Impact of distraction on the driving performance of adolescents with and without attention-deficit/hyperactivity disorder

How does attention deficit/hyperactivity disorder affect driving behavior components? Baseline findings from Persian traffic cohort

PURPOSE

Attention-deficit/hyperactivity disorder (ADHD) increases the risk of road traffic injuries through various mechanisms including higher risky driving behaviors. Therefore, drivers with ADHD are shown to be more prone to road traffic injuries. This study was conducted in a community-based sample of drivers to determine how ADHD affects driving behavior components.

METHODS

At the cross-sectional phase of a national population-based cohort, a representative sample of 1769 drivers were enrolled. Manchester driving behavior questionnaire and Conners' adult ADHD rating scales were used to assess driving behavior and ADHD symptom scores, respectively. Data were analyzed using Stata version 17. Multiple linear regression was used to investigate the association of driving behavior with ADHD while adjusting for the potential confounding role of age, sex, marital status, educational level, driving history, etc. RESULTS: According to the results, the normalized driving behavior score of drivers with ADHD was 4.64 points higher than drivers without ADHD. Having an academic compared to school education, increased the driving behavior score by 1.73 points. The normalized driving behavior score of drivers under 18 years of age was 6.27 points higher than drivers aged 31 - 45 years. The score of the aggressive violation subscale of drivers with ADHD was 7.33 points higher than drivers without ADHD compared to an increment of a range of 4.50-4.82 points for other driving subscales. The score of the ordinary violation subscale of female drivers was 2.23 points lower than that of male drivers. No significant relationship was found between sex and other subscales of driving.

CONCLUSION

Drivers with ADHD who are in adolescence or early adulthood exhibit more dangerous and aggressive driving behaviors than those who are older. Implementing training interventions to increase awareness of drivers with ADHD, their families, and psychologists regarding the effects of ADHD on driving is an essential step in preventing motor vehicle crashes among drivers with ADHD.

Research Review: Pharmacological and non-pharmacological treatments for adolescents with attention deficit/hyperactivity disorder - a systematic review of the literature

BACKGROUND

Attention Deficit/Hyperactivity Disorder (ADHD) demonstrates unique developmental manifestations in adolescence with implications for optimized, age-appropriate treatment. This 10-year update is the third in a series of systematic reviews examining the efficacy and safety of adolescent ADHD treatments. We broadly examined efficacy on ADHD symptoms, impairments, and other reported outcomes. Acute and long-term efficacy, and treatment moderators, were considered.

METHOD

We performed PubMed, EMBASE, and PsycINFO searches for articles published or in press from 2013 to 2024, integrated with hand search and randomized controlled trials (RCTs) identified in this series' earlier reviews. RCTs examining the safety or efficacy of interventions delivered to adolescents (ages 10.0-19.9) with a diagnosis of ADHD were included. Study characteristics were extracted and reviewed, quality of evidence was assessed using GRADE, and effect sizes were calculated for individual studies and illustrated using forest plots.

RESULTS

Sixty-three RCTs were identified. Quality of evidence ranged from high (medication; k = 29) to very low (nutrient supplementation, neurofeedback, occupational therapy; k = 1 each). Medications demonstrated consistent strong impact on ADHD symptoms and inconsistent impact on impairment. Diverse cognitive/behavioral treatments (C/BTs) demonstrated inconsistent impact on ADHD symptoms but strong and consistent impact on impairment and executive function skills, plus moderate benefits on internalizing symptoms. No interventions demonstrated significant safety concerns. Long-term maintenance (up to 3 years post-treatment) was demonstrated for C/BTs, though moderate quality of evidence was noted because participants cannot be fully blinded to receipt of treatment.

CONCLUSIONS

The effects of C/BTs and medication appear complementary, not duplicative. Combining medication and C/BT is advised at treatment outset to maximize engagement, maintenance, and response breadth (i.e. improving both ADHD symptoms/cognitive performance and coping skills/functional impairments). Engagement strategies (e.g. motivational interviewing) may facilitate uptake. Novel treatments do not yet demonstrate effects on ADHD symptoms or impairments in adolescents but remain a promising area for research.

Individual differences, ADHD diagnosis, and driving performance: effects of traffic density and distraction type

The present study examined the impact of individual differences, attention, and memory deficits on distracted driving. Drivers with ADHD are more susceptible to distraction which results in more frequent collisions, violations, and licence suspensions. Consequently, the present investigation had 36 participants complete preliminary questionnaires, memory tasks, workload indices, and four, 4-min simulated driving scenarios to evaluate such impact. It was hypothesised ADHD diagnosis, type of cellular distraction, and traffic density would each differentially and substantively impact driving performance. Results indicated traffic density and distraction type significantly affected the objective driving facets measured, as well as subjective and secondary task performance. ADHD diagnosis directly impacted secondary task performance. Results further showed significant interactions between distraction type and traffic density on both brake pressure and steering wheel angle negatively impacting lateral and horizontal vehicle control. Altogether, these findings provide substantial empirical evidence for the deleterious effect of cellphone use on driving performance.Practitioner summary: This study examined how ADHD diagnosis, traffic density, and distraction type affect driver behaviour. Participants completed driving behaviour questionnaires, memory tasks, workload indices, and driving scenarios. Results showed that ADHD diagnosis impacted secondary task performance, while traffic and distractions significantly impacted driving performance as well secondary task performance and workload.

Predicting Leadership Success in Extreme Organizations: A Prospective Study From Pre-Recruitment Through Leading in Real-Life

Organizations performing in stressful life-risking environments have unique features that directly influence human lives and communities’ well-being. Such organizations allocate vast resources to identify potential leaders as early as possible to direct and train them for leadership positions. Combat military contexts represent such organizations. The current manuscript offers a 5-year prospective study, addressing a critical gap in the literature regarding the generalization of established predictive leadership success models to leadership in extreme conditions. The study integrates leaders’ characteristics, followers’ perceptions, leadership training, and real-life contexts. Findings show that leadership traits measured years before enlistment related to leadership success, years down the line, when congruent with specific training contexts. Candidates higher in both task and relationship characteristics and in leadership emergence progressed to the senior leadership course compared to dropouts. Leadership emergence, measured in the first phase of leadership training, was the most relevant, stable, and reliable leader’s success predictor, directly and indirectly, of leadership development, above and beyond leadership characteristics. Findings emphasize the important influence of contextual congruency on leadership success in extreme organizations. Current findings may foster better leadership prospects for communities’ well-being and may improve cost-effectiveness in the leadership development processes in extreme occupations.

Inattention, Impulsivity, and Hyperactivity among Individuals with Self-Reported Impaired Wound Healing

Background: Inattention and impulsivity are common causes of accidents and injury. The aim of the current study was to examine the level of attention deficit (AD), hyperactivity, and impulsivity (HI) in individuals with and without self-reported impaired wound healing (IWH). Methods: A survey was conducted among N = 773 Dutch young adults, 18–30 years old. N = 198 were allocated to the IWH group and N = 575 to the control group. All participants completed the Attention Deficit Hyperactivity Disorder (ADHD) Rating Scale. Results: The analysis revealed that the IWH group has significantly higher scores on AD and HI, compared to the control group. Among the IWH group, 12.8% screened positive for AD (compared to 5.8% of the control group) and 14.0% screened positive for HI (compared to 7.4% of the control group). Conclusion: Clinically relevant increased inattention, impulsivity, and hyperactivity were observed among individuals with self-reported impaired wound healing.

Motor Functional Characteristics in Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorders: A Systematic Review

BACKGROUND

The development of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) has various influences on physical abilities. Identification of specific physical abilities of people with ADHD/ASDs as biomarkers for diagnosing these conditions is necessary. Therefore, in the present review, we aimed firstly to extract the difference in physical abilities of people with ADHD or ASDs compared to those of normal individuals. Secondly, we aimed to extract the specific physical ability characteristics for identifying potential diagnostic biomarkers in people with ADHD/ASDs.

METHODS

A systematic literature review was performed. The databases were searched for relevant articles on motor function deficits and characteristics of ADHD or ASD.

RESULTS

Forty-one cross-sectional studies and three randomized controlled trials were identified, comprising 33 studies of ADHD, 10 studies of ASDs, and 1 study of both ADHD and ASDs. The quality of studies varied. Three types of physical activities/exercises were identified, including coordinated movement, resistance-type sports, and aerobic-type sports. People with ADHD/ASDs generally exhibited poorer physical abilities for all types of activities, possibly because of low levels of physical activity. Specifically, we found temporal discoordination of movement in ADHD and integration or synchronization of separate movements in ASDs.

CONCLUSION

Specific deficits in physical ability may be attributed to ADHD/ASDs. However, there is not enough research on the physical abilities of people with ADHD and ASDs to clarify the specific deficits. Investigation of specific motor functions that characterize ADHD/ASDs should be facilitated.

Impact of L2 automated systems on hazard anticipation and mitigation behavior of young drivers with varying levels of Attention Deficit Hyperactivity Disorder symptomatology

Level 2 (L2) driving automation systems that maintain latitudinal and longitudinal control of the vehicle decrease mental workload and result in drivers failing to monitor and respond to potential roadway hazards. This issue is potentially important for young drivers with symptoms of Attention Deficit Hyperactivity Disorder (ADHD) since they have known difficulties anticipating and mitigating potential hazards on the road, a skill which requires attention. The objective of this study is to investigate how the use of partially automated (L2) systems and manual systems impacts hazard anticipation and mitigation among young drivers with varying levels of ADHD symptomatology. Sixty-eight drivers, classified into two groups - high and low ADHD symptomatology-navigated twice through three scenarios on a driving simulator, once with an L2 and once with a manual system. The results indicated that: (i) the hazard anticipation skills of drivers with both high and low ADHD symptomatology were depressed in the L2 condition relative to the manual condition; (ii) the hazard mitigations skills of drivers with both high and low ADHD symptomatology were depressed in the L2 condition relative to the manual condition on two measures, but improved on a third measure; and (iii) the hazard anticipation and mitigation skills of drivers with high and low ADHD symptomatology were differentially impacted, both within and across the two levels of automation. Taken together, the results indicate the pernicious and often hard to predict consequences of higher levels of automation for different populations of younger drivers.

The mere presence of a mobile phone: Does it influence driving performance?

The ubiquity of mobile phones has led to a rapid increase in its presence and use in vehicles, especially among young adults (up to 25 years), who are generally the least experienced group of drivers. The potential for phones to draw attention away from the main driving task has significant consequences for road safety. Previous studies have found that the mere presence of a mobile phone can be distracting by impairing attention in experimental non-driving contexts. However, the effect of phone presence, independent to usage, has not yet been examined in the context of driving. As such, the present study examined whether the mere presence of a mobile phone, its proximity to the driver, and power status (on/off) influenced the driving performance of young drivers. Additionally, this study assessed whether the effects of phone presence and proximity were moderated by an individual's level of dependence on, or emotional attachment to, their phone. A sample of 127 undergraduate psychology students (M = 19.76, SD = 1.63) were randomly assigned to one of four conditions: (1) phone absent (control), (2) phone on, in holder, (3) phone off, in holder, and (4) phone on, in pocket. They all completed the same simulated drive, and were measured for degree of phone dependence and phone emotional attachment. Overall, drivers in all the phone present conditions made significantly more driving errors (speeding and collision) compared to those in the phone absent (control) condition, irrespective of proximity to the phone and whether it was on or off. Phone dependence, but not phone emotional attachment, moderated the effect of phone presence on speeding behaviour. These findings suggest that the mere presence of a phone is distracting for drivers, especially so for those who are highly dependent on their phone, which may place them at a greater risk of a distraction induced crash.

Neuropsychological predictors of driving hazard detection in autism spectrum disorder and ADHD

Driving is a neuropsychologically complex task; this can present challenges for individuals with neurodevelopmental disorders (NDDs) such asautism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Deficits in theory of mind (ToM) and executive function (EF) are common features of ASD and ADHD, respectively, and may influence driving processes such as hazard perception. No studies have directly examined the neuropsychological contributions to hazard detection among drivers with ASD compared to ADHD.In the current study, 48 participants ages 16-30 years (13 ASD, 17 ADHD, 18 typically developing (TD)) completed a driving simulator task in which they encountered hazards in the driving environment. Hazards varied in whether they were social (contained a human component) or nonsocial (were physical objects) to examine the contribution of ToM and social processing to hazard response. Additionally, participants completed a neuropsychological battery targeting ToM and EF/attention skills (cognitive tasks and self-report measures).Within the ASD group, participants responded relatively slower to social compared to nonsocial hazards; no effect of hazard type was observed in the ADHD or TD groups. Additionally, measures of ToM and EF were correlated with driving performanceamong ASD participants; within the ADHD group, only self-reported behavior regulation was associated with driving performance. Broadly, this suggests that cognitive factors such as ToM and EF impact driving hazard performance in ASD and ADHD. The results of the study have implications for developing driving intervention programs for individuals with NDDs.

ADHD and accidents over the life span - A systematic review

Studies have demonstrated an increased risk of accidents and injuries in children, adolescents and adults with attention-deficit/hyperactivity disorder (ADHD). However, little is known about how accident risk may alter over the lifespan. Additionally, it would be important to know if the most common types of accidents and injuries differ in ADHD patients over different age groups. Furthermore, there is increasing evidence of an ameliorating effect of ADHD medication on accident risk. Lastly, the underlying risk factors and causal mechanisms behind increased accident risk remain unclear. We therefore conducted a systematic review focusing on the above described research questions. Our results suggested that accident/injury type and overall risk changes in ADHD patients over the lifespan. ADHD medication appeared to be similarly effective at reducing accident risk in all age groups. However, studies with direct comparisons of accident/injuries and effects of medication at different age groups or in old age are still missing. Finally, comorbidities associated with ADHD such as substance abuse appear to further increase the accident/injury risk.

The role of top-down attentional control and attention-deficit/hyperactivity disorder symptoms in predicting future motor vehicle crash risk

Objective: Attention-deficit/hyperactivity disorder (ADHD) confers elevated risk for automobile crashes, both as a clinical syndrome and continuously when examining risk as a function of symptom severity. However, the neurocognitive mechanisms and processes underlying this risk remain poorly understood. The current longitudinal study examined whether attention network components reflect neurocognitive pathways linking ADHD symptoms with adverse driving outcomes. Method: Drivers from six U.S. sites participating in the Strategic Highway Research Program Naturalistic Driving Study (N=3,226) were prospectively monitored for objectively identified crashes, near-crashes, and crash/near-crash fault. At study entry, drivers were assessed for ADHD symptoms; completed the Conners' Continuous Performance Test, Second Edition; and were then followed continuously for 1-2 years of routine, on-road driving using technology-enhanced in-car monitoring. Bias-corrected, bootstrapped mediation models examined the extent to which attention network components mediated the association between ADHD symptoms and future driving risk, controlling for known risk factors. Results: As expected, self-reported ADHD symptoms predicted all markers of future driving risk. Higher ADHD symptoms were associated with reduced inhibitory control, lower levels of top-down attentional control (endogenous orienting), and greater arousal decrements (phasic alertness). Controlling for ADHD symptoms, top-down attentional control uniquely predicted future crashes, near-crashes, and culpability for future crashes/near-crashes; only arousal decrements portended future near-crashes. Only top-down attentional control significantly mediated the association between baseline ADHD symptoms and future driving risk. Conclusions: The driving risks associated with ADHD appear to be conveyed in part by impairments in the top-down, voluntary control of attention, rather than by difficulties sustaining attention over time or inhibiting impulses, as is often assumed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Adult ADHD screening scores and hospitalization due to pedestrian injuries: a case-control study

BACKGROUND

The aim of this study was to investigate the association between adult ADHD screening scores and hospitalization due to pedestrian injuries in a sample of Iranian pedestrians.

METHODS

Through a case-control study, a case population of 177 pedestrians injured by the vehicles in road traffic crashes were compared with 177 controls who lacked a record of intentional or unintentional injuries enrolled from various wards of Imam Reza University Hospital which is a specialty teaching hospital located in the same city with similar referral level. The cases and controls had an age range of 18-65 years and were matched on gender and age. ADHD symptom profile was assessed using the Persian Self-report Screening Version of the Conner's Adult ADHD Rating Scales (CAARS-S:SV). The association of ADHD screening score and pedestrian injuries was investigated using multiple binary logistic regression to investigate the independent effect of ADHD index score on belonging to case group. Both crude and adjusted odds ratios were reported.

RESULTS

Men comprised 86.4% of the study subjects. The crude odds ratios for all the four ADHD subscales to be associated with pedestrian injuries were 1.05, 1.08, and 1.04 for the subscales A (attention deficit), B (hyperactivity/impulsiveness) and ADHD index respectively. However, the association for subscale A was not statistically significant with a borderline p-value. The final multivariate analysis showed that variables associated with pedestrian injuries in the road traffic crashes were ADHD Index score (OR = 1.06, 95% CI: 1.01-1.12); economic status (including household income and expenditure capacity); educational level and total walking time per 24 h.

CONCLUSIONS

Adult ADHD screening score can predict pedestrian injuries leading to hospitalization independently from sex, age, economic status, educational level and pedestrian exposure to traffic environment (average walking time).

Effects of Childhood and Adult Persistent Attention-Deficit/Hyperactivity Disorder on Risk of Motor Vehicle Crashes: Results From the Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

To determine motor vehicle crash (MVC) risk in adults with a history of childhood attention-deficit/hyperactivity disorder (ADHD) and persistent ADHD symptoms.

METHOD

Participants with (n = 441) and without (n = 239; local normative comparison group) childhood ADHD from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) Study were included. Participants provided self-reports on total number of MVCs they had been involved in and the time of licensure. Driving experience was estimated as the number of months since licensure. Total number of MVCs by adulthood was regressed on baseline ADHD status adjusting for sex, age at follow-up, driving experience, baseline oppositional defiant disorder/conduct disorder comorbidity, baseline household income level, adult oppositional defiant disorder/conduct disorder symptoms, adolescent and adult substance use, and adult antisocial personality disorder symptoms. We repeated the analysis using adult ADHD status (persistent versus desistant versus local normative comparison group) and symptom level as the predictor variables. Results are presented as incidence rate ratio (IRR) and CI.

RESULTS

Childhood ADHD was associated with a higher number of MVCs (IRR = 1.45, CI = 1.15-1.82), and adult ADHD symptom persistence was associated with more MVCs than desistance (IRR = 1.46, CI = 1.14-1.86). ADHD desistance was not associated with a significantly increased risk for MVCs compared with the local normative comparison group (IRR = 1.24, CI = 0.96-1.61). Concurrent symptoms of inattention and hyperactivity/impulsivity predicted MVC risk.

CONCLUSION

Persistence of ADHD into adulthood is a stronger predictor of MVC risk than childhood-limited ADHD.

CLINICAL TRIAL REGISTRATION INFORMATION

Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study; https://clinicaltrials.gov; NCT00000388.

Driving after pediatric traumatic brain injury: Impact of distraction and executive functioning

OBJECTIVE

The objective of the current study was to examine the driving performance of young drivers with a history of moderate to severe traumatic brain injury (TBI) compared with an uninjured control group. The impact of cell phone related distraction (conversation and texting) and executive functioning (EF) were also explored.

METHOD

Individuals aged 16-25 years with (n = 19) and without (n = 19) a history of TBI engaged in a simulated drive under 3 distraction conditions (no distraction, cell phone conversation, and texting). Mean speed, maximum speed, standard deviation of speed, standard deviation of lane position, and crash rates were used as outcomes. The Global Executive Composite (GEC) from the Behavior Rating Inventory of Executive Functioning (BRIEF) was used to measure EF.

RESULTS

Significant Injury × Distraction × GEC interaction effects were noted on max speed and speed variability, with a trending Distraction × GEC interaction noted for lane position variability. The effect of distraction was most notable among individuals with greater GEC scores, across both injury groups.

CONCLUSIONS

A history of pediatric TBI did not specifically impact driving performance independent of EF, with EF playing a central role in functioning across domains of driving performance. Consistent effect of EF suggests that deficits in driving performance may be associated with EF specifically, with individuals with EF difficulties following TBI at greater risk for poor driving performance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Road Crashes in Adults with Attention Deficit Hyperactivity Disorder and Risky Driving Behavior

Objective: Attention deficit hyperactivity disorder (ADHD) is one of the most common problems in adolescents. Risky behaviors in patients with ADHD are due to impaired impulse control resulting from problems with inhibition of proponent responses, controlling interference, and stopping ongoing responses after feedback on errors. The present study investigated the relationship between ADHD and risky driving behavior and the likelihood of car accident in Arak, Iran, in 2015-16. Method : This case-control study was conducted in the Emergency Department of Vali-Asr hospital in Arak (Iran) on drivers who met the inclusion criteria. The data gathering tools included the Demographic Questionnaire, Manchester Driving Behavior Questionnaire (MDBQ), and Wender Utah Rating Scale (WURS). Statistical analyses were performed using SPSS version 20 software. Results: The mean of ADHD (±SD) was higher among cases (81.64 [26.78]) than in controls (64 [24.28], P = 0.000). The mean of risky driving behaviors (±SD) was higher among cases (66.41[26.78]) than in controls (36.79 [25.42]). There was a significant relationship between ADHD, risky behavior, lapse errors, slips, deliberate ‎violation, and unintentional violation and car accident (P = 0.000). Conclusion: This study showed that ADHD increases the risk of road crashes and motor vehicle injuries. These drivers tend to drive at unauthorized speed, have less control over the vehicle, drive more carelessly, and are more likely to have an accident.

Prevalence of ADHD in Accident Victims: Results of the PRADA Study

Background: Recent research has shown an increased risk of accidents and injuries in ADHD patients, which could potentially be reduced by stimulant treatment. Therefore, the first aim of our study was to evaluate the prevalence of adult ADHD in a trauma surgery population. The second aim was to investigate accident mechanisms and circumstances which could be specific to ADHD patients, in comparison to the general population. Methods: We screened 905 accident victims for ADHD using the ASRS 18-item self-report questionnaire. The basic demographic data and circumstances of the accidents were also assessed. Results: Prevalence of adult ADHD was found to be 6.18% in our trauma surgery patient sample. ADHD accident victims reported significantly higher rates of distraction, stress and overconfidence in comparison to non-ADHD accident victims. Overconfidence and being in thoughts as causal mechanisms for the accidents remained significantly higher in ADHD patients after correction for multiple comparison. ADHD patients additionally reported a history of multiple accidents. Conclusion: The majority of ADHD patients in our sample had not previously been diagnosed and were therefore not receiving treatment. The results subsequently suggest that general ADHD screening in trauma surgery patients may be useful in preventing further accidents in ADHD patients. Furthermore, psychoeducation regarding specific causal accident mechanisms could be implemented in ADHD therapy to decrease accident incidence rate.

Assessing causality in the association between attention-deficit/hyperactivity disorder and obesity: a Mendelian randomization study

BACKGROUND/OBJECTIVES

Attention-deficit hyperactivity disorder (ADHD), one of the most common neurodevelopmental disorders in childhood and adolescence, is associated with obesity in observational studies. However, it is unclear whether ADHD contributes to, results from or is merely correlated with obesity. This study evaluates the presence and direction of a causal effect between ADHD and obesity.

SUBJECTS/METHODS

We performed a bidirectional two-sample Mendelian randomization using summary data from consortia of genome-wide association studies to investigate if ADHD (N = 55,374) has a causal effect on body mass index (BMI) in childhood (N = 35,668) and adulthood (N = 322,154-500,000), and vice-versa. The main analysis was performed using the inverse variance weighted (IVW) method. As sensitivity analyses, we used other Mendelian randomization methods that are more robust to horizontal pleiotropy (i.e., MR-Egger, weighted mode, and penalized weighted median estimators), as well as stratified the analysis by the putative mechanisms of genetic instruments (i.e., pathways involved or not in neurological processes).

RESULTS

The IVW method indicated a positive causal effect of BMI on ADHD: β = 0.324 (95% CI 0.198 to 0.449, p < 0.001; expressed as change in ln(odds ratio) of ADHD per each additional SD unit of BMI). IVW estimates were directionally consistent with other methods. On the other hand, we did not find consistent evidence for a causal effect of ADHD genetic liability on BMI.

CONCLUSIONS

The results suggested that higher BMI increases the risk of developing ADHD, but not the other way around.

The Teen Driver

For many teenagers, obtaining a driver's license is a rite of passage, conferring the ability to independently travel to school, work, or social events. However, immaturity, inexperience, and risky behavior put newly licensed teen drivers at risk. Motor vehicle crashes are the most common cause of mortality and injury for adolescents and young adults in developed countries. Teen drivers (15-19 years of age) have the highest rate of motor vehicle crashes among all age groups in the United States and contribute disproportionately to traffic fatalities. In addition to the deaths of teen drivers, more than half of 8- to 17-year-old children who die in car crashes are killed as passengers of drivers younger than 20 years of age. This policy statement, in which we update the previous 2006 iteration of this policy statement, is used to reflect new research on the risks faced by teen drivers and offer advice for pediatricians counseling teen drivers and their families.

Negative Consequences of Poor Driving Outcomes Reported by Adolescents With and Without ADHD

OBJECTIVE

Although adolescents with ADHD report less driving experience, a greater proportion of adolescents with ADHD report receiving at least one ticket; however, no study has examined the severity of infractions committed by adolescent drivers with ADHD.

METHOD

A total of 61 adolescents (28 ADHD, 33 controls) aged 16 to 17 with a valid driver's license completed a self-report Driving History Questionnaire (DHQ), which asked about months of driving experience, negative driving outcomes, and severity of consequences.

RESULTS

A greater proportion of adolescents with ADHD reported receiving fines, points on their driver's license, and remedial driving class. Furthermore, adolescents with ADHD reported attending a greater number of hours in remedial driving class, and a greater expense associated with fines.

CONCLUSION

Importantly, ADHD-related negative driving outcomes manifest early in driving careers. Furthermore, increased negative consequences of poor and/or risky driving among adolescents with ADHD were evident despite having fewer months of independent driving.

Positive Bias in Teenage Drivers With ADHD Within a Simulated Driving Task

OBJECTIVE

Youth with ADHD exhibit positive bias, an overestimation of ability, relative to external indicators. The positive bias construct is understudied in adolescents, particularly in the domain of driving. Study is needed as youth with ADHD experience greater negative outcomes in driving relative to typically developing teens.

METHOD

Positive bias on a driving simulator task was investigated with 172 teenagers with ADHD, combined type. Youth participated in a driving simulation task and rated driving performance afterward.

RESULTS

Compared with external ratings of driving performance, youth overestimated driving competence for specific driving behaviors as well as globally. The global rating demonstrated a greater degree of positive bias. Greater positive bias on global ratings of driving ability also predicted greater rates of risky driving behaviors during the simulator exercise independent from disruptive behavior disorder symptoms.

CONCLUSION

Results inform prevention and intervention efforts for teenage drivers with ADHD.

Driving among Adolescents with Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder

Over the past several decades there has been a surge of research on the contextual, biological, and psychological factors associated with transportation safety in adolescence. However, we know much less about the factors contributing to transportation safety among adolescents who do not follow a typical developmental trajectory. Adolescents with developmental disabilities (DD) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) have a wide range of behavioral and psychological deficits that may make the complex task of driving even more challenging. Because these adolescents often retain characteristic symptoms of their disorder into adulthood, it may impede their ability to achieve important milestones during the developmental transition from adolescent to adult. As the motivating force behind autonomous living and employment, the capacity for independent transportation is paramount to an adolescent’s overall success. This critical review will draw from the current body of literature on adolescent drivers with developmental disabilities to determine (1) areas of impairment; (2) safety risk factors; and (3) effective interventions for improving driving safety in this vulnerable population of adolescent drivers between the ages of 15–22. This review will also identify important unanswered research questions, and summarize the current state of the literature.

Does Talking on a Cell Phone, With a Passenger, or Dialing Affect Driving Performance? An Updated Systematic Review and Meta-Analysis of Experimental Studies

Objective An up-to-date meta-analysis of experimental research on talking and driving is needed to provide a comprehensive, empirical, and credible basis for policy, legislation, countermeasures, and future research. Background The effects of cell, mobile, and smart phone use on driving safety continues to be a contentious societal issue. Method All available studies that measured the effects of cell phone use on driving were identified through a variety of search methods and databases. A total of 93 studies containing 106 experiments met the inclusion criteria. Coded independent variables included conversation target (handheld, hands-free, and passenger), setting (laboratory, simulation, or on road), and conversation type (natural, cognitive task, and dialing). Coded dependent variables included reaction time, stimulus detection, lane positioning, speed, headway, eye movements, and collisions. Results The overall sample had 4,382 participants, with driver ages ranging from 14 to 84 years ( M = 25.5, SD = 5.2). Conversation on a handheld or hands-free phone resulted in performance costs when compared with baseline driving for reaction time, stimulus detection, and collisions. Passenger conversation had a similar pattern of effect sizes. Dialing while driving had large performance costs for many variables. Conclusion This meta-analysis found that cell phone and passenger conversation produced moderate performance costs. Drivers minimally compensated while conversing on a cell phone by increasing headway or reducing speed. A number of additional meta-analytic questions are discussed. Application The results can be used to guide legislation, policy, countermeasures, and future research.

Social and Non-social Hazard Response in Drivers with Autism Spectrum Disorder

Driving is a complex task that relies on manual, cognitive, visual and social skill. The social demands of driving may be challenging for individuals with Autism Spectrum Disorder (ASD) due to known social impairments. This study investigated how drivers with ASD respond to social (e.g., pedestrians) and non-social (e.g., vehicles) hazards in a driving simulator compared to typically developing drivers. Overall, participants responded faster to social hazards than non-social hazards. It was also found that drivers with typical development reacted faster to social hazards, while drivers with ASD showed no difference in reaction time to social versus non-social hazards. Future work should further investigate how social impairments in ASD may affect driving safety.

Distracted Walking, Bicycling, and Driving: Systematic Review and Meta-Analysis of Mobile Technology and Youth Crash Risk

This article examined the impact of mobile technology on young pedestrians, bicyclists, and drivers. A systematic search yielded 41 articles meeting inclusion criteria: peer-reviewed, published before February 1, 2016, behavioral outcome related to pedestrian, bicycling, or driving in the presence of mobile technology use, youth sample. Eleven studies were meta-analyzed to evaluate increased risk for crash/near-crash while distracted. Risk of bias and quality of research were assessed. Across methodologies, developmental stages, and type of distracting task, mobile technology use impairs youth safety on the road. Quality of evidence was low (pedestrian) to moderate (driving). Findings are discussed from the perspective of cognitive and visual distractions. Policy and behavioral efforts should continue to reduce mobile technology use in transportation settings.

Efficacy of a family-focused intervention for young drivers with attention-deficit hyperactivity disorder

OBJECTIVE

Teenage drivers diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at significant risk for negative driving outcomes related to morbidity and mortality. However, there are few viable psychosocial treatments for teens with ADHD and none focus on the key functional area of driving. The Supporting the Effective Entry to the Roadway (STEER) program was evaluated in a clinical trial to investigate whether it improved family functioning as a proximal outcome and driving behavior as a distal outcome.

METHOD

One hundred seventy-two teenagers with ADHD, combined type, were randomly assigned to STEER or a driver education driver practice program (DEDP).

RESULTS

Relative to parents in the DEDP condition, parents in STEER were observed to be less negative at posttreatment and 6-month follow-up but not at 12-month follow-up, and there were no significant differences for observed positive parenting. Relative to teens in the DEDP condition, teens in STEER reported lower levels of risky driving behaviors at posttreatment and 6-month follow-up, but not at 12-month follow-up. Groups did not differ on objective observations of risky driving or citations/accidents.

CONCLUSIONS

The STEER program for novice drivers with ADHD was effective in reducing observations of negative parenting behavior and teen self-reports of risky driving relative to DEDP; groups did not significantly differ on observations of positive parenting or driving behaviors. (PsycINFO Database Record

Texting while driving: the development and validation of the distracted driving survey and risk score among young adults

BACKGROUND

Texting while driving and other cell-phone reading and writing activities are high-risk activities associated with motor vehicle collisions and mortality. This paper describes the development and preliminary evaluation of the Distracted Driving Survey (DDS) and score.

METHODS

Survey questions were developed by a research team using semi-structured interviews, pilot-tested, and evaluated in young drivers for validity and reliability. Questions focused on texting while driving and use of email, social media, and maps on cellular phones with specific questions about the driving speeds at which these activities are performed.

RESULTS

In 228 drivers 18-24 years old, the DDS showed excellent internal consistency (Cronbach's alpha = 0.93) and correlations with reported 12-month crash rates. The score is reported on a 0-44 scale with 44 being highest risk behaviors. For every 1 unit increase of the DDS score, the odds of reporting a car crash increases 7 %. The survey can be completed in two minutes, or less than five minutes if demographic and background information is included. Text messaging was common; 59.2 and 71.5 % of respondents said they wrote and read text messages, respectively, while driving in the last 30 days.

CONCLUSION

The DDS is an 11-item scale that measures cell phone-related distracted driving risk and includes reading/viewing and writing subscores. The scale demonstrated strong validity and reliability in drivers age 24 and younger. The DDS may be useful for measuring rates of cell-phone related distracted driving and for evaluating public health interventions focused on reducing such behaviors.

Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder During Adolescence in the Primary Care Setting: A Concise Review

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder with a worldwide prevalence of about 5% in school-age children. This review is intended to assist primary care providers (PCPs) in diagnosing and treating ADHD in adolescents. PubMed, PsychInfo, and Science Citation Index databases were searched from March 1990 to 2015 with the keywords: ADHD, primary care/pediatrics, and children/adolescents. Abstracts addressing diagnosis and/or treatment with 105 citations were identified including supplementary treatment guidelines/books. Adolescent ADHD presents with significant disturbances in attention, academic performance, and family relationships with unique issues associated with this developmental period. Diagnostic challenges include the variable symptom presentation during adolescence, complex differential diagnosis, and limited training and time for PCPs to conduct thorough evaluations. The evidence base for treatments in adolescence in comparison to those in children or adults with ADHD is relatively weak. Providers should be cognizant of prevention, early identification, and treatment of conditions associated with ADHD that emerge during adolescence such as substance use disorders. Adolescent ADHD management for the PCP is complex, requires further research, and perhaps new primary care psychiatric models, to assist in determining the optimal care for patients at this critical period.

Extended Visual Glances Away from the Roadway are Associated with ADHD- and Texting-Related Driving Performance Deficits in Adolescents

The purpose of the research study was to determine whether ADHD- and texting-related driving impairments are mediated by extended visual glances away from the roadway. Sixty-one adolescents (ADHD =28, non-ADHD =33; 62% male; 11% minority) aged 16-17 with a valid driver's license were videotaped while engaging in a driving simulation that included a No Distraction, Hands-Free Phone Conversation, and Texting condition. Two indicators of visual inattention were coded: 1) percentage of time with eyes diverted from the roadway; and 2) number of extended (greater than 2 s) visual glances away from the roadway. Adolescents with ADHD displayed significantly more visual inattention to the roadway on both visual inattention measures. Increased lane position variability among adolescents with ADHD compared to those without ADHD during the Hands-Free Phone Conversation and Texting conditions was mediated by an increased number of extended glances away from the roadway. Similarly, texting resulted in decreased visual attention to the roadway. Finally, increased lane position variability during texting was also mediated by the number of extended glances away from the roadway. Both ADHD and texting impair visual attention to the roadway and the consequence of this visual inattention is increased lane position variability. Visual inattention is implicated as a possible mechanism for ADHD- and texting-related deficits and suggests that driving interventions designed to address ADHD- or texting-related deficits in adolescents need to focus on decreasing extended glances away from the roadway.

Preliminary research developing a theory of cell phone distraction and social relationships

Motor vehicle crashes remain the leading cause of death and injury for people aged 5-34, accounting annually for over 3000 deaths, and 100 times as many injuries. It is well established that distracted driving, and cell phone use while driving in particular, pose significant crash risk to drivers. Research has demonstrated that drivers are well aware of this danger but over 90% of drivers report using a cell phone while driving. Given the likely role that social influence plays in how people use cell phones while driving surprisingly little research has been conducted investigating to whom drivers are talking or texting. We report the results of a national survey to determine who drivers are most likely to call or text when behind the wheel and compared these results with general cell phone calling and texting patterns as well as previous findings on the prevalence of calling and texting while driving. The results suggest that social distance is a key factor in cell phone use while driving: Teens are more likely to talk with parents, and adults are more likely to talk with spouses than general calling patterns would suggest. We discuss whether the purpose of calls made while driving, such as coordination, could help explain these patterns. We propose next steps for further examining the role social relationships play in cell phone use while driving to potentially reduce teen driver cell phone use by lowering the number of calls from parents.

[Car driving and psychiatry]

Among the specialties involved in the order of 31 August 2010, psychiatry is in Chapter IV alongside addictive behavior and drug use may impair the ability of the driver. As well as for personal vehicles for professional vehicles the incompatibility of health with driving exists when clinical factors can interfere with the skills required of the driver. There would simply absolute incompatibility for psychoses in active phase. In the other phases of psychosis is at the discretion of specialist as for illiteracy or social maladjustment. The role of the authorized psychiatrist is therefore always subjective. This article also makes room for attention-deficit disorder with hyperactivity (ADHD), not listed, but the subject of numerous articles in the English literature.

Driving and attention deficit hyperactivity disorder

Adults with attention deficit hyperactivity disorder (ADHD) suffer from various impairments of cognitive, emotional and social functioning, which can have considerable consequences for many areas of daily living. One of those areas is driving a vehicle. Driving is an important activity of everyday life and requires an efficient interplay between multiple cognitive, perceptual, and motor skills. In the present study, a selective review of the literature on driving-related difficulties associated with ADHD is performed, seeking to answer whether individuals with ADHD show increased levels of unsafe driving behaviours, which cognitive (dys)functions of individuals with ADHD are related to driving difficulty, and whether pharmacological treatment significantly improves the driving behaviour of individuals with ADHD. The available research provides convincing evidence that individuals with ADHD have different and more adverse driving outcomes than individuals without the condition. However, it appears that not all individuals with ADHD are affected uniformly. Despite various cognitive functions being related with driving difficulties, these functions do not appear helpful in detecting high risk drivers with ADHD, nor in predicting driving outcomes in individuals with ADHD, since impairments in these functions are defining criteria for the diagnoses of ADHD (e.g., inattention and impulsivity). Pharmacological treatment of ADHD, in particular stimulant drug treatment, appears to be beneficial to the driving difficulties experienced by individuals with ADHD. However, additional research is needed, in particular further studies that address the numerous methodological weaknesses of many of the previous studies.

Distracted Driving in Teens With and Without Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

This study is among the first to examine the effect of talking on a cell phone or text messaging while driving in teens with and without attention deficit/hyperactivity disorder (ADHD).

METHOD

Teens (average age 17years) with a diagnosis of ADHD (N=16) were matched with typically developing controls (N=18). All participants operated a driving simulator while (1) conversing on a cell phone, (2) text messaging, and (3) with no distraction during a baseline condition. Six indicators of driving performance were recorded: (a) time to complete the drive; (b) lane deviations; (c) variability in lane position (i.e., root mean square [RMS]); (d) reaction time; (e) motor vehicle collisions; and, (f) speed fluctuation.

RESULTS

Significantly greater variation in lane position occurred in the texting task compared to no task and the cell phone task. While texting, in particular, teens with ADHD took significantly less time to complete the scenario. No significant main effects of group were found.

CONCLUSIONS

Generally, those with ADHD did not differ in regard to driving performance, when compared to controls, with the exception of one outcome: time to complete scenario. These findings suggest that distracted driving impairs driving performance of teen drivers, regardless of ADHD status. Texting while driving had the greatest negative impact on driving performance, particularly with regard to variability in lane position (i.e., RMS). This study sheds light on key issues regarding injury prevention, with the intent of providing pediatric care providers with the knowledge to inform teen drivers of risks associated with distracted driving which will ultimately result in reduced rates of motor vehicle crashes and concomitant injuries.

Driving behaviour in adults with attention deficit/hyperactivity disorder

BACKGROUND

Little is known about the impact of cognitive impairments on driving in adults with ADHD. The present study compared the performance of adults with and without ADHD in a driving simulator on two different routes: an urban route which we hypothesised would exacerbate weak impulse control in ADHD and a motorway route, to challenge deficits in sustained attention.

METHODS

Adults with (n = 22, 16 males) and without (n = 21, 18 males) ADHD completed a simulated driving session while eye movement data were recorded simultaneously. Participants also completed the Manchester Driving Behaviour Questionnaire (DBQ) and the Conners Adult ADHD Rating Scale (CAARS). Measures of driving performance included average speed, proportion distance travelled over speed limit (speeding) and lane deviation. These variables and the eye movement measures (spread of fixations, mean fixation duration) were compared between groups and routes. Also, driving behaviours, including responses to programmed events, were categorised and the frequencies within categories were compared between groups. Finally, speech analysis was performed to compare emotional verbal expressions during driving between groups.

RESULTS

ADHD participants reported significantly more Violations and Lapses on the DBQ than control participants and significantly more accidents. Average speed and speeding were also higher but did not interact with route type. ADHD participants showed poorer vehicle control, greater levels of frustration with other road users (including greater frequencies of negative comments) and a trend for less safe driving when changing lanes/overtaking on the motorway. These effects were predicted by hyperactive/impulsive CAARS scores. They were also more likely to cause a crash/near miss when an event occurred on the urban route.

CONCLUSIONS

The results suggest that difficulty regulating and controlling impulsive behavior, reflected in speeding, frustration with other road users, less safety when changing lanes on the motorway and a greater likelihood of an accident following an unexpected event, underlie impaired driving in ADHD. Hyperactivity/impulsivity symptoms correlated with these indices. Deficits in sustained attention seemed to play a lesser role in this particular study, although further research is needed to determine whether effects on attention emerge over longer periods of time and/or are influenced by the novelty of the simulator environment.

Traffic and Criminal Behavior of Adults with Attention Deficit-Hyperactivity with a Prospective Follow-Up from Birth to the Age of 40 Years

OBJECTIVE

The purpose of this study was to investigate whether individuals with attention deficit-hyperactivity disorder (ADHD) followed up to age 40 have a higher mortality, more involvement in criminal behavior, increased traffic accidents, and frequency or registered violations against traffic rules or whether they have been more frequently victims to crimes.

METHODS

The ADHD cohort (N = 122) born in 1971-1974 was isolated at the age of 9 years from the base cohort of 865 children who had known risk factors at birth and were still alive at the age of 5 years. Ninety-four healthy individuals born during the same years served as control subjects. None of the individuals with ADHD had used psychostimulants before their adolescence. The follow-up data were available from the newborn period until the ages of 5 and 9 years. At the ages of 16 and 30, the data were collected via questionnaire. For this study, the national police registers (last 5 years) were examined for traffic violations, crimes, or being an object of a criminal act when the persons reached the age of 40 years.

RESULTS

Ten men and one woman with ADHD but none of the controls had died by the age of 40. Three died of disease-related incidents, and 8 (13%) died of abnormal causes such as suicide (3), traffic accident (2), substance abuse (2), or violence (1). During the follow-up period, individuals with ADHD had been involved in violent behavior or economic criminality more frequently than the control subjects. They were also more commonly victims of criminal acts. No difference was found in traffic citations between those with ADHD and control subjects (at 35-40 years) when all traffic crimes were considered. A difference was not observed in the frequency of traffic accidents. However, there was a significant difference in drunk driving (at the ages of 30 and 35-40) and the number of persons without a driver's license.

DISCUSSION

Subjects with ADHD showed an elevated risk of being involved in criminality and had a higher risk of dying before the age of 40 years. The early detection of ADHD in childhood and appropriate treatments and family support may decrease criminality and save both money and human distress.

Determinants of risky driving behavior: a narrative review

Road traffic crashes (RTCs) account for great mortality and morbidity rates worldwide, resulting in substantial global burden. Factors contributing to RTC generally fall into three categories: environmental, vehicle, and human, with the human factor being by far the leading determinant. Obtaining an in-depth exploration of driving behavior and factors underpinning risky driving could be of particular importance to facilitate the establishment of effective policies. The present article provides insight to different aspects of risky driving behavior, at micro and macro levels, from individual attitudes, and psychological factors like personality, temperament, mood and emotions, to socioeconomic context, social norms, cultural backgrounds, level of law enforcement, and internalization of legality in the society. Risky driving behavior is a multidimensional issue and any effort to design and establish modification policies should be based on a comprehensive understanding of its determinants in different aspects.