The effectiveness and efficacy of driving interventions with ADHD: a Dutch perspective

Abstract

The diagnosis of attention deficit hyperactivity disorder (ADHD) has been identified as a factor associated with an increased risk of involvement in car crashes. As a result, individuals in the Netherlands who are diagnosed with ADHD are mandated to undergo a psychiatric evaluation before obtaining their driving licence, optionally complemented with a driving test. Recent research has, however, demonstrated that 96% of individuals pass this procedure and can drive unrestrictedly, suggesting that current regulations have a limited impact and that a different regulatory approach may be warranted. This paper addresses three such potential interventions, exploring the scientific basis of implementing mandatory behavioural training programmes, the mandatory installation of driver monitoring systems, and temporary driving restrictions. To initiate this exploration, an analysis is made of the body of literature pointing towards a subpar driving performance in those with ADHD, accompanied by a discussion of the underlying symptoms and behaviours contributing to these findings. Furthermore, between- and within-individual factors affecting ADHD driving performance are reviewed. This examination illuminates a consistent pattern of substandard driving performances among those with ADHD, whereby the period shortly post-licensure stands out as a focal point for regulatory approaches. Following these results, the three potential driving interventions are reviewed to discern their impact on road safety when implemented specifically for drivers with ADHD. Corresponding studies suggest that all these interventions hold promise in improving driving performances, but the analysis is limited by the scarcity of long-term, ADHD-specific research. The paper concludes by discussing the feasibility of these ADHD-specific driving interventions, weighing their potential benefits, e.g., reduced crash rates, along with their associated costs, such as potential stigma and hindrance in societal integration and participation. Additionally, avenues for future research in these domains are outlined.