Because of the inattentive, impulsive, and hyperactive traits, children with attention-deficit hyperactivity disorder (ADHD) are considerably more likely to experience injuries due to accidents than other children. Hartsough and Lambert (1985) found that up to 57 percent of children with ADHD were described as accident prone, and 15 percent had at least four or more serious accidental injuries, such as broken bones, lacerations, head injuries, severe bruises, lost teeth, or accidental poisonings. Children with ADHD may be admitted to intensive care units or have an injury result in disabilities more frequently than other children.

Several studies indicate that children with ADHD have an elevated risk of physical injuries or more frequent injuries and more severe injuries than other children. About 15.6 percent of hyperactive children have had at least four accidental injuries, whereas only 4.8 percent of children in the general population sustain such injuries. At the same time, 68.4 percent of children with ADHD have experienced physical trauma sufficient to warrant sutures, hospitalization, or extensive and painful injuries; only 39.5 percent of the general population of children have these injuries. Bone fractures are common. In addition, children with ADHD have an approximately threefold greater likelihood of accidental poisoning.

Some studies have related the degree of aggressiveness to the likelihood of accidental injury in preschoolers. Because some children with ADHD are more likely to be oppositional, the proneness may be due to this trait rather than just a level of impulsivity. A 2004 study of 10,000 children in Britain found that ADHD was more likely to be related to fractures, whereas oppositional defiant disorder (ODD) was more closely related to burns and poisonings. Thus both ADHD and ODD appear to be related to accidental injuries, but of different forms.

Parents report that their children with ADHD are inattentive and will engage in risky activities, are more heedless or thoughtless of the consequences, and thus place themselves in situations or engage in activities that are more likely to result in harm. For example, children with ADHD who are riding a bicycle may weave in and out of cars and may not look both ways before venturing into the street. They may be engage in risky behavior such as darting into the street, daring cars, or seeing how close they can come without colliding. They appear to be completely unaware of the danger or receive some thrill by challenging the edge of danger.

Teenagers with ADHD who drive automobiles are more dangerous because they have thousands of pounds of steel that they are taking chances with. They often enjoy the thrill of speeding and may have more speeding tickets and traffic violations than other students their age. These teenagers are twice as likely to have their driver's licenses suspended than drivers without ADHD.

Russell Barkley (2006) lists several other reasons that deserve consideration:

- Motor coordination. Children with ADHD may demonstrate more clumsiness, awkwardness, rapid and ill-timed motor movements, and slower reaction times.

- Comorbid ODD and conduct disorder (CD). Children with ODD and CD have more accidents than other children. Although sometimes the disorders are correlated with ADHD, it is these disorders that probably account for more accidents than hyperactivity itself.

- Poor parental supervision and monitoring of activities. Several studies have found that children who have more accidents have less supervision, especially out of doors than other children do.

Barkley believes that these factors must be considered in evaluating and preventing accidents among these children.

In a 2002 report Barkley also warns about summer events and activities when many children do not take stimulant medication because they are not in school. He suggests that children with ADHD continue to take medication in nonacademic setting and points to fewer behavioral problems at home, fewer disagreements with friends and siblings, and less irritability.

An event relating to accidents and ADHD is driving. Actually, driving is a major activity in the life of teens and adults, facilitating the ability for employment, family and work responsibilities, education, social engagement, shopping, and entertainment. All these activities are hampered if one cannot drive, especially in the United States. Driving is the one domain that can open up many possibilities in areas of living. However, it is also is an instrument that can lead to great harm to oneself and to other because there is a one- to two-ton projectile that can move at speeds of 80 miles per hour.

Barkley et al. (2003) conducted a series of studies of driving problems associated with ADHD that included surveys of nondisabled adolescents and adolescents with ADHD. The researchers found the following about teens and young adults and driving:

- They were more likely to have driven before the legal age without a license.

- According to the parents, they were not good drivers.

- They were more likely to have their licenses suspended or revoked.

- They were more likely to have been issued citations for driving infractions especially for speeding.

- They were four times more likely to have an accident while driving a vehicle.

Although some of the difficulties appeared related to ADHD, they were also connected with the degree of oppositional and conduct problems.

The Centers for Disease Control and Prevention (CDC) offers several suggestions for injury prevention that can be applied to people with ADHD:

- Ensure bicycle helmet use. Remind children as often as necessary to watch for cars and to avoid unsafe activities.

- Supervise children when they are involved in high-risk activities or are in a risky setting, such as climbing or when in or around a swimming pool.

- Keep potentially harmful household products, tools, equipment, and objects out of the reach of young children.

- Parents may want to enroll their teens in driving safety courses before they get their driver's license.

- Teens with ADHD may need to limit the amount of music listened to in the car while driving and drive without passengers or keep the number of passengers to a chosen few.

- Plan trips well ahead of time and know the best routes for short trips.

- Avoid the use of cellular phones, alcohol, and drugs.

Bibliography:

1) Barkley, Russell. 2002. ADHD and accident proneness. ADHD Report May:2-5

2) Barkley, R. A. et al. 2003. Driving-related risks and outcomes of attention deficit hyperactivity disorder in adolescents and young adults: A 3-5 year follow-up survey. Pediatrics 92:212-18

3) Barkley, R. A. 2006. Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. 3rd ed. New York: Guilford Press

4) Hartsough, C. S., and N. M. Lambert. 1985. Medical factors in hyperactive and normal children: Prenatal, developmental, and health history findings. American Journal of Orthopsychiatry 55:190-210

5) Rowe, R. et al. 2004. Childhood psychiatric disorder and unintentional injury: Findings from a national cohort study. Journal of Pediatric Psychology 29:119-30.

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