title: Higher magnitude cash payments improve research follow-up rates without increasing drug use or perceived coercion. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. Effect of stimulant medication on driving performance of young adults with attention-deficit hyperactivity disorder: a preliminary double-blind placebo controlled trial. Event-related potentials in adults with Attention-Deficit/Hyperactivity Disorder: an investigation using an inter-modal auditory/visual oddball task. Sex Differences in Effectiveness of Extended-Release Stimulant Medication among Adolescents with Attention-Deficit/Hyperactivity Disorder A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Impact of methylphenidate delivery profiles on driving performance of adolescents with attention-deficit/hyperactivity disorder: a pilot study. Methylphenidate significantly improves driving performance of adults with attention-deficit hyperactivity disorder: a randomized crossover trial Controlled-release methylphenidate improves attention during on-road driving by adolescents with attention-deficit/hyperactivity disorder. Simulated Driving Changes in Young Adults With ADHD Receiving Mixed Amphetamine Salts Extended Release and Atomoxetine Rebound effects with long-acting amphetamine or methylphenidate stimulant medication preparations among adolescent male drivers with attention-deficit/hyperactivity disorder. Effects of two doses of methylphenidate on simulator driving performance in adults with attention deficit hyperactivity disorder. 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 Long-Acting Methylphenidate Reduces Collision Rates of Young Adult Drivers With Attention-Deficit/Hyperactivity Disorder The effects of lisdexamfetamine dimesylate on driving behaviors in young adults with ADHD assessed with the Manchester driving behavior questionnaire. Motor vehicle driving competencies and risks in teens and young adults with attention deficit hyperactivity disorder. The effects of lisdexamfetamine dimesylate on the driving performance of young adults with ADHD: a randomized, double-blind, placebo-controlled study using a validated driving simulator paradigm.
abstract: In a prior study [ Festinger , D.S. , Marlowe , D.B. , Croft , J.R. , Dugosh , K.L. , Mastro , N.K. , Lee , P.A. , DeMatteo , D.S. , Patapis , N.S. , 2005 . Do research payments precipitate drug use or coerce participation ? Drug Alcohol Depend . 78 ( 3 ) 275 - 281 ] we found that neither the mode ( cash vs. gift card ) nor magnitude ( $ 10 , $ 40 , or $ 70 ) of research follow-up payments increased rates of new drug use or perceptions of coercion . However , higher payments and payments in cash were associated with better follow-up attendance , reduced tracking efforts , and improved participant satisfaction with the study . The present study extended those findings to higher payment magnitudes . Participants from an urban outpatient substance abuse treatment program were r and omly assigned to receive $ 70 , $ 100 , $ 130 , or $ 160 in either cash or a gift card for completing a follow-up assessment at 6 months post-admission ( n congruent with 50 per cell ) . Apart from the payment incentives , all participants received a st and ardized , minimal platform of follow-up efforts . Findings revealed that neither the magnitude nor mode of payment had a significant effect on new drug use or perceived coercion . Consistent with our previous findings , higher payments and cash payments result ed in significantly higher follow-up rates and fewer tracking calls . In addition participants receiving cash vs. gift cards were more likely to use their payments for essential , non-luxury purchases . Follow-up rates for participants receiving cash payments of $ 100 , $ 130 , and $ 160 approached or exceeded the FDA required minimum of 70 % for studies to be considered in evaluations of new medications . This suggests that the use of higher magnitude payments and cash payments may be effective strategies for obtaining more representative follow-up sample s without increasing new drug use or perceptions of coercion Past studies find that attention deficit hyperactivity disorder ( ADHD ) creates a higher risk for adverse driving outcomes . This study comprehensively evaluated driving in adults with ADHD by comparing 105 young adults with the disorder ( age 17 - 28 ) to 64 community control ( CC ) adults on five domains of driving ability and a battery of executive function tasks . The ADHD group self-reported significantly more traffic citations , particularly for speeding , vehicular crashes , and license suspensions than the CC group , with most of these differences corroborated in the official DMV records . Cognitively , the ADHD group was less attentive and made more errors during a visual reaction task under rule-reversed conditions than the CC group . The ADHD group also obtained lower sceres on a test of driving rules and decision-making but not on a simple driving simulator . Both self- and other-ratings showed the CC group employed safer routine driving habits than the ADHD group . Relationships between the cognitive and driving measures and the adverse outcomes were limited or absent , calling into question their use in screening ADHD adults for driving risks . Several executive functions also were significantly yet modestly related to accident frequency and total traffic violations after controlling for severity of ADHD . These results are consistent with earlier studies showing significant driving problems are associated with ADHD . This study found that these driving difficulties were not a function of comorbid oppositional defiant disorder , depression , anxiety , or frequency of alcohol or illegal drug use . Findings to date argue for the development of interventions to reduce driving risks among adults with ADHD Driving performance of adult males with attention-deficit hyperactivity disorder ( ADHD ) was compared with matched controls in a double-blind ( Ritalin vs. placebo ) cross-over design , using a high-fidelity driving simulator . Seven ADHD and six non-ADHD drivers ( mean age 22 ) were screened to rule out comorbidity and assess for ADHD , and then admitted to the General Clinical Research Center to control diet and sleep before testing . At 0800 and 1530 , subjects consumed either a placebo or Ritalin pill in a counter-balanced manner , and at 0930 and 1700 , subjects drove the simulator . After both drives , subjects rated their driving performance . Compared with non-ADHD subjects , ADHD subjects had more career driving accidents ( p < .04 ) and motor vehicle violations ( p = .059 ) , drove worse on the simulator under placebo condition ( p < .05 ) , demonstrated significant improvement under the Ritalin condition ( p < .05 ) , rated themselves as driving poorer during the placebo condition ( p = .05 ) , and tended to perceive their driving to be better during the Ritalin condition ( p = .07 ) . This would suggest that individuals with ADHD should have the therapeutic benefit of a stimulant medication when operating a vehicle This study investigated whether ERPs from an inter-modal oddball task could distinguish between adults with Attention-Deficit/Hyperactivity Disorder ( AD/HD ) and controls . Two age-matched groups of young adult males ( 18 AD/HD , 18 controls ) were presented with an inter-modal oddball task in which a counter-phasing checkerboard was the non-target visual stimulus ( r and omly presented on 80 % of trials ) , and a 2000 Hz tone was the auditory target ( 20 % of trials ) . Stimuli were presented at a fixed rate ( stimulus-onset asynchrony 1.03 s ) and participants were required to silently count all targets . The AD/HD group showed globally enhanced P2 and reduced N2 amplitudes to auditory targets , with no differences in target P3 , together with topographic differences in N1 to auditory targets , and P1 , N1 , P2 , N2 and P3 to visual non-targets , compared with controls . These results were interpreted in terms of early sensory-processing impairments in adults with AD/HD , which may be partially overcome through effortful processing , as reflected in the later endogenous ERP components This study examined whether adolescent females with attention-deficit/hyperactivity disorder ( ADHD ) are differentially responsive than their male counterparts to extended-release stimulant medications . This investigation may bear special importance for an adolescent ( as opposed to child ) population , because hormonal and metabolism differences between sexes are most likely to emerge at this time . Male ( n = 19 ) and female ( n = 16 ) adolescents , ages 16–19 with ADHD , participated in a r and omized , double-blind crossover study evaluating the effectiveness of osmotic-release methylpheni date , extended release amphetamine salts , placebo , and routine limited medication regimen . Medication efficacy was evaluated using ADHD symptom ratings from adolescent self-report and parent report , along with objective measures of inattention and hyperactivity/impulsivity during driving performance and neuropsychological tasks . Males and females were largely equivalent in impairment , and medication was similarly effective in reducing symptoms . No interactions were found between sex and medication on any measure of effectiveness or side effects . This finding suggests that the efficacy and tolerability of extended-release stimulant medications is equivalent for male and female adolescents with ADHD BACKGROUND Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder ( ADHD ) , but no longer-term ( i.e. , > 4 months ) investigations have compared these 2 treatments or their combination . METHODS A group of 579 children with ADHD Combined Type , aged 7 to 9.9 years , were assigned to 14 months of medication management ( titration followed by monthly visits ) ; intensive behavioral treatment ( parent , school , and child components , with therapist involvement gradually reduced over time ) ; the two combined ; or st and ard community care ( treatments by community providers ) . Outcomes were assessed in multiple domains before and during treatment and at treatment end point ( with the combined treatment and medication management groups continuing medication at all assessment points ) . Data were analyzed through intent-to-treat r and om-effects regression procedures . RESULTS All 4 groups showed sizable reductions in symptoms over time , with significant differences among them in degrees of change . For most ADHD symptoms , children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care . Combined and medication management treatments did not differ significantly on any direct comparisons , but in several instances ( oppositional/aggressive symptoms , internalizing symptoms , teacher-rated social skills , parent-child relations , and reading achievement )  combined treatment proved superior to intensive behavioral treatment and /or community care while medication management did not . Study medication strategies were superior to community care treatments , despite the fact that two thirds of community-treated subjects received medication during the study period . CONCLUSIONS For ADHD symptoms , our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication . Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms , but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes OBJECTIVE Adolescents with attention-deficit/hyperactivity disorder ( ADHD ) are at high risk for driving accidents . One dose of methylpheni date ( MPH ) improves simulator driving performances of ADHD-diagnosed adolescents at 1.5 hours post-dose . However , little is known about the effects of different MPH delivery profiles on driving performance throughout the day . METHOD This r and omized , crossover , single-blind study compared osmotic , controlled-release oral system ( OROS ) MPH ( Concerta ) given q.d . to immediate-release MPH ( Ritalin ) given in equal doses t.i.d . on driving performance among six male ADHD-diagnosed adolescent drivers aged 16 to 19 years . Under each treatment condition , participants were maintained on their medication dosage for 7 days , then drove a sophisticated driving simulator at 2 p.m. , 5 p.m. , 8 p.m. , and 11 p.m. The primary outcome measure was each participant 's computer-quantified Impaired Driving Score ( IDS ) . RESULTS IDS worsened in the evenings for participants receiving MPH t.i.d . but remained stable when they received once-daily OROS MPH . Participants performed significantly better when receiving OROS MPH q.d . compared with MPH t.i.d . ( F = 9.3 , df = 1 , p = .004 ) . When MPH was given t.i.d . , IDS significantly worsened beginning at 8 p.m. compared to OROS MPH ( p = .01 ) . CONCLUSIONS Participants demonstrated significantly less variability and better driving performance when receiving OROS MPH q.d . compared to MPH t.i.d . , particularly in the evenings Although patients with attention-deficit hyperactivity disorder ( ADHD ) have reported improved driving performance on methylpheni date , limited evidence exists to support an effect of treatment on driving performance and some regions prohibit driving on methylpheni date . A r and omized , crossover trial examining the effects of methylpheni date versus placebo on highway driving in 18 adults with ADHD was carried out . After three days of no treatment , patients received either their usual methylpheni date dose ( mean : 14.7 mg ; range : 10—30 mg ) or placebo and then the opposite treatment after a six to seven days washout period . Patients performed a 100 km driving test during normal traffic , 1.5 h after treatment administration . St and ard deviation of lateral position ( SDLP ) , the weaving of the car , was the primary outcome measure . Secondary outcome measurements included the st and ard deviation of speed and patient reports of driving performance . Driving performance was significantly better in the methylpheni date than in the placebo condition , as reflected by the SDLP difference ( 2.3 cm , 95 % CI = 0.8—3.8 , P = 0.004 ) . Variation in speed was similar on treatment and on placebo ( -0.05 km/h , 95 % CI = -0.4 to 0.2 , P = 0.70 ) . Among adults with ADHD , with a history of a positive clinical response to methylpheni date , methylpheni date significantly improves driving performance BACKGROUND Attention-deficit/hyperactivity disorder ( ADHD ) is associated with a 3- to 4-fold increase in both driving-related accidents and associated injuries .  Methylpheni date ( MPH ) is the most commonly prescribed psychostimulant medication for ADHD . It has been demonstrated to improve performance on a driving simulator . This study investigated whether a once-daily , long-acting , osmotic , controlled-release MPH formulation improves the driving performance of ADHD adolescents while driving their own car on an actual road segment . METHODS Twelve ADHD-diagnosed male adolescent drivers ( mean age , 17.8 years ) prescribed a st  and ard  dose of 1.0 mg/kg ( if they were not already taking methylpheni date ) of controlled-release MPH participated in this repeated- measures crossover study . On 2 separate occasions ( off/on medication r and omized ) , participants drove a st and ard 16-mile road course incorporating rural , highway , and urban streets . A rater , blind to medication conditions , sat in the back seat and rated impulsive ( eg , " cutting off " another driver ) and inattentive ( eg , drove past design ated turn ) driving errors . RESULTS Impulsive driving errors were observed to occur rarely under both medication and no medication conditions . Inattentive driving errors were more common and were significantly reduced while the subject was on medication ( 4.6 versus 7.8 ; P < .01 ) . The improvement in driving performance ( change in number of errors recorded ) from first to second testing was positively correlated with medication dosage ( r = 0.60 ; P < .01 ) . CONCLUSIONS Once-daily controlled-release MPH improves real-life driving performance of adolescent males diagnosed with ADHD . In particular , it significantly reduces driving errors arising from inattention Background : Psychostimulant treatment may improve simulated driving performance in young adults with attention-deficit/hyperactivity disorder ( ADHD ) . Method : This was a r and omized , double-blind , placebo-controlled , crossover study of simulated driving performance with mixed amphetamine salts — extended release ( MAS XR ) 50 mg/day ( Cohort 1 ) and atomoxetine 80 mg/day ( Cohort 2 ) in young adults with ADHD . Results : Adults aged 19 to 25 years with AD/HD ( N = 19 ) who were administered MAS XR significantly improved overall simulated driving performance  versus placebo up to 12 hours after dosing . In contrast , there were no statistically significant differences in simulated-driving-performance scores  between atomoxetine and placebo . At endpoint , MAS XR reduced ADHD Rating Scale scores ≥ 30 % in 80 % of subjects , whereas atomoxetine achieved this level of improvement for 40 % . Limitations : Small sample size and use of simulated driving may limit generalizability of the findings . Conclusion : MAS XR in young adults with ADHD yields significant improvements in simulated driving performance and ADHD symptoms . ( J. of Att . Dis . 2009 ; 12(4 ) 316 - 329 This study investigated whether OROS methylpheni date ( OROS MPH , Concerta ) or extended-release mixed amphetamine salts ( se-AMPH ER , Adderall XR ) were associated with worsening of driving performance , or drug rebound , relative to placebo 16 - 17 hours post-ingestion . Nineteen male adolescent drivers aged 17 - 19 with attention-deficit/hyperactivity disorder ( ADHD ) were compared on a virtual reality driving simulator and an on-road drive after taking 72 mg of OROS MPH , 30 mg of se-AMPH ER , or placebo . Medication was taken at 08:00 in a r and omized , double-blind , placebo-controlled , crossover study . Participants drove a simulator at 17:00 , 20:00 , 23:00 , and 01:00 , and drove their own cars over a 16-mile road course at 24:00 . The main outcome measures were composite scores of driving performance . Neither OROS MPH nor se-AMPH ER was associated with significant worsening of simulator performance relative to placebo 17 hours post-ingestion in group comparisons . However , inattentive on-road driving errors were significantly more common on se-AMPH ER relative to placebo at midnight ( p = 0.04 ) , suggesting possible rebound . During both late simulator and on-road testing , driving performance variance was approximately 300 % greater during the se-AMPH ER compared to the OROS MPH condition INTRODUCTION Numerous studies have documented an increased frequency of vehicular crashes , traffic citations , driving performance deficits , and driving-related cognitive impairments in teens and adults with attention deficit hyperactivity disorder . METHOD The present study evaluated the effects of two single , acute doses of methylpheni date ( 10 and 20 mg ) and a placebo on the driving performance of 53 adults with ADHD ( mean age=37 years , range=18 - 65 ) using a virtual reality driving simulator , examiner and self-ratings of simulator performance , and a continuous performance test ( CPT ) to evaluate attention and inhibition . A double-blind , drug-placebo , within-subjects crossover design was used in which all participants were tested at baseline and then experienced all three drug conditions . RESULTS A significant beneficial effect for the high dose of medication was observed on impulsiveness on CPT , variability of steering in the st and ard driving course , and driving speed during the obstacle course . A beneficial effect of the low dose of medication also was evident on turn signal use during the st and ard driving course . An apparent practice effect was noted on some of the simulator measures between the baseline and subsequent testing sessions that may have interacted with and thereby obscured drug effects on those measures . CONCLUSIONS The results , when placed in the context of prior studies of stimulants on driving performance , continue to recommend their clinical use as one means of reducing the driving risks in ADHD teens and adults . IMPACT ON INDUSTRY Given the significantly higher risk of adverse driving outcomes associated with ADHD , industry needs to better screen for ADHD among employees who drive as part of employment so as to improve safety and reduce costs . Use of stimulants to treat the adult ADHD driver may reduce safety risks 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 methylpheni date , 30 mg of mixed amphetamine salts extended release , or placebo in a r and omized , 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 methylpheni date 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 methylpheni date result ed 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 methylpheni date 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 vali date s the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder . In the study , OROS methylpheni date promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release Abstract This study investigated whether methylpheni date delivered through a long-acting transdermal system ( MTS ) would reduce collision rates of young adult drivers with attention-deficit/hyperactivity disorder ( ADHD ) . Seventeen young adults completing the study ( mean [ SD ] age , 20.82 [ 2.40 ] years ; 14 men and 13 white ) met the following inclusion criteria : ADHD diagnoses but not routinely taking ADHD medication , previously responsive to ADHD medication , active drivers with more than 1 collision or citation in the past 2 years , and no significant comorbidities . In this open-labeled , crossover design drivers were r and omly assigned either to the no-medication condition for 3 months and then MTS for 3 months or to the reverse sequence . In-car video monitoring of routine driving occurred during these 6 months . At baseline and after each condition , participants completed the Conners Adult ADHD Rating Scale and the Cox Assessment of Risky Driving Scale , and their blood pressure , heart rate , and body weight were monitored . Compared with the no-medication condition , participants in the MTS condition self-reported fewer total ADHD ( P < 0.04 ) and inattentive symptoms ( P = 0.014 ) and a trend for risky driving behaviors ( P = 0.059 ) and had fewer video-recorded collisions ( P < 0.005 ) and other problematic driving events . There were no significant changes in blood pressure , heart rate , or body weight across conditions or any significant skin reactions to the MTS patch . This is the first study demonstrating that long-acting methylpheni date improves activities of daily living among young adults with ADHD . Specifically , methylpheni date improved safety in routine driving while reducing ADHD symptoms with minimal adverse effects PURPOSE Young adults with ADHD have been shown to be at increased risk for impairment in driving behaviors . Although stimulant medications have proven efficacy in reducing ADHD symptomatology , there is limited knowledge as to their effects on driving behavior . The focus of this report is on assessing the impact of lisdexamfetamine dimesylate ( LDX ) on driving behaviors in young adults with ADHD using a vali date d driving behavior question naire . METHODS This assessment was carried out in the context of a r and omized , double-blind , 6-week , placebo-controlled , parallel- design study of LDX versus placebo .  Subjects were 61 out patients of both sexes , 18 - 26 years of age , who met Diagnostic and Statistical Manual of Mental Disorders , fourth edition , criteria for ADHD . Subjects were r and omized to receive LDX or placebo for 6 weeks . Driving behavior was assessed at baseline and at the end of treatment using a U.S. version of the Manchester Driving Behavior Question naire ( DBQ ) . RESULTS Highly significant improvements were documented on LDX , over placebo , in driving behaviors assessed through the DBQ in measures of driving errors , driving lapses , and a trend toward fewer driving violations . There were no meaningful associations between these DBQ results and previously documented changes in a laboratory driving simulation paradigm or with improvement in symptoms of ADHD assessed through the ADHD rating scale . CONCLUSIONS LDX treatment was associated with significant improvements in self-reported driving behaviors that were independent of improvement in symptoms of ADHD . These results suggest that LDX may reduce behaviors associated with driving risks in young adults with ADHD PURPOSE To evaluate the motor vehicle driving knowledge , skills , and negative driving outcomes of older teens and young adults with attention deficit hyperactivity disorder ( ADHD ) . LOCATION A university medical center clinic for adult ADHD . SUBJECTS A total of 25 young adults with ADHD and 23 young adults without ADHD 17 to 30 years old drawn from the community and equated for age , gender , and educational level . MEASURES  Structured interview , behavior ratings by self- and others , video test of driving knowledge , computer simulated driving test , and official motor vehicle records .  RESULTS ADHD young adults were cited more often for speeding , were more likely to have had their licenses suspended , were involved in more crashes , were more likely to have had crashes causing bodily injury , and were rated by themselves and others as using poorer driving habits . Official driving records corroborated these negative outcomes . Although no group differences in driving knowledge were evident , young adults with ADHD had more crashes , scrapes , and erratic steering during the computer-stimulated driving test than did the control subjects . CONCLUSIONS Findings supported previous research suggesting that greater driving risks are associated with ADHD and suggested that ADHD does not interfere with driving knowledge so much as with actual performance ( motor control ) during vehicle operation Young adults with Attention Deficit Hyperactivity Disorder ( ADHD ) have been shown to be at increased risk for impairment in driving behaviors . While stimulant medications have proven efficacy in reducing ADHD symptomatology , there is limited knowledge as to their effects on driving impairment . The main aim of this study was to assess the impact of lisdexamfetamine dimesylate ( LDX ) on driving performance in young adults with ADHD using a vali date d driving simulation paradigm . This was a r and omized , double-blind , 6-week , placebo-controlled , parallel- design study of LDX vs. a placebo on driving performance in a vali date d driving simulation paradigm . Subjects were sixty-one out patients of both sexes , 18 - 26 years of age , who met DSM-IV criteria for ADHD . Subjects were r and omized to receive LDX or placebo after a baseline driving simulation and completed a second driving simulation six weeks after beginning drug or placebo . Examination of reaction time across five surprise events at post-treatment showed a significant positive effect of medication status . LDX treatment was also associated with significantly fewer accidents vs. placebo . LDX treatment was associated with significantly faster reaction times and a lower rate of simulated driving collisions than placebo . These results suggest that LDX may reduce driving risks in young adults with ADHD
target: In general , stimulants improved driving performance in ADHD patients ( either in RCTs conducted in simulators and /or cars ) .
  MPH-OROS  improved driving performance compared with MAS-XR , placebo , or no-drug conditions .
  Although MPH-OROS and MPH-IR produced similar improvements during the day , MPH-IR lost its efficacy in the evening .
  MAS-XR also improved driving performance , but worsened driving performance in the evening .
  Studies with ATX report conflicting results .
  Improvement was more consistent in teenagers and young adults .
  In general , treatment with psychostimulants or ATX in therapeutic dosages had no negative impact on driving performance of ADHD patients .
  To conclude , treatment with stimulants in therapeutic doses improves driving performance in ADHD patients , especially teenagers and young adults
background: Adults with Attention Deficit Hyperactivity Disorder ( ADHD ) , especially teenagers and young adults , show important car driving impairments , including risky driving , accidents , fines and suspension of driver׳s license .
  We systematic ally review ed the efficacy of stimulant and non-stimulant drugs on driving performance of ADHD patients .