Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. e704-e710 (doi:10.1542/peds.2005-2947)
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ARTICLE

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

Daniel J. Cox, PhD, R. Lawrence Merkel, MD, PhD, Melissa Moore, MD, Frances Thorndike, PhD, Carrie Muller, BS and Boris Kovatchev, PhD

Department of Psychiatric Medicine, University of Virginia, Charlottesville, Virginia

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 methylphenidate, 30 mg of mixed amphetamine salts extended release, or placebo in a randomized, 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 methylphenidate 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 methylphenidate resulted 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 methylphenidate 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 validates the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder. In the study, OROS methylphenidate promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release.

Key Words: adolescents • automobile driving • medication effects • stimulant therapy • attention-deficit/hyperactivity disorder • ADHD • OROS methylphenidate • mixed amphetamine salts extended release

Abbreviations: ADHD—attention-deficit/hyperactivity disorder • IR MPH—immediate-release methylphenidate • tid—3 times daily • OROS MPH—OROS methylphenidate • se-AMPH ER—mixed amphetamine salts extended release • IDS—Impaired Driving Score

Accepted Mar 20, 2006.




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