I ask several questions of every late teen or young adult who sees me for an ADHD evaluation. At the top of the list is "How's your driving?" A few look at me quizzically, never having considered that all those speeding tickets and fender-benders might be caused by their brain chemistry. Some start laughing sheepishly and ask, "How did you know about that?" See if any of these statements apply to you:
> I've had more fender-benders than most of my friends.
> I sometimes drive for miles while in a trance, then pop back to attention without a memory of what happened or what I saw.
> People are scared to ride with me.
> I often don't allow myself enough drive time to get where I need to be.
Not every person with ADHD has driving challenges. But a Swedish study (not funded by a pharmaceutical company) that looked at 17,000 adults with ADHD was published last year in JAMA Psychiatry online. Having ADHD increased a man's risk of a traffic accident by 47 percent, and a woman's risk by 45 percent. Earlier studies suggest that ADHD drivers are more likely to speed, drive erratically, hit the brakes at inappropriate times, and accelerate into accidents. All of the subjects in these studies were doing their driving in virtual-reality simulators and not on the road.
The Swedish study found that taking medication reduced an ADHD man's risk of a car wreck by 58 percent. Though there was no improvement for women, clinical experience suggests that getting behind the wheel without your meds can be dangerous for both genders.
Getting meds in sync with your driving is easier said than done. As ADHD people know, long-acting medication is good for only eight to 10 hours at best. (Three to five hours for short-acting medication.) So, one of the first rules of driving is to mind your meds. Know how long your stimulant works and tailor your driving to it.
Here are other ideas ADHD drivers can use to decrease the risk of accidents:
> Enroll in a defensive driving course. Defensive driving teaches you to assume that whatever can go wrong, probably will. You learn to stay constantly vigilant about your own driving and how others are handling the road. It assumes that everyone else is about to swerve into your lane or run a stoplight and asks you to think: "What would I do if that happened?" It's basically a mindful driving program — or a lesson in paranoia, depending on how you look at it. Defensive driving works because it makes you a bit more anxious about driving. A little anxiety can make a positive difference.
> Limit distraction. This is good advice for any aspect of life, but it is a lifesaver when driving. Recent research on voice-activated devices (like Siri or GPS voice command) suggests that they're more dangerous than helpful while driving. The same goes for talking on the phone, eating messy, complicated food, fiddling with your iPad, and, worst of all, texting. This is such a serious problem that I've started asking my ADHD drivers to lock their smartphones in the trunk. That's caused a few of them to cry, but, tears or not, distractions need to be out of reach. You can text your boyfriend or watch YouTube after you arrive at Chipotle for a sit-down lunch.
> Make things right before you drive. It's easy to hop in your car and take off for a wonderful new adventure. Instead, take a quick walk around the vehicle to be sure it's ready to go. Tires inflated? Doors closed? A client recently failed to close her driver's-side door and lost it to a nearby tree. Then get in the car, sit there for a few moments, and think: "What am I doing right now?" Consider all that needs to be done before you leave. Buckle up (please), adjust the mirrors, set the air conditioner or heater, make sure your seat is where it belongs, check for warning lights on the dash. Ask yourself if everything is as it should be before you pull out for your destination.
> Always use cruise control. Never buy a car without this option. While most people use cruise control only on highways, I suggest using it on any open road when driving over 40 mph, assuming traffic allows. Cruise control reduces your crash risk by keeping you traveling at a safe speed, and lowers your number of speeding tickets, as long as you keep track of different speed zones. Cruise isn't an excuse to let your car do the driving (Google is working on that one). It's a way to keep you within the safe-speed zone.
> Use GPS wisely. It helps you find your way from Point A to Point B, and gives you an honest estimate of your arrival time. This reduces the habit of being late and fudging time. There are a couple of catches. If you fool with it while you're driving, or become preoccupied with its interesting little screen, GPS becomes a distraction. If you're serious about GPS, get the real deal — Garmin, Magellan, or TomTom — and have it installed by the dealer when you buy your car. Trying to navigate while holding your iPhone or Android may be technically possible, but it's only one click better than texting and driving. Your head is down, your attention is off the road, and you increase your chances of running into something. Or worse.
> Get a copilot. Two sets of eyes are better than one, especially if one is attached to an ADHD brain. Sometimes driving is a team affair. Your copilot can take care of navigation or keep an eye out for changes in speed limit or incoming hazards. This help is useful for young drivers when they are traveling long distances. Note: Having a copilot takes work and patience to get the teamwork down. It takes a while for the driver not to get annoyed with the copilot constantly issuing comments.