A study of performance on the UK Driving Test and presence of Attention Deficit Hyperactivity Disorder (ADHD) symptoms on subsequent driving offences in youth (17-23 years)

Supervisors: Dr Alastair Sutcliffe and Dr Paramala Santosh

Description:
1.5 million driving tests are sat per year in the UK. The commonest cause of death in adolescents and young people aged 17 to 23 years is accidents, of which Road Traffic Accidents are the most common. The incidence of attention deficit hyperactivity disorder (ADHD) is estimated to be around 4% of men. Untreated ADHD is a risk for accidents according to existing small studies. There is a significant public health issue with dangerous driving and yet the treatment for ADHD is unusually effective and easily available.

ADHD behaviours expose the driver even IF they pass their driving test and their passengers to an enhanced risk of accidents and have broader health implications, if public service driver or HGV drivers are involved these effects magnify.

Dr Sutcliffe and Dr Santosh have met with the Driving Standards Authority in Nottingham and their research team have agreed to collaborate with our group to conduct a multi-tiered project to investigate this problem in young people. The GAP Unit is the lead department for Adolescent Health in the UK and the Child Psychiatry Department at King’s College London is internationally recognised for its work on ADHD and its pharmacological treatment.

We will review all the computerised simulated driving questions of the driving test and develop a methodology that will allow for re-classifying the items based on the executive function that each of them are tapping into. The expertise available at KCL will be used for this purpose. Based on the new classification based on possible executive dysfunction, we will develop risk scores for candidates. We will develop risk groupings (e.g., low risk, moderate risk and high risk) and then compare this classification with test outcome and how many times they have attempted the test. Repeat failers of the compulsory test in males aged 17 to 23 years would be expected to fall predominantly in the high-risk grouping based on executive dysfunction.

We then intend to anonymously identify whether the data held by the DVLA about actual driving offences of the subjects in the 3 risk categories, to demonstrate that there will be an increase in actual driving offences in those with greater executive dysfunction.

We will approach individuals who have repeatedly failed the driving test (3 or more times) to be formally tested online using the HealthTrackerTM platform (a health assessment and monitoring platform) for ADHD and other psychopathology that may be affecting driving performance. The PhD project will involve the development of the executive function classification, linking this with the DVLA driving offences data and ADHD symptoms.

As part of the larger programme, we will then recruit those with ADHD into a double blind placebo controlled trial of methylphenidate (Concerta XL) and placebo and retest them under controlled situations, using computerised driving simulation as well as driving going on the DSA real test circuit.

References:
1) Classen S and Monahan M, Evidence-Based Review on Interventions and Determinants of Driving Performance in Teens with Attention Deficit Hyperactivity Disorder or Autism Spectrum Disorder, Traffic Injury Prevention, 2013 14;188-193.
2) Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenare K, De Girolamo G,Haro JM, Karam EG, Lara C, Lepine JP, Ormel J, Posada-Villa J, Zaslavsky AM, Jin R, Cross-national prevalence of adult attention-deficit hyperactivity disorder, Br. J. Psychiatry 2007 190;402-409
3) Jerome L, Segal A, Habinski L, What we know about ADHD and Driving Risk: A literature review, meta analysis and Critique. J Can Acad Child Adolesc Psychiatry 2006 15:3 105-125
4) Joint Formulary Committee (Sept 2012). British National Formulary. 64th edition. London: British Medical Association and Royal Pharmaceutical Society of Great Britain. Page 253
5) Kessler RC, Adler L, Barkley R, Biederman J, Connors CK, Demler O, Faraone S, Greenhill L, Howes MJ, Secnik K, Spencer T, Bedirhan Ustun T, Walters EE, Zaslavsky AM, The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication. Am J Psychiatry 2006, 163:716-723.