Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) und Straßenverkehr
Was gibt es in der Behandlung Jugendlicher mit ADHS zu beachten?
Abstract
Die Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) besteht bei ca. einem Drittel der Betroffenen auch noch in der Adoleszenz und im jungen Erwachsenenalter fort. Relevante Auswirkungen der Störung können die weiterhin bestehende Unaufmerksamkeit, Konzentrationsschwäche und auch gesteigertes impulsives Verhalten im Straßenverkehr sein: Jugendliche und junge Erwachsene mit ADHS verursachen im Vergleich zu Gleichaltrigen insgesamt mehr als doppelt so häufig Verkehrsunfälle mit Kraftfahrzeugen. In dieser Übersichtsarbeit soll ein kurzer Abriss der rechtlichen Situation und der aktuellen Studienlage zum Fahrverhalten von jungen Menschen mit ADHS gegeben werden. Stimulanzien gehören nach der Straßenverkehrsordnung (StVO) zu den verbotenen Rauschmitteln, verbessern aber nach heutiger Studienlage die Fahrleistung von ADHS-Patienten signifikant. Für Atomoxetin, das als nicht BtM-rezeptpflichtiges Arzneimittel problemlos gegeben werden kann, da es nicht in der StVO aufgeführt ist, sind die Forschungsergebnisse noch nicht so eindeutig. Die Psychoedukation jugendlicher ADHS Betroffener bezüglich ihres erhöhten Risikos im Straßenverkehr, Verhaltensempfehlungen und Aufklärung über die rechtliche Lage werden in der klinischen Praxis oft vernachlässigt. Unter dem Gesichtspunkt der Prävention ist eine Beratung aber angesichts der hohen Zahlen der Verkehrstoten in dieser Altersgruppe von höchster Relevanz.
Attention Deficit Hyperactivity Disorder (ADHD) is not only a childhood disorder but symptoms persist into adolescence and adulthood in approximately one third of the patients. Especially inattention and poor concentration impair driving performance in road traffic. Adolescents and young adults with ADHD are twice as likely to be involved in traffic accidents as people of the same age. This review sums up the legal situation in Germany and provides an overview of the current existing experimental studies on driving performance of adolescents and young adults with ADHD. Psychostimulant therapy seems to improve driving performance in ADHD patients. At the same time psychostimulants are prohibited, according to the road traffic act. Atomoxetine as a non-stimulant is not mentioned there. Therefore it could be unproblematically prescribed, however, the evidence for improved driving is not as unequivocal as for methylphenidate. The psychoeducation of adolescents and young adults with ADHD concerning their increased risk in road traffic often seems to be insufficient in clinical practice. Given the high number of traffic deaths in these young age groups consulting regarding this matter should be of high priority.
Literatur
2007). A pilot study of the effects of atomoxetine on driving performance in adults with ADHD. Journal of Attention Disorders, 10, 306–316.
(2002). Driving in young adults with attention deficit hyperactivity disorder: Knowledge, performance, adverse outcomes, and the role of executive functioning. Journal of the International Neuropsychological Society, 8, 655–72.
(1996) Hyperkinetisches Syndrom und Auffälligkeiten im Straßenverkehr: Eine fallkontrollierte Pilotstudie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 24, 82–91.
(2004). Assessment of fitness to drive among patients with learning difficulties. IMMORTAL. Deliverable R1.8. Retrieved on November 1, 2005, from www.immortal.or.at/index.php
(2006). Adolescents with attention deficit and hyperactivity disorder/learning disability and their proneness to accidents. Indian Journal of Pediatrics, 73, 299–303.
(2003). Stimulant rebound: How common is it and what does it mean? Journal of Child and Adolescent Psychopharmacology, 13, 137–142.
(2000). Effect of stimulant medication on driving performance of young adults with attention-deficit hyperactivity disorder: A preliminary double-blind placebo controlled trial. The Journal of Nervous and Mental Disease, 188, 230–234.
(2006a). 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. Pediatrics, 118, e704–710.
(2004). Impact of methylphenidate delivery profiles on driving performance of adolescents with attention-deficit/hyperactivity disorder: A pilot study. Journal of the American Academy Child and Adolescent Psychiatry, 43, 269–275.
(2008). Rebound effects with long-acting amphetamine or methylphenidate stimulant medication preparations among adolescent male drivers with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 18, 1–10.
(2006b). Manual transmission enhances attention and driving performance of ADHD adolescent males: Pilot study. Journal of Attention Disorders, 10, 212–216.
(2003). ADHS – Führerschein und Medikation. Nervenheilkunde, 22, 376–378.
(2009). Fahrtauglichkeit. In , Psychiatrie und Psychotherapie der Adoleszenz und des jungen Erwachsenenalters. Stuttgart: Schattauer.
(2006). Characterizing impaired driving in adults with attention-deficit/hyperactivity disorder: A controlled study. Journal of Clinical Psychiatry, 67, 567–74.
(2006). Earlier development of the accumbens relative to orbitofrontal cortex might underlie risk-taking behaviour in adolescents. Journal of Neuroscience, 26, 6885–6892.
(2006). What we know about ADHD and driving risk: A literature review, meta-analysis and critique. Journal of Canadian Academy of Child and Adolescent Psychiatry, 15, 105–25.
(1988). Psychostimulant rebound in attention deficit disordered boys. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 806–810.
(2008). Simulated driving changes in young adults with ADHD receiving mixed amphetamine salts extended release and atomoxetine. Journal of Attention Disorders. [Epub ahead of print].
(2008). Dopaminergic dysfunction in attention deficit hyperactivity disorder (ADHD), differences between pharmacologically treated and never treated young adults: A 3.4-dihydroxy-6-[18F]fluorophenyl-l-alanine PET study. Neuroimage, 41, 718–727.
(2007). Cortical thinning of the attention and executive function networks in adults with attention-deficit/hyperactivity disorder. Cerebral Cortex, 6, 1364–1375.
(1983). A naturalistic assessment of the motor activity of hyperactive boys. II. Stimulant drug effects. Archives of General Psychiatry, 40, 688–693.
, (2008). Switching from neurostimulant therapy to atomoxetine in children and adolescents with attention-deficit hyperactivity disorder: Clinical approaches and review of current available evidence. Paediatric Drugs, 10, 39–47.
(1978). Dextroamphetamine: Cognitive and behavioral effects in normal prepubertal boys. Science, 199, 560–563.
(2004). Childhood psychiatric disorder and unintentional injury: Findings from a national cohort study. Journal of Pediatric Psychology, 29, 119–30.
(2007). Traumatic dental injuries and attention-deficit/hyperactivity disorder: Is there a link? Dental Traumatology, 23, 137–142.
(2002). Can stimulant rebound mimic pediatric bipolar disorder? Journal of Child and Adolescent Psychopharmacology, 12, 63–67.
(2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences USA, 104, 19649–19654.
(2008). Methylphenidate significantly improves driving performance of adults with attention-deficit hyperactivity disorder: A randomized crossover trial. Journal of Psychopharmacology, 22, 230–237.
(2004). Changes in symptoms and adverse events after discontinuation of atomoxetine in children and adults with attention deficit/hyperactivity disorder: A prospective, placebo-controlled assessment. Journal of Clinical Psychopharmacology, 24, 30–5.
(2003). Teenage drivers: Patterns of risk. Journal of Safety Research, 34, 5–15.
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