My Kid’s Driving Me Med
Recently my “youthful” daughter left town around 4PM for a 4-hour drive to visit friends out of state. Needless to say I was worried when the clock stroke 9pm, 10pm and 11pm while my cell phone kept suspiciously silent. I sent my darling a text message to contact me ASAP. Obviously, I did not go to sleep. After all a parent’s role is to endlessly worry when the kids are out at night, isn’t it?
By 1am I received a laconic text:
“I am safe, good night!”
“why did it take you so long to let me know you have arrived safely”
She answered (truthfully):
“I was having a good time, I forgot”.
I did not text her what I was really thinking “I don’t want you to have too much fun because it is risky”.
Game, Set, Match.
I realized that it is a lost cause and I went to sleep (still worried until she returned 2 days later unharmed). I am sure that this kind of story sounds familiar to the parents of young drivers?
I would like to review briefly the following: why young drivers are so vulnerable, how important is compliance with prescribed medications for drivers with attention deficit hyperactivity disorder (ADHD) and finally provide a severe warning regarding the effects of an “alleged” medication (marijuana) to increased unsafe and lethal driving.
Motor vehicle crashes (MVCs) are the leading cause of mortality and morbidity for American youth. In 2011, 2,650 teens aged 16–19 were killed and 292,000 were treated in emergency departments for injuries due to MVCs. Preventing youth MVCs should be a primary public health priority in order to save lives, reduce injury risk, lower the rate of emergency room (ER) visits and reduce economic losses resulting from personal and property damage.
One key to understanding why youth drivers are at increased risk for high risk driving behaviors (HRDB) is to measure relevant developmental and neurobehavioral changes that influence driving behavior. This may also provide clues to which youth are at increased risk of involvement in a MVC. Adolescence is a transitional developmental phase that is characterized by an increase in risky and disinhibited behaviors. According to the neurobiological model of adolescent brain development, an imbalance between the development of the limbic (Reward) system and the higher control center in the prefrontal cortex (PFC) suggest a determinant in adolescent behavior. The maturation of the limbic system with heightened reward sensitivity in conjunction with the protracted development of PFC and immature cognitive control may be at the core of risk-taking behavior. PFC development is also responsible for developing executive functioning skills. While these regions are still developing between the ages of 16-25 years, the behavioral effects include less effective decision making, problem solving and compromised judgment, which are critical for the task of driving. Compared to other age groups, teen drivers were more likely to speed, underestimate risks associated with hazards, and follow vehicles too closely. Adding to it a relative lack of driving experience is a recipe for disaster. Additional variables, including high level of impulsivity and sensation seeking traits reach their normative peaks around mid-adolescence at the same time teens apply for driving licensure.
Although Graduated Driving Licensing (GDL) system has been found useful in reducing MVCs, the conflict between Nature (of the adolescent) and Nurture (of the environment) claims too many casualties.
In Conclusion: Every additional year of delaying the onset of driving age by (e.g., age 18) reduces significantly the probability to be involved in a car crash due to the accelerated process of brain maturation.
Adolescents with ADHD and risk for MVC
ADHD is a common neurobiological disorder in childhood that can continue during adolescence and adulthood. In ADHD, neurobiological maturation is slowed on average by 3 years and this may contribute to the underlying symptoms of the disorder. Those with an ADHD diagnosis may experience difficulties with planning, managing time, or attending to and remembering details. Many of these behaviors occur secondary to deficits in executive functioning, critical for skilled driving. Exploration of ADHD symptoms in relation to deficits in executive functioning found that weakness in these domains are associated with the inattention symptoms of ADHD. The diagnosis of ADHD is associated with increased rates of road crashes. Inattention is a significant predictor of driving problems and reduced driving safety. The relationship between hyperactivity/impulsivity and self-reported violations showed a trend towards poor driving behaviors. Youth with ADHD who are treated with stimulants have statistically significant improvements in simulated driving performance compared to those treated with placebo
In conclusion: Treatment of Attention Deficit Hyperactivity Disorder in affected youth reduces the risk for MVC. In addition, since night time MVCs among young drivers has been a growing concern, long acting stimulant medications that extend their effect should address night time driving in youth with ADHD. Increasing medication adherence is crucial in reducing MVCs in this population.
Marijuana and Driving
An increase in fatal crashes due to recent ingestion of marijuana has been reported officially in the states of Colorado and Washington where Marijuana has been legalized. Many adolescents refuse to accept the fact that smoking marijuana while driving is as dangerous as drinking and driving.
It is important to emphasize this information while educating our youth about the harmfulness of marijuana use. It is crucial to refute the “smoke and mirrors” tactics of pro-marijuana legalization who cannot agree with any data that does not support their campaign and keep on feeding our youth with false or compromised information.
Not So Fast: Parenting Your Child through the Dangers of Driving – Tim Hollister
Reefer Sanity: 7 Great Myths About Marijuana –Kevin Sabet
Jillani. S. & Kaminer. Y. : High-risk driving in treated and untreated youth with ADHD: Public health implications. Adolescent Psychiatry. (In press)
Dr. Kaminer is a Professor of Psychiatry in the Department of Psychiatry & The Alcohol Research Center, University of Connecticut Health Center, Farmington, CT. He has a joint appointment as Professor at the Department of Pediatrics, where he is involved in research of youth high-risk driving and suicidal behavior at the Injury Prevention Center of the Connecticut Children’s Medical Center (CCMC), Hartford.