADHD ) creates a higher risk for adverse driving outcomes . This study comprehensively evaluated driving in adults with ADHD by comparing 105 young adults with the disorder ( age 17 - 28 ) to 64 community control ( CC ) adults on five domains of driving ability and a battery of executive function tasks . The ADHD group self-reported significantly more traffic citations , particularly for speeding , vehicular crashes , and license suspensions than the CC group , with most of these differences corroborated in the official DMV records . Cognitively , the ADHD group was less attentive and made more errors during a visual reaction task under rule-reversed conditions than the CC group . The ADHD group also obtained lower sceres on a test of driving rules and decision-making but not on a simple driving simulator . Both self- and other-ratings showed the CC group employed safer routine driving habits than the ADHD group . Relationships between the cognitive and driving measures and the adverse outcomes were limited or absent , calling into question their use in screening ADHD adults for driving risks . Several executive functions also were significantly yet modestly related to accident frequency and total traffic violations after controlling for severity of ADHD . These results are consistent with earlier studies showing significant driving problems are associated with ADHD . This study found that these driving difficulties were not a function of comorbid oppositional defiant disorder , depression , anxiety , or frequency of alcohol or illegal drug use . Findings to date argue for the development of interventions to reduce driving risks among adults with ADHD Abstract This study investigated whether methylpheni date delivered through a long-acting transdermal system ( MTS ) would reduce collision rates of young adult drivers with attention-deficit/hyperactivity disorder ( ADHD ) . Seventeen young adults completing the study ( mean [ SD ] age , 20.82 [ 2.40 ] years ; 14 men and 13 white ) met the following inclusion criteria : ADHD diagnoses but not routinely taking ADHD medication , previously responsive to ADHD medication , active drivers with more than 1 collision or citation in the past 2 years , and no significant comorbidities . In this open-labeled , crossover design drivers were r and omly assigned either to the no-medication condition for 3 months and then MTS for 3 months or to the reverse sequence . In-car video monitoring of routine driving occurred during these 6 months . At baseline and after each condition , participants completed the Conners Adult ADHD Rating Scale and the Cox Assessment of Risky Driving Scale , and their blood pressure , heart rate , and body weight were monitored . Compared with the no-medication condition , participants in the MTS condition self-reported fewer total ADHD ( P < 0.04 ) and inattentive symptoms ( P = 0.014 ) and a trend for risky driving behaviors ( P = 0.059 ) and had fewer video-recorded collisions ( P < 0.005 ) and other problematic driving events . There were no significant changes in blood pressure , heart rate , or body weight across conditions or any significant skin reactions to the MTS patch . This is the first study demonstrating that long-acting methylpheni date improves activities of daily living among young adults with ADHD . Specifically , methylpheni date improved safety in routine driving while reducing ADHD symptoms with minimal adverse effects Young adults with Attention Deficit Hyperactivity Disorder ( ADHD ) have been shown to be at increased risk for impairment in driving behaviors . While stimulant medications have proven efficacy in reducing ADHD symptomatology , there is limited knowledge as to their effects on driving impairment . The main aim of this study was to assess the impact of lisdexamfetamine dimesylate ( LDX ) on driving performance in young adults with ADHD using a vali date d driving simulation paradigm . This was a r and omized , double-blind , 6-week , placebo-controlled , parallel- design study of LDX vs. a placebo on driving performance in a vali date d driving simulation paradigm . Subjects were sixty-one out patients of both sexes , 18 - 26 years of age , who met DSM-IV criteria for ADHD . Subjects were r and omized to receive LDX or placebo after a baseline driving simulation and completed a second driving simulation six weeks after beginning drug or placebo . Examination of reaction time across five surprise events at post-treatment showed a significant positive effect of medication status . LDX treatment was also associated with significantly fewer accidents vs. placebo . LDX treatment was associated with significantly faster reaction times and a lower rate of simulated driving collisions than placebo . These results suggest that LDX may reduce driving risks in young adults with ADHD PURPOSE To evaluate the motor vehicle driving knowledge , skills , and negative driving outcomes of older teens and young adults with attention deficit hyperactivity disorder ( ADHD ) . LOCATION A university medical center clinic for adult ADHD . SUBJECTS A total of 25 young adults with ADHD and 23 young adults without ADHD 17 to 30 years old drawn from the community and equated for age , gender , and educational level . MEASURES  Structured interview , behavior ratings by self- and others , video test of driving knowledge , computer simulated driving test , and official motor vehicle records .  RESULTS ADHD young adults were cited more often for speeding , were more likely to have had their licenses suspended , were involved in more crashes , were more likely to have had crashes causing bodily injury , and were rated by themselves and others as using poorer driving habits . Official driving records corroborated these negative outcomes . Although no group differences in driving knowledge were evident , young adults with ADHD had more crashes , scrapes , and erratic steering during the computer-stimulated driving test than did the control subjects . CONCLUSIONS Findings supported previous research suggesting that greater driving risks are associated with ADHD and suggested that ADHD does not interfere with driving knowledge so much as with actual performance ( motor control ) during vehicle operation INTRODUCTION Numerous studies have documented an increased frequency of vehicular crashes , traffic citations , driving performance deficits , and driving-related cognitive impairments in teens and adults with attention deficit hyperactivity disorder . METHOD The present study evaluated the effects of two single , acute doses of methylpheni date ( 10 and 20 mg ) and a placebo on the driving performance of 53 adults with ADHD ( mean age=37 years , range=18 - 65 ) using a virtual reality driving simulator , examiner and self-ratings of simulator performance , and a continuous performance test ( CPT ) to evaluate attention and inhibition . A double-blind , drug-placebo , within-subjects crossover design was used in which all participants were tested at baseline and then experienced all three drug conditions . RESULTS A significant beneficial effect for the high dose of medication was observed on impulsiveness on CPT , variability of steering in the st and ard driving course , and driving speed during the obstacle course . A beneficial effect of the low dose of medication also was evident on turn signal use during the st and ard driving course . An apparent practice effect was noted on some of the simulator measures between the baseline and subsequent testing sessions that may have interacted with and thereby obscured drug effects on those measures . CONCLUSIONS The results , when placed in the context of prior studies of stimulants on driving performance , continue to recommend their clinical use as one means of reducing the driving risks in ADHD teens and adults . IMPACT ON INDUSTRY Given the significantly higher risk of adverse driving outcomes associated with ADHD , industry needs to better screen for ADHD among employees who drive as part of employment so as to improve safety and reduce costs . Use of stimulants to treat the adult ADHD driver may reduce safety risks OBJECTIVE . Automobile accidents are the leading cause of death among adolescents , and collisions are 2 to 4 times more likely to occur among adolescents with attention-deficit/hyperactivity disorder . Studies have demonstrated that stimulants improve driving performance . This study compared 2 long-acting stimulant medications during daytime and evening driving evaluations . METHODS . Adolescent drivers with attention-deficit/hyperactivity disorder were compared on a driving simulator after taking 72 mg of OROS methylpheni date , 30 mg of mixed amphetamine salts extended release , or placebo in a r and omized , double-blind , placebo-controlled , crossover study design . During laboratory testing , adolescents drove a driving simulator at 5:00 pm , 8:00 pm , and 11:00 pm . Driving performance was rated by adolescents and investigators . RESULTS . The study included 35 adolescent drivers with attention-deficit/hyperactivity disorder ( 19 boys/16 girls ) . The mean age was 17.8 years . The overall Impaired Driving Score demonstrated that OROS methylpheni date led to better driving performance compared with placebo and mixed amphetamine salts extended release , whereas mixed amphetamine salts extended release demonstrated no statistical improvement over placebo . Specifically , relative to placebo , OROS methylpheni date result ed in less time driving off the road , fewer instances of speeding , less erratic speed control , more time executing left turns , and less inappropriate use of brakes .  OROS methylpheni date and mixed amphetamine salts extended release worked equally well for male and female adolescents and equally as well with teenagers who have combined and inattentive subtypes of attention-deficit/hyperactivity disorder . CONCLUSIONS . This study vali date s the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder . In the study , OROS methylpheni date promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release BACKGROUND Attention-deficit/hyperactivity disorder ( ADHD ) is associated with a 3- to 4-fold increase in both driving-related accidents and associated injuries .  Methylpheni date ( MPH ) is the most commonly prescribed psychostimulant medication for ADHD . It has been demonstrated to improve performance on a driving simulator . This study investigated whether a once-daily , long-acting , osmotic , controlled-release MPH formulation improves the driving performance of ADHD adolescents while driving their own car on an actual road segment . METHODS Twelve ADHD-diagnosed male adolescent drivers ( mean age , 17.8 years ) prescribed a st  and ard  dose of 1.0 mg/kg ( if they were not already taking methylpheni date ) of controlled-release MPH participated in this repeated- measures crossover study . On 2 separate occasions ( off/on medication r and omized ) , participants drove a st and ard 16-mile road course incorporating rural , highway , and urban streets . A rater , blind to medication conditions , sat in the back seat and rated impulsive ( eg , " cutting off " another driver ) and inattentive ( eg , drove past design ated turn ) driving errors . RESULTS Impulsive driving errors were observed to occur rarely under both medication and no medication conditions . Inattentive driving errors were more common and were significantly reduced while the subject was on medication ( 4.6 versus 7.8 ; P < .01 ) . The improvement in driving performance ( change in number of errors recorded ) from first to second testing was positively correlated with medication dosage ( r = 0.60 ; P < .01 ) . CONCLUSIONS Once-daily controlled-release MPH improves real-life driving performance of adolescent males diagnosed with ADHD . In particular , it significantly reduces driving errors arising from inattention This study investigated whether OROS methylpheni date ( OROS MPH , Concerta ) or extended-release mixed amphetamine salts ( se-AMPH ER , Adderall XR ) were associated with worsening of driving performance , or drug rebound , relative to placebo 16 - 17 hours post-ingestion . Nineteen male adolescent drivers aged 17 - 19 with attention-deficit/hyperactivity disorder ( ADHD ) were compared on a virtual reality driving simulator and an on-road drive after taking 72 mg of OROS MPH , 30 mg of se-AMPH ER , or placebo . Medication was taken at 08:00 in a r and omized , double-blind , placebo-controlled , crossover study . Participants drove a simulator at 17:00 , 20:00 , 23:00 , and 01:00 , and drove their own cars over a 16-mile road course at 24:00 . The main outcome measures were composite scores of driving performance . Neither OROS MPH nor se-AMPH ER was associated with significant worsening of simulator performance relative to placebo 17 hours post-ingestion in group comparisons . However , inattentive on-road driving errors were significantly more common on se-AMPH ER relative to placebo at midnight ( p = 0.04 ) , suggesting possible rebound . During both late simulator and on-road testing , driving performance variance was approximately 300 % greater during the se-AMPH ER compared to the OROS MPH condition OBJECTIVE Adolescents with attention-deficit/hyperactivity disorder ( ADHD ) are at high risk for driving accidents . One dose of methylpheni date ( MPH ) improves simulator driving performances of ADHD-diagnosed adolescents at 1.5 hours post-dose . However , little is known about the effects of different MPH delivery profiles on driving performance throughout the day . METHOD This r and omized , crossover , single-blind study compared osmotic , controlled-release oral system ( OROS ) MPH ( Concerta ) given q.d . to immediate-release MPH ( Ritalin ) given in equal doses t.i.d . on driving performance among six male ADHD-diagnosed adolescent drivers aged 16 to 19 years . Under each treatment condition , participants were maintained on their medication dosage for 7 days , then drove a sophisticated driving simulator at 2 p.m. , 5 p.m. , 8 p.m. , and 11 p.m. The primary outcome measure was each participant 's computer-quantified Impaired Driving Score ( IDS ) . RESULTS IDS worsened in the evenings for participants receiving MPH t.i.d . but remained stable when they received once-daily OROS MPH . Participants performed significantly better when receiving OROS MPH q.d . compared with MPH t.i.d . ( F = 9.3 , df = 1 , p = .004 ) . When MPH was given t.i.d . , IDS significantly worsened beginning at 8 p.m. compared to OROS MPH ( p = .01 ) . CONCLUSIONS Participants demonstrated significantly less variability and better driving performance when receiving OROS MPH q.d . compared to MPH t.i.d . , particularly in the evenings Although patients with attention-deficit hyperactivity disorder ( ADHD ) have reported improved driving performance on methylpheni date , limited evidence exists to support an effect of treatment on driving performance and some regions prohibit driving on methylpheni date . A r and omized , crossover trial examining the effects of methylpheni date versus placebo on highway driving in 18 adults with ADHD was carried out . After three days of no treatment , patients received either their usual methylpheni date dose ( mean : 14.7 mg ; range : 10—30 mg ) or placebo and then the opposite treatment after a six to seven days washout period . Patients performed a 100 km driving test during normal traffic , 1.5 h after treatment administration . St and ard deviation of lateral position ( SDLP ) , the weaving of the car , was the primary outcome measure . Secondary outcome measurements included the st and ard deviation of speed and patient reports of driving performance . Driving performance was significantly better in the methylpheni date than in the placebo condition , as reflected by the SDLP difference ( 2.3 cm , 95 % CI = 0.8—3.8 , P = 0.004 ) . Variation in speed was similar on treatment and on placebo ( -0.05 km/h , 95 % CI = -0.4 to 0.2 , P = 0.70 ) . Among adults with ADHD , with a history of a positive clinical response to methylpheni date , methylpheni date significantly improves driving performance Background : Psychostimulant treatment may improve simulated driving performance in young adults with attention-deficit/hyperactivity disorder ( ADHD ) . Method : This was a r and omized , double-blind , placebo-controlled , crossover study of simulated driving performance with mixed amphetamine salts — extended release ( MAS XR ) 50 mg/day ( Cohort 1 ) and atomoxetine 80 mg/day ( Cohort 2 ) in young adults with ADHD . Results : Adults aged 19 to 25 years with AD/HD ( N = 19 ) who were administered MAS XR significantly improved overall simulated driving performance  versus placebo up to 12 hours after dosing . In contrast , there were no statistically significant differences in simulated-driving-performance scores  between atomoxetine and placebo . At endpoint , MAS XR reduced ADHD Rating Scale scores ≥ 30 % in 80 % of subjects , whereas atomoxetine achieved this level of improvement for 40 % . Limitations : Small sample size and use of simulated driving may limit generalizability of the findings . Conclusion : MAS XR in young adults with ADHD yields significant improvements in simulated driving performance and ADHD symptoms . ( J. of Att . Dis . 2009 ; 12(4 ) 316 - 329 This study examined whether adolescent females with attention-deficit/hyperactivity disorder ( ADHD ) are differentially responsive than their male counterparts to extended-release stimulant medications . This investigation may bear special importance for an adolescent ( as opposed to child ) population , because hormonal and metabolism differences between sexes are most likely to emerge at this time . Male ( n = 19 ) and female ( n = 16 ) adolescents , ages 16–19 with ADHD , participated in a r and omized , double-blind crossover study evaluating the effectiveness of osmotic-release methylpheni date , extended release amphetamine salts , placebo , and routine limited medication regimen . Medication efficacy was evaluated using ADHD symptom ratings from adolescent self-report and parent report , along with objective measures of inattention and hyperactivity/impulsivity during driving performance and neuropsychological tasks . Males and females were largely equivalent in impairment , and medication was similarly effective in reducing symptoms . No interactions were found between sex and medication on any measure of effectiveness or side effects . This finding suggests that the efficacy and tolerability of extended-release stimulant medications is equivalent for male and female adolescents with ADHD PURPOSE Young adults with ADHD have been shown to be at increased risk for impairment in driving behaviors . Although stimulant medications have proven efficacy in reducing ADHD symptomatology , there is limited knowledge as to their effects on driving behavior . The focus of this report is on assessing the impact of lisdexamfetamine dimesylate ( LDX ) on driving behaviors in young adults with ADHD using a vali date d driving behavior question naire . METHODS This assessment was carried out in the context of a r and omized , double-blind , 6-week , placebo-controlled , parallel- design study of LDX versus placebo .  Subjects were 61 out patients of both sexes , 18 - 26 years of age , who met Diagnostic and Statistical Manual of Mental Disorders , fourth edition , criteria for ADHD . Subjects were r and omized to receive LDX or placebo for 6 weeks . Driving behavior was assessed at baseline and at the end of treatment using a U.S. version of the Manchester Driving Behavior Question naire ( DBQ ) . RESULTS Highly significant improvements were documented on LDX , over placebo , in driving behaviors assessed through the DBQ in measures of driving errors , driving lapses , and a trend toward fewer driving violations . There were no meaningful associations between these DBQ results and previously documented changes in a laboratory driving simulation paradigm or with improvement in symptoms of ADHD assessed through the ADHD rating scale . CONCLUSIONS LDX treatment was associated with significant improvements in self-reported driving behaviors that were independent of improvement in symptoms of ADHD . These results suggest that LDX may reduce behaviors associated with driving risks in young adults with ADHD Context The effectiveness of coffee drinking and napping to maintain alertness during nighttime driving is unknown . Contribution Twelve healthy young men drove 125 miles on a straight highway in 4 sessions : 1 session during daylight and 3 sessions from 2:00 a.m. to 3:30 a.m. An hour before the nighttime driving sessions , participants drank decaffeinated coffee ( placebo ) or caffeinated coffee or took a 30-minute nap . The principal outcome was crossing the line between the lanes . The proportion of participants with no or 1 line crossing was 13 % , 66 % , and 75 % after placebo , nap , and caffeinated coffee , respectively . Implication s Drinking coffee or napping reduces impaired nighttime driving . The Editors Sleep-related accidents represent up to 20 % of all traffic accidents in industrial societies ( 1 - 3 ) . Although sleepiness at the wheel is a well-known risk factor for traffic accidents , many people drive at night ( 4 , 5 ) when alertness is at its lowest level . Connor and colleagues ( 3 ) have shown that driving between 2:00 a.m. and 5:00 a.m. increases the risk for traffic accidents by 5.6 times . Many people repeat this dangerous behavior because of economic rewards for professional drivers ( 6 ) or because of sociocultural factors ( 5 , 7 ) . The age group that is most often involved in sleep-related accidents is 18 years to 25 years ( 1 , 8) . Nurses or physicians who often must stay awake for very long hours face the same risk ( 9 , 10 ) . Traffic accidents occurring between the workplace and home are a major cause of injury and death among workers ( 11 , 12 ) , and medical interns are particularly exposed ( 13 ) . Because of the conflicts between physiologic needs and social or professional activities ( 13 - 15 ) , developing safe and affordable counter measures to sleepiness at the wheel is a key issue in accident prevention . These counter measures include sleeping ( or napping ) and the use of awakening agents , such as caffeine . Caffeine is a widely used awakening substance . Adults in western societies are estimated to have an average all- source daily caffeine intake of about 200 mg to 300 mg ( 16 ) . Within and above this dose range , caffeine increases alertness and reduces sleep propensity . Some studies have tested the effects of caffeine on daytime driving in simulators by young sleep-deprived participants using caffeine pills , caffeinated beverages , or energy drinks ( 17 , 18 ) . Other studies have compared daytime naps with caffeine in driving simulators ( 19 ) . However , no studies to date have tested the effects of coffee or napping on nighttime driving performances in a real-life environment . A recent study comparing performances in real driving and driving simulators showed that sleepiness and performances are significantly more affected by sleep deprivation in a simulated environment than in the real world ( 20 ) . This questions the validity of driving simulator studies , at least in the amplitude of effect of sleep deprivation or effect of counter measures . A real-life environment ( such as a freeway rest area ) may also affect napping . A laboratory near a driving simulator after a night of sleep deprivation is an optimal place to fall asleep , even in the daytime . In real life , sleeping in a car at a highway rest area may not be so easy . On the other h and , the implication s of real driving may reactivate the participants and could defer the effects of sleepiness at the wheel compared with the safe and boring environment of a driving simulator , which we have shown in a recent study ( 20 ) . Another very important point is the timing of the test : A combination of homeostatic and chronobiological factors explains the driving impairment . Epidemiologic studies show that sleep-related accidents occur most frequently in the middle of the night ( 3 , 8) . Testing counter measures at that time is therefore crucial , combining extended wakefulness and chronobiological pressure . Other studies ( 19 , 21 ) have tested the effect of caffeine , naps , or both on simulated driving , but the driving sessions were performed during the day or the early morning . For these reasons , we design ed a controlled , crossover study of real driving at night to study the effects of coffee or napping on nighttime driving performance . Methods Participants We recruited 12 healthy men ( mean age , 21.3 years [ SD , 1.8 ] ; range , 20 to 25 years ) . All participants provided written informed consent , and the local ethics committee ( consultative committee for the protection of persons participating in biomedical research [ CCPPRB Bordeaux A ] ) approved the study . All participants completed an Epworth Sleepiness Scale ( ESS ) ( 22 ) , a Symptom Checklist 90 ( SCL-90 ) ( 23 ) , a HorneOstberg question naire ( 24 ) , and a Basic Nordic Sleep Question naire ( BNSQ ) ( 25 ) . We excluded participants who reported a sleep disorder , such as sleep apnea , insomnia ( BNSQ score > 3 ) , or excessive daytime  somnolence ( ESS score > 9 ) . We excluded participants with preexisting sleep disorders ( diagnosed by clinical interview ) , organic disorders affecting sleep , or poor sleep hygiene and participants who were night or shift workers . Aside from the psychological profile evaluated by the SCL-90 , we asked questions about substance abuse ( caffeine , drug , or alcohol ) during the clinical interview . We excluded participants who reported drug or alcohol abuse ( more than 21 units per week ) or who had an SCL-90 score greater than 59 . All recruited participants were intermediate according to the HorneOstberg question naire . Participants were not professional drivers , had had their driving license for at least 2 years , and drove between 10000 km and 20000 km per year . Sleep Variables Volunteers had to have normal usual sleep patterns as determined from an interview with a sleep specialist and 7 days ' monitoring with actimeters ( Actiwatch , Cambridge Neurotechnology , Cambridge , United Kingdom ) ( 26 ) showing at least 85 % mean sleep efficiency ( 27 ) over a week . Study Design This was a r and omized , partly blinded , crossover study . All participants performed 4 driving sessions : 1 session from 6:00 p.m. to 7:30 p.m. in the daytime ( reference condition ) and 3 sessions from 2:00 a.m. to 3:30 a.m. ( coffee , decaffeinated coffee , or nap condition ) , with at least 1 week between sessions . All participants started with the reference condition ( Table ) . We r and omly attributed the order of nocturnal driving sessions ( nap , decaffeinated coffee , or coffee ) to each participant in a balanced design by using a r and om permutations sequence . Table . Line Crossings per Participant and Driving Session Sleep Schedules and Sleep Recordings We instructed the participants to maintain a regular sleepwake schedule and monitored them by actimetry during the 3 days before each experimental session to verify the absence of sleep deprivation . We report only the last night 's sleep duration in the Results section . We did not allow stimulants of any kind during the study . For the nocturnal testing periods , the participants came to the laboratory at 8:00 p.m. and were equipped with an ambulatory polysomnograph ( Deltamed , Paris , France ) . Participants were not allowed to sleep before the driving sessions or the nap . We performed  electroencephalography , electromyography , and electrooculography  during the nap , the driving session , and the rest of the night after driving . All participants slept in a research room in the laboratory after the driving session . We calculated sleep latency from the time of lights out to the first epoch of stage 1 sleep . We calculated sleep efficiency by dividing the time in bed by the total sleep time from lights out to lights on . Coffee and Placebo We prepared coffee and placebo from 2 single packs of instant coffee ( normal or decaffeinated ) provided by Nestl ( Nestl France , Noisiel , France ) . Coffee contained 4.25 % of caffeine , and placebo ( decaffeinated coffee ) contained less than 0.3 % of caffeine . Placebo and coffee were not distinguishable by taste or aspect . Each participant drank 125 mL of instant coffee ( about half a cup of coffee containing 200 mg of caffeine ) or 125 mL of placebo ( containing 15 mg of caffeine ) 30 minutes before the nighttime driving session . Napping During the naps , the driver 's seat was fully reclined , the participants were covered with a blanket , and an electrical heating system , which was installed in the car , maintained a constant temperature ( 19 C ) . The car was parked in a quiet rest area and was guarded by the copilot so that no one disturbed the driver . The 30-minute nap started at 1:00 a.m. , 1 hour before the driving session . Driving Sessions All participants drove 200 km ( 125 miles ) on the same highway in separate lanes ( 100 km [ 62.5 miles ] one way and 100 km [ 62.5 miles ] the other way ) for all conditions . The nighttime driving session started 30 minutes after ingestion of coffee or placebo or 30 minutes after awakening from the nap . Driving conditions were a straight highway on weekdays with usually light traffic conditions , in fair weather . All drivers were exposed to the same or very similar conditions . During a training session , participants were instructed to maintain a constant speed ( 130 kph [ 80 mph ] ) , to drive in the center of the lane , and to not cross the painted lines separating the lanes except to pass a slower vehicle . During the whole experiment , a professional driving instructor monitored the driving speed and noted the number of line crossings . The instructor was ready to take control of the car ( which was equipped with dual controls ) if needed . If a participant could no longer drive during a session , the participant was driven back to the rest area . The car used for the experiment was equipped with a video camera , which filmed and recorded the road , as described elsewhere ( 28 , 29 ) . Sleepiness and Fatigue Immediately before each driving session , we asked participants to rate their instantaneous fatigue ( Describe how fatigued you are now ) on a 100-mm visual analogue scale . Scores ranged from 0 ( not at all tired ) to 100 ( very Background : The stimulant methylpheni date ( MPH ) has been a mainstay of treatment for attention-deficit/hyperactivity disorder ( ADHD ) for many years . Owing to the short half-life and the issues associated with multiple daily dosing of immediate-release MPH formulations , a new generation of long-acting MPH formulations has emerged . Direct head-to-head studies of these long-acting MPH formulations are important to facilitate an evaluation of their comparative pharmacokinetics and efficacy ; however , to date , relatively few head-to-head studies have been performed . The objective of this systematic review was to compare the evidence available from head-to-head studies of long-acting MPH formulations and provide information that can guide treatment selection . Methods : A systematic literature search was conducted in MEDLINE and PsycINFO in March 2012 using the MeSH terms : attention deficit disorder with hyperactivity/drug therapy ; methylpheni date /therapeutic use and All Fields : Concerta ; Ritalin LA ; OROS and ADHD ; Medikinet ; Equasym XL and ADHD ; long-acting methylpheni date ; Diffucaps and ADHD ; SODAS and methylpheni date . No filters were applied and no language , publication date or publication status limitations were imposed . Articles were selected if the title indicated a comparison of two or more long-acting MPH preparations in human subjects of any age ; non- systematic review articles and unpublished data were not included . Results : Of 15,295 references returned in the literature search and screened by title , 34 articles were identified for inclusion : nine articles from pharmacokinetic studies ( nine studies ) ; nine articles from laboratory school studies ( six studies ) ; two articles from r and omized controlled trials ( two studies ) ; three articles from switching studies ( two studies ) and three articles from one observational study . Conclusions : Emerging head-to-head studies provide important data on the comparative efficacy of the formulations available . At a group level , efficacy across the day generally follows the pharmacokinetic profile of the MPH formulation . No formulation is clearly superior to another ; careful consideration of patient needs and subtle differences between formulations is required to optimize treatment . For patients achieving suboptimal symptom control , switching long-acting MPH formulations may be beneficial . When switching formulations , it is usually appropriate to titrate the immediate-release component of the formulation ; a limitation of current studies is a focus on total daily dose rather than equivalent immediate-release components . Further studies are necessary to provide guidance in clinical practice , particularly in the treatment of adults and pre-school children and the impact of comorbidities and symptom severity on treatment response Background Current st and ardized treatments for cognitive impairment in attention-deficit/hyperactivity disorder remain limited and their efficacy restricted . Transcranial direct current stimulation ( tDCS ) is a promising tool for enhancing cognitive performance in several neuropsychiatric disorders . Nevertheless , the effects of tDCS in reducing cognitive impairment in patients with attention-deficit/hyperactivity disorder ( ADHD ) have not yet been investigated . Methods A parallel , r and omized , double-blind , sham-controlled trial was conducted to examine the efficacy of tDCS on the modulation of inhibitory control in adults with ADHD . Thirty patients were r and omly allocated to each group and performed a go/no-go task before and after a single session of either anodal stimulation ( 1 mA ) over the left dorsolateral prefrontal cortex or sham stimulation . Results A nonparametric two- sample Wilcoxon rank-sum ( Mann-Whitney ) test revealed no significant differences between the two groups of individuals with ADHD ( tDCS vs. sham ) in regard to behavioral performance in the go/no go tasks . Furthermore , the effect sizes of group differences after treatment for the primary outcome measures —correct responses , impulsivity and omission errors — were small . No adverse events result ing from stimulation were reported . Conclusion According to these findings , there is no evidence in support of the use of anodal stimulation over the left dorsolateral prefrontal cortex as an approach for improving inhibitory control in ADHD patients . To the best of our knowledge , this is the first clinical study to assess the cognitive effects of tDCS in individuals with ADHD . Further research is needed to assess the clinical efficacy of tDCS in this population . Trial Registration Clinical Trials.gov
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 .
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
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 systematic ally review ed the efficacy of stimulant and non-stimulant drugs on driving performance of ADHD patients .