In finding a higher percentage of stimulant users in the cardiac death group compared with the percentage of stimulant users in the motor vehicle victim group, Dr. Gould et al. made the interpretation that stimulants are likely to increase the risk of cardiac death. However, there is an alternative interpretation that deserves consideration and that, perhaps, has more support in the recent literature. There is a burgeoning interest among clinicians and researchers regarding the effect of attention deficit hyperactivity disorder (ADHD) on driving behavior. The evidence is strong that ADHD is associated with an increased risk of motor vehicle accidents (2) and that stimulants significantly attenuate this risk (2, 3). Thus, it may not be that stimulants were overrepresented in the cardiac death group. It may just appear so because they actually lower the risk of motor vehicle accidents in adolescents and young adults with ADHD and therefore were underrepresented in the comparator group.