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Scoten O, Tabi K, Paquette V, Carrion P, Ryan D, Radonjic NV, Whitham EA, Hippman C. Attention-deficit/hyperactivity disorder in pregnancy and the postpartum period. Am J Obstet Gynecol 2024; 231:19-35. [PMID: 38432409 DOI: 10.1016/j.ajog.2024.02.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/10/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Attention-deficit/hyperactivity disorder is a childhood-onset neurodevelopmental disorder that frequently persists into adulthood with 3% of adult women having a diagnosis of attention-deficit/hyperactivity disorder. Many women are diagnosed and treated during their reproductive years, which leads to management implications during pregnancy and the postpartum period. We know from clinical practice that attention-deficit/hyperactivity disorder symptoms frequently become challenging to manage during the perinatal period and require additional support and attention. There is often uncertainty among healthcare providers about the management of attention-deficit/hyperactivity disorder in the perinatal period, particularly the safety of pharmacotherapy for the developing fetus. This guideline is focused on best practices in managing attention-deficit/hyperactivity disorder in the perinatal period. We recommend (1) mitigating the risks associated with attention-deficit/hyperactivity disorder that worsen during the perinatal period via individualized treatment planning; (2) providing psychoeducation, self-management strategies or coaching, and psychotherapies; and, for those with moderate or severe attention-deficit/hyperactivity disorder, (3) considering pharmacotherapy for attention-deficit/hyperactivity disorder, which largely has reassuring safety data. Specifically, providers should work collaboratively with patients and their support networks to balance the risks of perinatal attention-deficit/hyperactivity disorder medication with the risks of inadequately treated attention-deficit/hyperactivity disorder during pregnancy. The risks and impacts of attention-deficit/hyperactivity disorder in pregnancy can be successfully managed through preconception counselling and appropriate perinatal planning, management, and support.
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Affiliation(s)
- Olivia Scoten
- University of British Columbia (UBC), Vancouver, BC, Canada
| | - Katarina Tabi
- Department of Psychiatry, UBC, Vancouver, BC, Canada; Reproductive Mental Health Program, BC Women's Hospital, Vancouver, BC, Canada; BCCH Centre for Mindfulness, BC Children's Hospital, Vancouver, BC, Canada; BC Women's Health Research Institute, Vancouver, BC, Canada
| | | | - Prescilla Carrion
- Department of Psychiatry, UBC, Vancouver, BC, Canada; Reproductive Mental Health Program, BC Women's Hospital, Vancouver, BC, Canada
| | - Deirdre Ryan
- Department of Psychiatry, UBC, Vancouver, BC, Canada; Reproductive Mental Health Program, BC Women's Hospital, Vancouver, BC, Canada
| | - Nevena V Radonjic
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY
| | | | - Catriona Hippman
- Department of Obstetrics & Gynaecology, UBC, Vancouver, BC, Canada; Reproductive Mental Health Program, BC Women's Hospital, Vancouver, BC, Canada; BC Women's Health Research Institute, Vancouver, BC, Canada; University of Calgary, Calgary, AB, Canada.
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Fuermaier ABM, Gontijo-Santos Lima C, Tucha O. Impairment Assessment in Adult ADHD and Related Disorders: Current Opinions From Clinic and Research. J Atten Disord 2024:10870547241261598. [PMID: 38898706 DOI: 10.1177/10870547241261598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVES Assessing functional impairment is one of the essential components in the clinical evaluation of ADHD in adulthood, serving both diagnostic and outcome evaluation purposes. However, clinicians and researchers may face challenges in selecting suitable instruments due to variations in accessibility and quality of instruments. METHODS We conducted an online survey involving an international group of 92 respondents engaged in clinical practice and/or research on ADHD. The survey aimed to evaluate current practices in assessing impairment in adult ADHD and related disorders, while also identifying areas requiring adaptation or potential new developments. RESULTS Our findings revealed that clinicians and researchers utilize a diverse range of instruments for assessing impairment in adults with ADHD, including some that may lack adequate properties for this purpose. Notably, dissatisfaction with current practice standards was expressed, underscoring the need for novel assessment approaches and improved psychometric properties. CONCLUSION It is evident that research endeavors are warranted to either refine existing measures or devise new ones for assessing functional impairment in adult ADHD. Emphasis should be placed on disseminating instruments that enhance accessibility in both research and clinical settings, and facilitate streamlined administration and interpretation.
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Affiliation(s)
| | | | - Oliver Tucha
- University Medical Center Rostock, Germany
- National University of Ireland, Maynooth, Ireland
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Arca AA, Mouloua M, Hancock PA. Individual differences, ADHD diagnosis, and driving performance: effects of traffic density and distraction type. ERGONOMICS 2024; 67:288-304. [PMID: 37267092 DOI: 10.1080/00140139.2023.2221417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/31/2023] [Indexed: 06/04/2023]
Abstract
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.
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Affiliation(s)
- Alejandro A Arca
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Mustapha Mouloua
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Peter A Hancock
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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Nissim M, Shfir O, Ratzon NZ. Simulator Driving Abilities, Executive Functions, and Adaptive Behavior Among Adolescents With Complex Attention Deficit Hyperactivity Disorder. J Atten Disord 2024; 28:350-363. [PMID: 38084062 DOI: 10.1177/10870547231214975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To examines the driving skills, executive functions, and adaptive behavior of adolescents diagnosed with Attention-deficit/hyperactivity disorder (ADHD) combined with emotional difficulties and/or learning disabilities (complex ADHD), compared to adolescents without ADHD. METHOD A cross-sectional study including 30 adolescents with complex ADHD and 33 adolescents without ADHD aged 15 to 18 years. Driving skills on a simulator, executive functions, and adaptive behavior were evaluated. RESULTS Adolescents without ADHD demonstrated significantly higher total scores on the driving simulator, indicating better driving performance compared to adolescents with complex ADHD. In the complex ADHD group, after controlling for different Conners Comprehensive Behavior Rating Scale-Self Report scales, driving simulator scores were partially correlated with executive functions. CONCLUSION These findings emphasize the unique needs of adolescents with complex ADHD. Given the significance of driving in today's society, it is crucial to consider the development of intervention programs to support this population's driving skills.
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Affiliation(s)
- Michal Nissim
- The David Yellin Academic College of Education, Jerusalem, Israel
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McManus B, Kana R, Rajpari I, Holm HB, Stavrinos D. Risky driving behavior among individuals with Autism, ADHD, and typically developing persons. ACCIDENT; ANALYSIS AND PREVENTION 2024; 195:107367. [PMID: 38096625 DOI: 10.1016/j.aap.2023.107367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/16/2023] [Accepted: 10/24/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Many individuals with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) often experience difficulty with driving, including difficulty with obtaining a driver's license as well as driving safely and efficiently. Such difficulties negatively impact their ability to function independently and participate in daily activities that require driving. ASD and ADHD commonly occur co-morbidly and share many overlapping clinical features. Few studies have directly compared the nature of difficulties in driving safety outcomes between ASD and ADHD. The overarching goal of the current study was to characterize and compare self-reported driving behavior among young autistic drivers, ADHD drivers, and typically developing (TD) drivers. METHOD Fifty-four participants (14 ASD, 20 ADHD, 20 TD); ages 16-30) completed the Autism Spectrum Quotient and ADHD Adult Rating scale as a method of screening of symptoms. All three groups then completed the Driving Behavior Questionnaire (DBQ), which measured self-reported driving violations, driving errors, and overall risky driving behavior. The three groups of ASD, ADHD, and TD individuals were then compared regarding symptomology and driving behavior differences. RESULTS One-way ANOVAs indicated group differences in DBQ total scores and DBQ errors. Drivers with ADHD reported significantly greater overall risky driving behaviors and driving errors compared to ASD and TD drivers. There were no significant differences between ASD and TD drivers in reported risky driving behaviors and errors. Linear regressions indicated that among all drivers, self-reported ADHD symptoms were significantly associated with higher levels of self-reported overall risky driving and driving errors, regardless of diagnostic group. DISCUSSION Risky driving and driving errors may be more closely related to symptoms that are characteristic of ADHD. This has implications for individuals with ADHD and autistic individuals who often show or report higher rates of ADHD symptoms. Future studies should compare driving skills of ASD and ADHD drivers using objective measures of driving performance, such as driving simulators or on-road tests.
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Affiliation(s)
- Benjamin McManus
- University of Alabama at Birmingham, Department of Psychology, Campbell Hall 415, 1300 University Blvd., Birmingham, AL 35233, United States; The University of Alabama, Institute for Social Science Research, 306 Paul W. Bryant Dr, Tuscaloosa, AL 35401, United States.
| | - Rajesh Kana
- University of Alabama, Department of Psychology, 505 Hackberry Lane, Tuscaloosa, AL 35487, United States.
| | - Inaara Rajpari
- University of Alabama at Birmingham, Department of Psychology, Campbell Hall 415, 1300 University Blvd., Birmingham, AL 35233, United States.
| | - Haley B Holm
- Children's Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA 30329, United States.
| | - Despina Stavrinos
- University of Alabama at Birmingham, Department of Psychology, Campbell Hall 415, 1300 University Blvd., Birmingham, AL 35233, United States; The University of Alabama, Institute for Social Science Research, 306 Paul W. Bryant Dr, Tuscaloosa, AL 35401, United States.
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Terranova Ap C, Pozzebon F, Cinquetti A, Perilli M, Palumbi S, Favretto Ap D, Viel Ap G, Aprile Ap A. Driving impairment due to psychoactive substances and attention deficit disorder: A pilot study. Heliyon 2024; 10:e24083. [PMID: 38293447 PMCID: PMC10825441 DOI: 10.1016/j.heliyon.2024.e24083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
Objective Attention disorder and substance use disorder are linked to driving impairment and increased road crash involvement. This study explores attention deficits in a population of drivers found driving under the influence (DUI) of psychoactive substances. Methods A case-control study was conducted comparing subjects with a previous DUI episode (cases) to subjects who were negative for DUI offenses (controls). Personal, socio-demographic, and DUI data were collected for both groups. All subjects were administered the Continuous Performance Test-third edition (CPT-3), which measures dimensions of attention, including inattentiveness, impulsivity, sustained attention, and vigilance. Possible associations with a previous DUI episode, the use of illicit substances or excessive alcohol use, and road crash involvement were analyzed statistically. Results Overall, the study included 147 subjects (100 cases, 47 controls). The parameter distributions of detectability, probability of ADHD, and inattentiveness indicated statistical differences between the two groups. No attention deficits predicted substance use disorder or excessive alcohol consumption. Inattentiveness was an independent risk factor for previous road collision involvement. Conclusions The results suggest that alterations exist in some attention dimensions in a population of DUI subjects who were users of alcohol or other psychoactive substances and involved in road traffic crashes. The CPT-3 had successfully distinguished between the two study groups, and after validation, it could be useful in the process of reinstating a driver's license. Future research should expand the study sample to better understand the relevance of the proposed methodological approach in terms of prevention, rehabilitation, and the monitoring of subjects evaluated for driving eligibility requirements.
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Affiliation(s)
- Claudio Terranova Ap
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio n.50, Padova, 35121, Italy
| | - Francesco Pozzebon
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio n.50, Padova, 35121, Italy
| | - Alessandro Cinquetti
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio n.50, Padova, 35121, Italy
| | - Matteo Perilli
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio n.50, Padova, 35121, Italy
| | - Stefano Palumbi
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio n.50, Padova, 35121, Italy
| | - Donata Favretto Ap
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio n.50, Padova, 35121, Italy
| | - Guido Viel Ap
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio n.50, Padova, 35121, Italy
| | - Anna Aprile Ap
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio n.50, Padova, 35121, Italy
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Chutko LS, Surushkina SY, Yakovenko EA, Cherednichenko DV. [Attention deficit hyperactivity disorder in adults]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:97-102. [PMID: 38465816 DOI: 10.17116/jnevro202412402197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The article presents a review of scientific publications devoted to the study of the characteristics of the clinical picture and the dynamics of the main symptoms in adult patients with attention deficit hyperactivity disorder (ADHD). The authors present current data on the prevalence of this disease, leading clinical manifestations and the most common comorbid pathology. Research data on the impact of ADHD in adulthood on educational and professional activities are presented, and the economic and criminological aspects of ADHD are considered. The main methods of psychotherapeutic correction and pharmacological therapy are presented.
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Affiliation(s)
- L S Chutko
- N.P. Bechtereva Institute of Human BraIn Russian Academy of Sciences, St. Petersburg, Russia
| | - S Yu Surushkina
- N.P. Bechtereva Institute of Human BraIn Russian Academy of Sciences, St. Petersburg, Russia
| | - E A Yakovenko
- N.P. Bechtereva Institute of Human BraIn Russian Academy of Sciences, St. Petersburg, Russia
| | - D V Cherednichenko
- N.P. Bechtereva Institute of Human BraIn Russian Academy of Sciences, St. Petersburg, Russia
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Liu TL, Hsiao RC, Chou WJ, Yen CF. Hopelessness in caregivers of children with attention-deficit/hyperactivity disorder: Associations with depression and anxiety and multidimensionally related factors. J Formos Med Assoc 2023; 122:1158-1164. [PMID: 37230914 DOI: 10.1016/j.jfma.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND/PURPOSE Hopelessness can compromise caregivers' mental health and impede their ability to take care of their child with attention-deficit/hyperactivity disorder (ADHD). The study aimed to explore the associations of hopelessness with caregiver depression and anxiety in caregivers of children with attention-deficit/hyperactivity disorder (ADHD). Additionally, the study examined the associations of child demographics, ADHD and oppositional defiance symptoms, and caregiver demographics, parenting stress, and affiliate stigma with hopelessness. METHODS The study included 213 caregivers of children with ADHD who completed various assessments. Caregiver hopelessness was assessed using the Beck Hopelessness Scale, while child ADHD and oppositional defiance symptoms were assessed using the Parent Form of the Swanson, Nolan, and Pelham Scale, Version IV. Parenting stress was measured using the Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF), and affiliate stigma using the Affiliate Stigma Scale. Hierarchical regression analysis was used to investigate the multidimensional factors associated with caregiver hopelessness. RESULTS Caregiver hopelessness was significantly linked to caregiver depression and anxiety. Child inattention, caregiver parenting stress, and affiliate stigma were significantly associated with caregiver hopelessness. A higher level of affiliate stigma increased the association between child inattention and caregiver hopelessness. CONCLUSION These findings suggest that it is necessary to develop intervention programs for alleviating the sense of hopelessness among caregivers of children with ADHD. Such programs should focus on addressing child inattention, caregiver parenting stress, and affiliate stigma.
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Affiliation(s)
- Tai-Ling Liu
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
| | - Ray C Hsiao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195-6560, USA; Department of Psychiatry, Seattle Children's, Seattle, WA98105, USA.
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, 83301, Taiwan; School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan; College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan.
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Heal DJ, Gosden J, Smith SL. Stimulant prodrugs: A pharmacological and clinical assessment of their role in treating ADHD and binge-eating disorder. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2023; 99:251-286. [PMID: 38467483 DOI: 10.1016/bs.apha.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
In this review, we critically evaluate the contribution of prodrugs to treating two related psychiatric disorders, attention-deficit hyperactivity disorder (ADHD) and binge-eating disorder (BED). ADHD is characterized by inattentiveness, distractibility, impulsiveness, and hyperactivity. BED is also an impulse-control disorder which leads to frequent, compulsive episodes of excessive eating (binges). Lisdexamfetamine (LDX; prodrug of d-amphetamine) is approved to treat both ADHD and BED. Serdexmethylphenidate (SDX; prodrug of d-threo-methylphenidate) is not clinically approved as monotherapy but, in a fixed-dose combination with immediate release d-threo-methylphenidate (Azstarys™), SDX is approved for managing ADHD in children/adolescents. The pharmacological actions of a stimulant mediate both its efficacy and side-effects. Therefore, daily management of ADHD or BED to maintain optimum efficacy and tolerability places highly restrictive requirements on the pharmacokinetic/pharmacodynamic (PK/PD) characteristics of stimulant medications, especially prodrugs. Prodrugs must have good bioavailability and rapid metabolism to provide therapeutic efficacy soon after morning dosing combined with providing stimulant coverage throughout the day/evening. A wide selection of dosages and linear PK for the prodrug and its active metabolite are essential requirements for treatment of these conditions. The proposed neurobiological causes of ADHD and BED are described. The chemical, pharmacological and PK/PD properties responsible for the therapeutic actions of the prodrugs, LDX and SDX, are compared and contrasted. Finally, we critically assess their contribution as ADHD and BED medications, including advantages over their respective active metabolites, d-amphetamine and d-threo-methylphenidate, and also their potential for misuse and abuse.
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Affiliation(s)
- David J Heal
- DevelRx Limited, BioCity, Pennyfoot Street, Nottingham, United Kingdom; Department of Life Sciences, University of Bath, Bath, United Kingdom.
| | - Jane Gosden
- DevelRx Limited, BioCity, Pennyfoot Street, Nottingham, United Kingdom
| | - Sharon L Smith
- DevelRx Limited, BioCity, Pennyfoot Street, Nottingham, United Kingdom
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Liu Y, Chihuri S, Mielenz TJ, Andrews HF, Betz ME, DiGuiseppi C, Eby DW, Hill LL, Jones V, Molnar LJ, Strogatz D, Li G. Motor Vehicle Crash Risk in Older Adult Drivers With Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open 2023; 6:e2336960. [PMID: 37792374 PMCID: PMC10551766 DOI: 10.1001/jamanetworkopen.2023.36960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
Importance Symptoms of attention-deficit/hyperactivity disorder (ADHD), such as inattentiveness and impulsivity, could affect daily functioning and driving performance throughout the life span. Previous research on ADHD and driving safety is largely limited to adolescents and young adults. Objective To examine the prevalence of ADHD and the association between ADHD and crash risk among older adult drivers. Design, Setting, and Participants This prospective cohort study collected data from primary care clinics and residential communities in 5 US sites (Ann Arbor, Michigan; Baltimore, Maryland; Cooperstown, New York; Denver, Colorado; and San Diego, California) between July 6, 2015, and March 31, 2019. Participants were active drivers aged 65 to 79 years at baseline enrolled in the Longitudinal Research on Aging Drivers project who were studied for up to 44 months through in-vehicle data recording devices and annual assessments. The data analysis was performed between July 15, 2022, and August 14, 2023. Exposure Lifetime ADHD based on an affirmative response to the question of whether the participant had ever had ADHD or had ever been told by a physician or other health professional that he or she had ADHD. Main Outcomes and Measures The main outcomes were hard-braking events defined as maneuvers with deceleration rates of 0.4g or greater, self-reported traffic ticket events, and self-reported vehicular crashes. Multivariable negative binomial modeling was used to estimate adjusted incidence rate ratios (aIRRs) and 95% CIs of outcomes according to exposure status. Results Of the 2832 drivers studied, 1500 (53.0%) were women and 1332 (47.0%) were men with a mean (SD) age of 71 (4) years. The lifetime prevalence of ADHD in the study sample was 2.6%. Older adult drivers with ADHD had significantly higher incidence rates of hard-braking events per 1000 miles than those without ADHD (1.35 [95% CI, 1.30-1.41] vs 1.15 [95% CI, 1.14-1.16]), as well as self-reported traffic ticket events per 1 million miles (22.47 [95% CI, 16.06-31.45] vs 9.74 [95% CI, 8.99-10.55]) and self-reported vehicular crashes per 1 million miles (27.10 [95% CI, 19.95-36.80] vs 13.50 [95% CI, 12.61-14.46]). With adjustment for baseline characteristics, ADHD was associated with a significant 7% increased risk of hard-braking events (aIRR, 1.07; 95% CI, 1.02-1.12), a 102% increased risk of self-reported traffic ticket events (aIRR, 2.02; 95% CI, 1.42-2.88), and a 74% increased risk of self-reported vehicular crashes (aIRR, 1.74; 95% CI, 1.26-2.40). Conclusions and Relevance As observed in this prospective cohort study, older adult drivers with ADHD may be at a significantly elevated crash risk compared with their counterparts without ADHD. These findings suggest that effective interventions to improve the diagnosis and clinical management of ADHD among older adults are warranted to promote safe mobility and healthy aging.
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Affiliation(s)
- Yuxin Liu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Stanford Chihuri
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Thelma J. Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Center for Injury Science and Prevention, Columbia University Irving Medical Center, New York, New York
| | - Howard F. Andrews
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - David W. Eby
- University of Michigan Transportation Research Institute, Ann Arbor
| | - Linda L. Hill
- School of Public Health, University of California, San Diego, La Jolla
| | - Vanya Jones
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa J. Molnar
- University of Michigan Transportation Research Institute, Ann Arbor
| | | | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Center for Injury Science and Prevention, Columbia University Irving Medical Center, New York, New York
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11
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Rapoport MJ, Chee JN, Prabha T, Dow J, Gillespie I, Koppel S, Charlton JL, O'Neill D, Donaghy PC, Ho AO, Taylor JP, Tant M. A Systematic Review of the Risks of Motor Vehicle Crashes Associated with Psychiatric Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:221-240. [PMID: 36198019 PMCID: PMC10037743 DOI: 10.1177/07067437221128468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Psychiatric disorders and their treatments have the potential to adversely impact driving skills. However, it is unclear to what extent this poses a public health risk by increasing the risk of motor vehicle crashes (MVCs). The aim of this systematic review was to synthesize and critically appraise evidence on the risk of MVC for drivers with psychiatric disorders. METHOD We conducted a systematic review of the MVC risk associated with psychiatric disorders using seven databases in November 2019. Two reviewers examined each study and extracted data. The National Heart, Lung, and Blood Institute Quality Assessment tools were used to assess each study's quality of evidence. RESULTS We identified 24 studies that met the inclusion criteria, including eight cohort, 10 case-control, and six cross-sectional designs. Quality assessment ratings were "Good" for four studies, "Fair" for 10, and "Poor" for 10. Self-report or questionnaires were used in place of objective measures of either MVC, psychiatric disorder, or both in 12 studies, and only seven adjusted for driving exposure. Fifteen studies reported an increased risk of MVC associated with psychiatric disorders, and nine did not. There was no category of disorder that was consistently associated with increased MVC risk. CONCLUSION The available evidence is mixed, not of high quality, and does not support a blanket restriction on drivers with psychiatric disorder. An individualized approach, as recommended by international guidelines, should continue. Further research should include objective assessments of psychiatric disorders and MVC risk and adjust for driving exposure.
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Affiliation(s)
- Mark J Rapoport
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Faculty of Medicine - Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | - Jamie Dow
- Société de l'assurance automobile du Québec, Gatineau, QC, Canada
| | - Ian Gillespie
- 12358Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sjaan Koppel
- Monash University Accident Research Centre, 2541Monash University, Clayton, VIC, Australia
| | - Judith L Charlton
- Monash University Accident Research Centre, 2541Monash University, Clayton, VIC, Australia
| | | | - Paul C Donaghy
- Translational and Clinical Research Institute, 5994Newcastle University, Newcastle upon Tyne, UK
| | - Angela Onkay Ho
- Faculty of Medicine - Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - John-Paul Taylor
- Translational and Clinical Research Institute, 5994Newcastle University, Newcastle upon Tyne, UK
| | - Mark Tant
- CARA, Vias Institute, Brussels, Belgium
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12
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Tokko T, Miškinyte G, Eensoo D, Harro J. Driving risks of young drivers with symptoms of attention deficit hyperactivity disorder: association with the dopamine transporter gene VNTR polymorphism. Nord J Psychiatry 2022; 76:575-583. [PMID: 35130472 DOI: 10.1080/08039488.2022.2032330] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Road traffic injuries are a leading cause of death for young adults, and young drivers with higher expression of symptoms of attention deficit-hyperactivity disorder (ADHD) could pose an even greater risk in traffic. Dopaminergic dysfunction has been found to occur in ADHD, with the dopamine transporter (DAT) gene VNTR polymorphism (DAT1 VNTR; rs28363170) being one of the most consistent genetic markers. Thus, we aimed at clarifying how the ADHD symptoms and the DAT1 VNTR relate to risk-taking behaviour in traffic, impulsivity and driving anger in young drivers. METHOD We used data of two traffic behaviour study samples (n = 741, mean age = 23.3 ± 7.2 years; n = 995, mean age = 22.9 ± 8.1 years) and the Estonian Children Personality Behaviour and Health Study (ECPBHS; traffic behaviour data n = 1,016, mean age = 25.2 ± 2.1 years). ADHD symptoms were assessed by self-report with the Adult ADHD Self-Report Scale (ASRS v1.1) and impulsivity with the Adaptive and Maladaptive Impulsivity Scale. Traffic behavioural measures were either self-reported (Driver Behaviour Questionnaire, Driving Anger Scale) or obtained from databases (registered accidents and violations). RESULTS Drivers with more self-reported ADHD symptoms also reported more risk-taking in traffic and had more of recorded traffic accidents and violations. DAT1 9 R carriers had a higher probability of high traffic risk behaviour only if they also had ADHD symptoms. CONCLUSION Higher level of ADHD symptoms is a significant risk factor in traffic, and carrying of the DAT1 9 R allele appears to aggravate these risks.
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Affiliation(s)
- Tõnis Tokko
- Department of Psychology, University of Tartu, Tartu, Estonia
| | - Grete Miškinyte
- Department of Psychology, University of Tartu, Tartu, Estonia
| | - Diva Eensoo
- Department of Chronic Diseases, Research Centre, National Institute for Health Development, Tallinn, Estonia
| | - Jaanus Harro
- Department of Neuropsychopharmacology, Institute of Chemistry, University of Tartu, Tartu, Estonia
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13
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Romer S, Dickerson A, Wu Q. Driving Performance of Experienced Young Adult Drivers with and without Autism Spectrum Disorder While Listening to Music on Two Scenarios: Hazards versus Wayfinding. Occup Ther Health Care 2022; 38:92-109. [PMID: 36112015 DOI: 10.1080/07380577.2022.2116761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 08/20/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
This study explored the effect of music on the driving performance of experienced young adult drivers with and without autism spectrum disorder (ASD) using an interactive driving simulator with two types of scenarios. A 2 (Group: autism/neurotypical) × 2 (Music: music/no music) × 2 (Scenario: hazards/wayfinding) factorial design was used with the order of scenarios and music conditions counterbalanced. Participants were 34 neurotypical drivers and 5 drivers with ASD, all with at least 3 years of driving experience. Paired sample t-tests demonstrated no effect of music for any condition. Overall, the drivers with ASD had higher performance means than the neurotypical group with significant differences in the wayfinding scenario and the category for following regulations. Neurotypical drivers had better performance on the wayfinding scenario than the hazard scenario in maneuvers and being attentive to the environment. Although this study had a low number of drivers with ASD, it suggests drivers with ASD can perform better than neurotypical drivers, possibly because they follow road rule guidelines more consistently than neurotypical peers. In addition, this is the first study to examine wayfinding skills in teens/young adults with and without ASD.
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Affiliation(s)
- Sydney Romer
- All About Kids Therapy Services, Atlanta, GA, USA
| | - Anne Dickerson
- Department of Occupational Therapy, East Carolina University, Greenville, NC, USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC, USA
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14
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Olesen AV, Madsen TKO, Lahrmann H, Nielsen J. Use of psychotropic medication and risk of road traffic crashes: a registry-based case-control study in Denmark, 1996-2018. Psychopharmacology (Berl) 2022; 239:2537-2546. [PMID: 35460342 PMCID: PMC9293868 DOI: 10.1007/s00213-022-06146-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/14/2022] [Indexed: 11/07/2022]
Abstract
RATIONALE Use of psychotropics is relatively prevalent amongst motor vehicle drivers because mobility is also important for persons suffering from psychiatric illness. However, medication side effects may increase the likelihood of being involved in traffic crashes. OBJECTIVES This study aimed to assess the association between the use of four types of medication (antipsychotics, benzodiazepines and z-hypnotics, antidepressants and stimulants of ADHD treatment) and the risk of traffic crashes, in general, and single crashes subsequently. METHOD We conducted a case-control study of data from 130,000 drivers involved in traffic crashes with personal injury and prescription data from all of Denmark during the period 1996-2018. RESULTS For antipsychotics, we found odds ratios of 0.86 and 1.29 for traffic crashes and single crashes, respectively; for benzodiazepines and z-hypnotics, 1.29 and 2.49, respectively; for antidepressants, 1.30 and 2.25, respectively; and for stimulants of ADHD treatment, 1.62 and 1.95, respectively. All p values were below 0.001. CONCLUSIONS Based on our results on twofold increased risks of single crashes and moderately increased risks in persons with ADHD, it might seem tempting to ban psychotropic medication in traffic. Conversely, we accept increased risks of traffic crashes in young drivers and in the physically disabled with special aids and, to some extent, with exposure to alcohol. In the end, it is the authorities who must review the evidence and decide whether to prohibit (some types of) psychotropic medication in traffic. Finally, underlying disease and not the drug may increase the risk of being involved in a traffic crash.
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Affiliation(s)
- Anne Vingaard Olesen
- The Traffic Research Group, Department of the Built Environment, Aalborg University, Thomas Manns Vej 23, Aalborg Ø, 9220, Denmark.
| | - Tanja Kidholm Osmann Madsen
- grid.5117.20000 0001 0742 471XThe Traffic Research Group, Department of the Built Environment, Aalborg University, Thomas Manns Vej 23, Aalborg Ø, 9220 Denmark
| | - Harry Lahrmann
- grid.5117.20000 0001 0742 471XThe Traffic Research Group, Department of the Built Environment, Aalborg University, Thomas Manns Vej 23, Aalborg Ø, 9220 Denmark
| | - Jimmi Nielsen
- grid.4973.90000 0004 0646 7373The Mental Health Center Glostrup, Copenhagen University Hospital, Nordstjernevej 41, Glostrup, 2600 Denmark
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15
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Bednarz HM, Stavrinos D, Svancara AM, Sherrod GM, McManus B, Deshpande HD, Kana RK. Executive Function Brain Network Activation Predicts Driving Hazard Detection in ADHD. Brain Topogr 2021; 35:251-267. [PMID: 34716524 DOI: 10.1007/s10548-021-00877-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
Drivers with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are at increased risk of experiencing driving difficulties. An important aspect of driving safety and skill involves hazard detection. This functional magnetic resonance imaging study examined the neural responses associated with driving hazard detection in drivers with ASD, ADHD, and typically developing (TD) drivers. Forty participants (12 ASD, 15 ADHD, 13 TD) ages 16-30 years completed a driving simulator task in which they encountered social and nonsocial hazards; reaction time (RT) for responding to hazards was measured. Participants then completed a similar hazard detection task in the MRI scanner so that neural response to hazards could be measured. Activation of regions of interest considered part of the executive function (EF) and theory of mind (ToM) networks were examined and related to driving simulator behavior. Results showed that stronger activation of the EF network during social hazard processing, including the bilateral dorsolateral prefrontal cortex and posterior parietal cortex, was associated with faster RT to social hazards among drivers with ADHD, but not among drivers with ASD. This provides the first evidence of a relationship between EF network brain activation and driving skills in ADHD and suggests that alterations in this network may underlie driving behavior. In comparison, the current study did not observe a relationship between ToM network activation and RT to social hazards in any group. This study lays the groundwork for relating neural activation to driving behavior among individuals with NDDs.
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Affiliation(s)
- Haley M Bednarz
- Department of Psychology, University of Alabama at Birmingham, Birmingham, USA
| | - Despina Stavrinos
- Department of Psychology, University of Alabama at Birmingham, Birmingham, USA
| | - Austin M Svancara
- Department of Psychology, University of Alabama at Birmingham, Birmingham, USA
| | - Gabriela M Sherrod
- Department of Psychology, University of Alabama at Birmingham, Birmingham, USA
| | - Benjamin McManus
- Department of Psychology, University of Alabama at Birmingham, Birmingham, USA
| | | | - Rajesh K Kana
- Department of Psychology, University of Alabama at Birmingham, Birmingham, USA. .,Department of Psychology & the Center for Innovative Research in Autism, University of Alabama, Tuscaloosa, USA.
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16
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Butzbach M, Fuermaier ABM, Aschenbrenner S, Weisbrod M, Tucha L, Tucha O. Metacognition, psychopathology and daily functioning in adult ADHD. J Clin Exp Neuropsychol 2021; 43:384-398. [PMID: 34157944 DOI: 10.1080/13803395.2021.1940104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Previous research indicated that adults with ADHD may have deficits in metacognition, yet the evidence base is scarce. This study aims to explore the existence and nature of metacognitive deficits in adults with ADHD, how psychopathology (such as inattention and depression) may affect metacognition and whether metacognition may impact daily functioning in adults with ADHD. METHOD Forty-six adult patients with ADHD and 46 controls completed questionnaires for metacognition, psychopathology and daily functioning (subjective assessment; self- and informant report). Participants performed two attention tests in a neuropsychological assessment. After test completion, participants were asked to evaluate their performance with the help of a visual aid and this self-evaluation of test performance was compared with their actual test performance (objective assessment). RESULTS Patients with ADHD reported large deficits in knowledge of cognition and medium deficits in regulation of cognition compared to controls. Self-evaluation of cognitive test performance revealed no significant deficits. Regression analyses revealed that psychopathology may explain a part of the variation in metacognition. Further regressions indicated that metacognition may account for a significant and meaningful proportion of variance in daily functioning, both self-rated and informant-rated. CONCLUSIONS Current findings of compromised metacognitive functioning of adults with ADHD suggest that clinicians may not want to rely on patients' self-reports in the clinical assessment. Inattention predicted impairments in metacognition, pointing toward the importance of attention for awareness and metacognition. Finally, we recommend that metacognition is addressed in the treatment trajectory of patients with ADHD, given that aspects of metacognition were directly linked to impairments in daily functioning as rated by participants and their relatives.
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Affiliation(s)
- Marah Butzbach
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Steffen Aschenbrenner
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany.,Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany
| | - Matthias Weisbrod
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany.,Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Lara Tucha
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany.,Department of Psychology, Maynooth University, National University of Ireland, Maynooth, Ireland
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17
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Bednarz HM, Kana RK, Svancara AM, Sherrod GM, Stavrinos D. Neuropsychological predictors of driving hazard detection in autism spectrum disorder and ADHD. Child Neuropsychol 2021; 27:857-887. [PMID: 33881380 DOI: 10.1080/09297049.2021.1908531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Haley M Bednarz
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajesh K Kana
- University of Alabama, Tuscaloosa, AL, USA.,Department of Psychology & The Center for Innovative Research in Autism, University of Alabama, USA
| | - Austin M Svancara
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabriela M Sherrod
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Despina Stavrinos
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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Loskutova NY, Callen E, Pinckney RG, Staton EW, Pace WD. Feasibility, Implementation and Outcomes of Tablet-Based Two-Step Screening for Adult ADHD in Primary Care Practice. J Atten Disord 2021; 25:794-802. [PMID: 31014157 DOI: 10.1177/1087054719841133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Primary care clinicians need to recognize and diagnose Adult ADHD (AADHD). We tested the feasibility and outcomes of a two-step screening process for AADHD in primary care. Methods: Seven practices screened patients using computerized surveys. Patients screening positive completed the AADHD Quality of Life (AAQoL). We explored the impact of screening on workflow and the acceptability to patients, and identified key barriers/opportunities to continuing screening. Results: Of the 711 participating adults, 188 (26.4%) screened positive, of which 32 (17.0%) had scores at least one standard deviation below means on two or more domains on the AAQoL (average 23.6 ± 7.3). These 32 individuals represented 4.5% of all participants. Clinicians were willing to screen, diagnose, and treat AADHD, but need additional resources. The screening process and technology was acceptable to patients and staff. Conclusions: A two-step screening method shows promise for routine screening for AADHD.
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19
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Butzbach M, Fuermaier ABM, Aschenbrenner S, Weisbrod M, Tucha L, Tucha O. Metacognition in adult ADHD: subjective and objective perspectives on self-awareness of cognitive functioning. J Neural Transm (Vienna) 2021; 128:939-955. [PMID: 33464422 PMCID: PMC8295131 DOI: 10.1007/s00702-020-02293-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
Although attention deficit hyperactivity disorder (ADHD) in adulthood is associated with marked cognitive impairment, research on metacognition in adult ADHD is scarce. Deficits in metacognition may have a negative impact on treatment adherence, functional outcomes, and everyday life. This study explores metacognition, specifically self-awareness of cognitive performance, in adults with ADHD by combining objective and subjective assessments. Forty-seven patients with ADHD and 47 control individuals completed a neuropsychological assessment battery including tests for attention, executive functions and memory (objective assessment), as well as questionnaires for cognitive functioning and symptom severity (subjective assessment; self- and informant-report). Participants evaluated their test performance of the objective assessment after test completion by selecting a percentile rank which was subtracted from their normed test result, yielding a discrepancy score. Compared to controls, adults with ADHD showed impairments in attention (medium effects) and memory (small and medium effects), but not in executive functions. The discrepancy scores between self-evaluation and cognitive performance revealed deficits in self-awareness of attentional functions (small effects), but not in executive functions and memory in patients with ADHD compared to controls. Discrepancy scores between self- and informant-reports of cognitive functioning revealed no significant differences. Adults with ADHD show impairments in metacognition in attentional functions, but may have intact metacognitive abilities in other domains. Patients with ADHD tend to overestimate their abilities, especially in attentional functions. Subjective and objective measures of metacognition may not correspond, highlighting the need for clinicians to not solely rely on patients' self-report in their assessment.
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Affiliation(s)
- Marah Butzbach
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen, 9712 TS Groningen, The Netherlands.
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen, 9712 TS Groningen, The Netherlands
| | - Steffen Aschenbrenner
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany.,Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany
| | - Matthias Weisbrod
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany.,Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Lara Tucha
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen, 9712 TS Groningen, The Netherlands.,Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
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20
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Federico A, Mantovani E, Casari R, Bertoldi A, Lugoboni F, Tamburin S. Adult attention-deficit/hyperactivity disorder symptoms, cognitive dysfunction and quality of life in high-dose use of benzodiazepine and Z-drug. J Neural Transm (Vienna) 2020; 128:1109-1119. [PMID: 33331955 PMCID: PMC8295124 DOI: 10.1007/s00702-020-02285-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022]
Abstract
High-dose use of benzodiazepines (BZDs) and Z-drugs was found to be associated with adult attention deficit/hyperactivity disorder (ADHD) and multidomain cognitive deficits, but the interplay between these factors and its effect on quality of life (QoL) is unclear. We explored (a) whether cognitive dysfunction differs in high-dose BZD/Z-drug users with and without adult ADHD and (b) the impact of cognitive deficits and adult ADHD on QoL in this substance-use disorder (SUD). From January 2015 to December 2019, we recruited 207 high-dose BZD/Z-drug users seeking treatment. We assessed the presence of adult ADHD with a screening tool, which was validated in SUD patients, and collected demographic, clinical and QoL data from the 76 included patients. A neuropsychological battery explored five cognitive domains. We found that: (a) screening for adult ADHD was frequently positive; (b) Short Form-36 (SF-36), a self-administered QoL questionnaire, was worse than the general population and worse in patients positive (ADHD+) vs. those negative (ADHD−) to ADHD screening tool; (c) executive function was significantly worse in ADHD+ than ADHD− patients; (d) some SF-36 dimensions were negatively influenced by executive dysfunction; (e) multivariate analysis showed an interplay between adult ADHD and cognitive dysfunction in worsening QoL. We documented a complex interplay between adult ADHD, cognitive dysfunction and QoL in high-dose BZD/Z-drug users. Assessing adult ADHD, neuropsychological measures and QoL may offer a full scenario of these patients, who are frequently impaired in everyday activities. Future research should explore whether pharmacological treatment might improve cognitive dysfunction and QoL in this SUD.
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Affiliation(s)
- Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | - Rebecca Casari
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Anna Bertoldi
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Fabio Lugoboni
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy.
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21
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Aduen PA, Kofler MJ, Bradshaw CP, Sarver DE, Cox DJ. The role of top-down attentional control and attention-deficit/hyperactivity disorder symptoms in predicting future motor vehicle crash risk. Neuropsychology 2020; 34:894-905. [PMID: 33197201 DOI: 10.1037/neu0000707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
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).
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Affiliation(s)
- Paula A Aduen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School
| | | | | | - Dustin E Sarver
- Department of Pediatrics, Center for Advancement of Youth, University of Mississippi Medical Center
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22
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Bangma DF, Tucha L, Fuermaier ABM, Tucha O, Koerts J. Financial decision-making in a community sample of adults with and without current symptoms of ADHD. PLoS One 2020; 15:e0239343. [PMID: 33044961 PMCID: PMC7549773 DOI: 10.1371/journal.pone.0239343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022] Open
Abstract
Research found that adults with attention deficit hyperactivity disorder (ADHD) have more problems with financial decision-making than healthy controls. The present study investigates the impact of symptoms of ADHD on impulsive buying and the use of financial decision styles. Furthermore, the influence of personality, symptoms of depression and demographics on the association between ADHD and these aspects of financial decision-making is evaluated. A community sample of 1292 participants (age range 18–93 years, 45.4% male) completed questionnaires related to ADHD, impulsive buying, financial decision styles, personal financial situation, depression and personality. Four groups were formed based on self-reported ADHD symptoms: an ‘ADHD’ group (n = 45), an ‘Adult-only ADHD’ group (n = 57), a ‘Subthreshold ADHD’ group (n = 162) and a ‘No ADHD’ group (n = 265). Groups were compared using ANOVA and chi-square tests. Furthermore, multiple regression analyses in the complete sample were employed to examine the association between ADHD and financial decision-making. The ADHD and Adult-only ADHD groups reported significantly more impulsive buying, used more often an avoidant or spontaneous decision style and less often saved money compared to the No ADHD group. Regression analyses revealed that impulsive buying and financial decision styles were not significantly associated with ADHD symptoms when controlling for personality, symptoms of depression and demographics. The present study confirms previous research on adults with ADHD by indicating more impulsive buying and a more frequent use of disadvantageous financial decision styles (i.e., avoidant and spontaneous styles) in individuals with an elevated number of current symptoms of ADHD compared to individuals without symptoms of ADHD. Personality and demographic variables were found to be related to both impulsive buying and the use of specific financial decision styles and might be of influence on the association between impulsive buying, the use of financial decision styles and ADHD.
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Affiliation(s)
- Dorien F Bangma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Lara Tucha
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands.,Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
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23
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Akbary A, Heydari ST, Sarikhani Y, Vossoughi M, Tabrizi R, Akabri M, Movahhedian N, Mani A, Sadeghi-Bazargani H, Ostovar T, Bagheri Lankarani K. Association between Adult Attention-Deficit/Hyperactivity Disorder and Driving Behaviors among Iranian Motorcyclists. Bull Emerg Trauma 2020; 8:163-168. [PMID: 32944576 DOI: 10.30476/beat.2020.84937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective To investigate the association between attention-deficit/hyperactivity disorder (ADHD) score and driving behaviors among motorcycle drivers in Iran. Methods This multi-center cross-sectional study was conducted on 1747 motorcyclists in three cities of Iran. We used a random sampling method in this study and gathered data using two standard questionnaires. Data were presented using descriptive statistics, also t-test, and ANOVA used for analysis. Results The mean age of participants was 27.41±8.80 years. ADHD scores of the participants ranged from 0 to 87, with a mean score 31±15.86. All risky driving behaviors (RDBs) were significantly associated with a higher mean of ADHD score. For example, driving with illegal speed (p<0.001), not wearing a crash helmet (p=0.016), driving while exhausting (p<0.001), talking with other passengers (p<0.001), being fined by the police in the past year (p=0.028), and maneuvering while driving (p<0.001) were related to a higher mean of ADHD score. Conclusion All RDBs were significantly associated with the ADHD score among motorcyclists in Iran. In this regard, health care providers should inform people with ADHD about the negative consequences associated with driving and ADHD. Public health policymakers should consider management of ADHD through a comprehensive approach to improve driving performance and competencies among motorcyclists in order to decrease RDBs and traffic accidents.
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Affiliation(s)
- Ali Akbary
- Department of Psychiatry, Faculty of Medicine, Social Development & Health Promotion Research Centre, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Vossoughi
- Oral and Dental Disease Research Center, Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Tabrizi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Akabri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Movahhedian
- Oral and Maxillofacial Radiology Department, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Mani
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Statistics & Epidemiology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tahereh Ostovar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Sadeghpour A, Sadeghi-Bazargani H, Ghaffari-fam S, Salarilak S, Farahbakhsh M, Ekman R, Daemi A. Adult ADHD screening scores and hospitalization due to pedestrian injuries: a case-control study. BMC Psychiatry 2020; 20:444. [PMID: 32912205 PMCID: PMC7488147 DOI: 10.1186/s12888-020-02848-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
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).
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Affiliation(s)
- Alireza Sadeghpour
- grid.412888.f0000 0001 2174 8913Department of Orthopedics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Central campus, Golshahr square, Elgoli Ave, Tabriz, 5167846185, Iran.
| | - Saber Ghaffari-fam
- grid.412763.50000 0004 0442 8645School of Nursing of Miyandoab, Urmia University of Medical Sciences, Urmia, Iran
| | - Shaker Salarilak
- grid.459617.80000 0004 0494 2783Department of Public Health, Islamic Azad University of Tabriz, Medical school, Tabriz, Iran
| | - Mostafa Farahbakhsh
- grid.412888.f0000 0001 2174 8913Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Robert Ekman
- grid.5371.00000 0001 0775 6028Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Amin Daemi
- grid.411746.10000 0004 4911 7066Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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Driving Accidents, Driving Violations, Symptoms of Attention-Deficit-Hyperactivity (ADHD) and Attentional Network Tasks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145238. [PMID: 32698490 PMCID: PMC7400088 DOI: 10.3390/ijerph17145238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/12/2020] [Accepted: 07/16/2020] [Indexed: 01/21/2023]
Abstract
Background: Iran has serious problems with traffic-related injuries and death. A major reason for traffic accidents is cognitive failure due to deficits in attention. In this study, we investigated the associations between traffic violations, traffic accidents, symptoms of attention-deficit/hyperactivity disorder (ADHD), age, and on an attentional network task in a sample of Iranian adults. Methods: A total of 274 participants (mean age: 31.37 years; 80.7% males) completed questionnaires covering demographic information, driving violations, traffic accidents, and symptoms of ADHD. In addition, they underwent an objective attentional network task (ANT), based on Posner’s concept of attentional networks. Results: More frequent traffic violations, correlated with lower age and poorer performance on the attentional network tasks. Higher symptoms of ADHD were associated with more accidents and more traffic violations, but not with the performance of the attentional tasks. Higher ADHD scores, a poorer performance on attentional network tasks, and younger age predicted traffic violations. Only higher symptoms of ADHD predicted more traffic accidents. Conclusions: In a sample of Iranian drivers, self-rated symptoms of ADHD appeared to be associated with traffic violations and accidents, while symptoms of ADHD were unrelated to objectively assessed performance on an attentional network task. Poor attentional network performance was a significant predictor of traffic violations but not of accidents. To increase traffic safety, both symptoms of ADHD and attentional network performance appear to merit particular attention.
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Abstract
OBJECTIVES To explore the relationships between tobacco, social support, job satisfaction, and depression among truck drivers. METHODS Cross-sectional data were collected from 797 truck drivers in six US states. Data collected included self-reported medical history and biological samples. Modified Zung depression scale and Work Apgar scores were used to measure depression and social support. Adjusted logistic regression models were used to calculate odds ratios (OR). RESULTS 24.0% of tobacco users were in the least depressed category and 18.2% were most depressed. 22.8% of the tobacco users had the most social support compared with 27.9% of the non-users. Drivers in the two most depressed categories were significantly less likely to use tobacco (OR = 0.62, 95% confidence interval [CI] = 0.39-0.96, and OR = 0.64, 95% CI = 0.41-0.99). CONCLUSIONS Drivers with low social support or low levels of depression are more likely to be tobacco users.
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Luderer M, Reinhard I, Richter A, Kiefer F, Weber T. ADHD Is Associated with a Higher Risk for Traumatic Events, Self-Reported PTSD, and a Higher Severity of PTSD Symptoms in Alcohol-Dependent Patients. Eur Addict Res 2020; 26:245-253. [PMID: 32653887 DOI: 10.1159/000508918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Alcohol dependence (AD) is frequently associated with attention-deficit/hyperactivity disorder (ADHD) as well as with posttraumatic stress disorder (PTSD). OBJECTIVE Aim of this study was to investigate whether in patients with AD, ADHD is associated with an increased rate of exposure to potentially traumatic events (PTEs) and PTSD, with increased PTSD severity and higher impact on daily functioning. METHODS Patients with AD were thoroughly assessed for ADHD during long-term residential treatment. Participants also completed the Posttraumatic Diagnostic Scale (PDS). The PDS is a 49-item self-report instrument that assesses exposure to different PTEs, DSM-IV criteria for PTSD, severity of PTSD, and related functional impairment. RESULTS Of 341 patients with AD, 66 were diagnosed with ADHD (19%). ADHD was associated with a more frequent exposure to PTEs (88 vs. 65%, p < 0.001). In patients with PTEs (n = 237), odds for PTSD were higher in ADHD versus no-ADHD patients (OR 8.9, 95% CI 3.9-20.5). Furthermore, PTSD severity and functional impairment were increased in ADHD patients. CONCLUSIONS ADHD in patients with AD is associated with a higher frequency of PTEs and PTSD with more severe and more impairing PTSD symptoms. In alcohol-dependent patients with ADHD, regular screening for PTSD should be considered.
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Affiliation(s)
- Mathias Luderer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany, .,Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany,
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | | | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany.,Feuerlein Center of Translational Addiction Medicine, Heidelberg, Germany
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Prevalence of ADHD in Accident Victims: Results of the PRADA Study. J Clin Med 2019; 8:jcm8101643. [PMID: 31597400 PMCID: PMC6832520 DOI: 10.3390/jcm8101643] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/19/2022] Open
Abstract
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.
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Romo L, Julien Sweerts S, Ordonneau P, Blot E, Gicquel L. Road accidents in young adults with ADHD: Which factors can explain the occurrence of injuries in drivers with ADHD and how to prevent it? APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:372-377. [PMID: 31311322 DOI: 10.1080/23279095.2019.1640697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Some 1.35 million people die and more than 50 million are injured or disabled from road accidents annually across the globe. Driving is a complex task with multiple complex cognitive functions, including perception, motor coordination, and executive function. Thus, driving can be a significant challenge for patients suffering from attention-deficit hyperactivity disorder (ADHD), a common neurodevelopmental disorder with cognitive symptoms such as inattention, impulsivity, and executive dysfunction. Undoubtedly, risk of car accidents is higher in people with ADHD. The aim of this article is to explore factors that could explain the occurrence of road accidents in patients with ADHD and to highlight prevention points. Indeed, reduction of risky driving is an important priority for public health.
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Affiliation(s)
- Lucia Romo
- EA 4430 Clipsyd, Paris Nanterre University, Nanterre Cedex, France.,Clinique des Maladies Mentales et de l'Encéphale (CMME) Sainte Anne Hospital Center, INSERM unit U-894, Paris, France
| | | | - Pauline Ordonneau
- University Center of Child and Adolescent Psychiatry, Research Unit, Henri Laborit Hospital Center, Poitiers University, Poitiers, France
| | - Emilie Blot
- University Center of Child and Adolescent Psychiatry, Research Unit, Henri Laborit Hospital Center, Poitiers University, Poitiers, France
| | - Ludovic Gicquel
- University Center of Child and Adolescent Psychiatry, Research Unit, Henri Laborit Hospital Center, Poitiers University, Poitiers, France
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Ornoy A, Spivak A. Cost effectiveness of optimal treatment of ADHD in Israel: a suggestion for national policy. HEALTH ECONOMICS REVIEW 2019; 9:24. [PMID: 31289954 PMCID: PMC6734254 DOI: 10.1186/s13561-019-0240-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/26/2019] [Indexed: 05/23/2023]
Abstract
OBJECTIVES There are well known behavioral complications of ADHD at adulthood such as learning difficulties resulting in lower education attainments; increased rate of car and other accidents; substance abuse; misconduct and imprisonment. These complications can be prevented or alleviated by effective treatment. In this study we calculated the economic burden of ADHD among adults in Israel and the cost of diagnosing and treating ADHD from childhood to adulthood. We then obtained the cost-benefit ratio of the treatment. METHODS The data were calculated using accepted estimations of prevalence and cost for the Israeli population assuming a prevalence of 4% among adults which is based on the ADHD prevalence among school age children. RESULTS The estimated cost per person with ADHD due to lower education attainment, higher involvement in crime and car accidents and more drug abuse is 289,969 USD and the estimated cost for optimal treatment is 41,667 USD. Hence, the benefit cost ratio is 7.02 and, assuming only 50% success of treatment, it is 3.51, still a very high cost benefit ratio. CONCLUSIONS Since early diagnosis and appropriate treatment of ADHD is very effective in reducing the various symptoms and complications at adulthood thus enabling a better education and higher income, it seems important to diagnose and offer comprehensive treatment to children with ADHD. Moreover, it seems equally important to continue treatment at adulthood.
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Affiliation(s)
- Asher Ornoy
- Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Avia Spivak
- Department of Economics, Ben Gurion University, Beersheba, Israel
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Ferro MA, Leatherdale ST. Traffic Violations among Young People with Attention-Deficit Hyperactivity Disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:511-515. [PMID: 30370781 PMCID: PMC6610566 DOI: 10.1177/0706743718809340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence whether individuals with attention-deficit hyperactivity disorder (ADHD) are at increased risk for traffic violations/collisions is mixed. This study investigated the association between ADHD and traffic violations among youth and young adults; examined whether this association differed by age, sex, or comorbid mental or physical problems; and modelled factors associated with traffic violations among individuals with ADHD. METHODS Data come from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH), a cross-sectional epidemiological study. The sample was restricted to youth and young adults aged 15 to 39 years and categorized into 3 groups: 15 to 19 years (n = 1886), 20 to 29 years (n = 3679), and 30 to 39 years (n = 3659). Lifetime ADHD and past-year contact with police for traffic violations were self-reported. Logistic regression models quantified the association between ADHD and traffic violations, stratified by age. Interactions were included to examine moderating effects. RESULTS No evidence suggested an association between ADHD and past-year traffic violations (odds ratio [OR], 1.07; 95% confidence interval (CI), 0.64 to 1.79), age-specific estimates did not differ across age groups (P = 0.696), and no factors moderated the association. Three factors were found to increase odds for past-year traffic violations among individuals with ADHD: aged 20 to 29 years (OR, 3.84; 95% CI, 1.47 to 10.06), male sex (OR, 3.48; 95% CI, 1.39 to 8.59), and white ethnicity (OR, 5.62; 95% CI, 1.24 to 25.51). CONCLUSIONS Individuals with ADHD are not an at-risk group for traffic violations but instead share similar risk factors with individuals in the general population without ADHD-information useful for health professionals. Replication studies are needed to examine the robustness of these findings.
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Affiliation(s)
- Mark A Ferro
- 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario
| | - Scott T Leatherdale
- 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario
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Hong M, Lee YS, Kim B, Joung YS, Yoo HK, Kim EJ, Lee SI, Bhang SY, Lee SY, Han D, Bahn GH. Clinical Utility and Cut-Off Scores of the Korean Adult Attention-Deficit/Hyperactivity Disorder Rating Scale. Soa Chongsonyon Chongsin Uihak 2019; 30:116-120. [PMID: 32595329 PMCID: PMC7298890 DOI: 10.5765/jkacap.190022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study was conducted to re-validate the clinical efficacy of the Korean Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale (K-AARS), which is a self-report scale for ADHD in adults, and to determine the clinical utility and cut-off scores of K-AARS. METHODS The participants were 135 drug naïve adults with ADHD and 144 healthy controls. To diagnose ADHD based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, two board-certified pediatric psychiatrists interviewed the participants and completed the Mini International Neuropsychiatric Interview. K-AARS was applied to all participants. K-AARS comprises six clinical subscales, one impairment subscale, and one driving behavior subscale. The receiver operating characteristic analysis was conducted to calculate the cut-off scores of K-AARS. RESULTS All subscale scores, including six clinical subscale, impairment subscale, and driving behavior subscale scores, were found to be significant in distinguishing adults with ADHD from healthy controls. The sensitivity and specificity of the six clinical subscales were 63.0-77.0% and 66.7-79.9%, respectively. The combined total score of the six clinical subscales, had a sensitivity of 80.0% and specificity of 79.9%. CONCLUSION The discriminative power of K-AARS for the diagnosis of ADHD in adults was excellent, and K-AARS and the empirical diagnosis of adults can be useful in diagnosing ADHD in adulthood.
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Affiliation(s)
- Minha Hong
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Young Sik Lee
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Bongseog Kim
- Department of Psychiatry, Inje University College of Medicine, Seoul, Korea
| | - Yoo Sook Joung
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Hanik K Yoo
- Seoul Brain Research Institute, Seoul, Korea
| | - Eui-Jung Kim
- Department of Psychiatry, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Buchun, Korea
| | - Soo Young Bhang
- Department of Psychiatry, Eulji University School of Medicine, Seoul, Korea
| | - Seung Yup Lee
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Doughyun Han
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
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Aduen PA, Cox DJ, Fabiano GA, Garner AA, Kofler MJ. Expert Recommendations for Improving Driving Safety for Teens and Adult Drivers with ADHD. ACTA ACUST UNITED AC 2019; 27:8-14. [PMID: 31431797 DOI: 10.1521/adhd.2019.27.4.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Paula A Aduen
- Harvard Partners Neuropsychology Consortium, Brigham and Women's Hospital, 60 Fenwood Road., Boston, MA 02115
| | - Daniel J Cox
- University of Virginia Health Sciences Center, Virginia Driving Safety Laboratory, Box 800-223, Charlottesville, VA 22908
| | - Gregory A Fabiano
- University at Buffalo, 334 Diefendorf Hall, University at Buffalo, Buffalo NY 14214
| | - Annie A Garner
- Saint Louis University, Department of Psychology, 3700 Lindell Boulevard, Room 2323, St. Louis, MO 63108
| | - Michael J Kofler
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306
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Efficacy of intervention at traffic schools reducing impulsive action, and association with candidate gene variants. Acta Neuropsychiatr 2019; 31:159-166. [PMID: 31182183 DOI: 10.1017/neu.2019.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Road traffic injuries are the leading cause of death among young people. Recognition of the contribution of impulsive behaviour may help novice drivers to behave more safely. Previously a brief intervention focusing on impulsive traffic behaviour conducted by psychologists in driving schools had been effective. The aim of this study was an independent re-evaluation of the effect of the intervention, as conducted by driving school teachers, and assessment of the potential associations with candidate genotypes. METHODS Driving school students (mean age 22.5, SD=7.9) were divided into intervention (n=704) and control (n=737) groups. Driving school teachers were trained to administer the intervention which consisted of a lecture and group work (1.5 h in total) on impulsivity. Traffic offences and crashes were monitored during 3 years, using police and traffic insurance fund databases. Functional polymorphisms of the dopamine transporter (DAT) and serotonin transporter genes (DAT1 VNTR and 5-HTTLPR) were assessed. RESULTS The intervention significantly lowered general traffic risk and prevalence of traffic accidents. DAT1 VNTR 9R carriers, particularly males, had higher general traffic risk in the whole sample. Female 5-HTTLPR s' allele carriers of the intervention group had the lowest general traffic risk. Intervention was most effective in female DAT1 VNTR 10R/10R homozygotes. CONCLUSIONS Brief impulsivity-centred intervention appears as a promising strategy for preventing risk-taking behaviour in novice drivers and can be fully integrated to driving school curriculum.
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Yuval-Greenberg S, Keren A, Hilo R, Paz A, Ratzon N. Gaze Control During Simulator Driving in Adolescents With and Without Attention Deficit Hyperactivity Disorder. Am J Occup Ther 2019; 73:7303345030p1-7303345030p8. [DOI: 10.5014/ajot.2019.031500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Importance: Attention deficit hyperactivity disorder (ADHD) is associated with driving deficits. Visual standards for driving define minimum qualifications for safe driving, including acuity and field of vision, but they do not consider the ability to explore the environment efficiently by shifting the gaze, which is a critical element of safe driving.
Objective: To examine visual exploration during simulated driving in adolescents with and without ADHD.
Design: Adolescents with and without ADHD drove a driving simulator for approximately 10 min while their gaze was monitored. They then completed a battery of questionnaires.
Setting: University lab.
Participants: Participants with (n = 16) and without (n = 15) ADHD were included. Participants had a history of neurological disorders other than ADHD and normal or corrected-to-normal vision. Control participants reported not having a diagnosis of ADHD. Participants with ADHD had been previously diagnosed by a qualified professional.
Outcomes and Measures: We compared the following measures between ADHD and non-ADHD groups: dashboard dwell times, fixation variance, entropy, and fixation duration.
Results: Findings showed that participants with ADHD were more restricted in their patterns of exploration than control group participants. They spent considerably more time gazing at the dashboard and had longer periods of fixation with lower variability and randomness.
Conclusions and Relevance: The results support the hypothesis that adolescents with ADHD engage in less active exploration during simulated driving.
What This Article Adds: This study raises concerns regarding the driving competence of people with ADHD and opens up new directions for potential training programs that focus on exploratory gaze control.
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Affiliation(s)
- Shlomit Yuval-Greenberg
- Shlomit Yuval-Greenberg, PhD, is Senior Lecturer, School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel;
| | - Anat Keren
- Anat Keren, MSc, OT, is Account Manager, Futuring Up, and Occupational Therapist, Private Practice, Tel Aviv, Israel. At the time of the study, she was Master’s Student, Department of Occupational Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Hilo
- Rinat Hilo, MA, is PhD Student, School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Adar Paz
- Adar Paz, BA, is PhD Student, Department of Psychology, Bar Ilan University. At the time of the study, he was BA Student, School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Navah Ratzon
- Navah Ratzon, PhD, MPH, OT, is Professor, Department of Occupational Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Healthcare Utilization and Morbidity among Adolescents with ADHD in Children Aged 11-17 Years, NHIS, 2017. ACTA ACUST UNITED AC 2019. [DOI: 10.1155/2019/4047395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose. Children with ADHD have known behaviors of hyperactivity and impulsivity which may result in adverse outcomes. The purpose of this study is to examine the association of serious adverse outcomes (emergency department visits within the previous year) in preadolescents and adolescents with ADHD as compared with preadolescents and adolescents without ADHD. Method. The researchers conducted a cross-sectional, secondary data analysis of National Health Interview Survey (NHIS) 2017 data concerning 2,965 children (>11 to 17 years). The NHIS data resulted from face-to-face interviews of a household member selected from a multistage area probability design representing households in the US. Data analyses for this study included Chi-square bivariate analyses and logistic regression analyses. Results. There were 13.2% of children in the sample who had ADHD. Children with ADHD were more likely to be male and non-Hispanic white. They were also more likely to have one or more additional disease or condition excluding ADHD. In adjusted logistic regression analysis on emergency department utilization by ADHD status, the adjusted odds ratio was 1.93 (95%CI: 1.35, 2.74; p = 0.0003) for preadolescents and adolescents with ADHD as compared with preadolescents and adolescents without ADHD. Conclusion. Children with ADHD were more likely to have emergency department utilization than children without ADHD. Preventive medical visits were similar between preadolescent and adolescent children with and without ADHD. Characteristics associated with ADHD may explain the increased need for emergent care. Developing interventions for children with ADHD may decrease emergency department utilization.
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Lee YC, Ward McIntosh C, Winston F, Power T, Huang P, Ontañón S, Gonzalez A. Design of an experimental protocol to examine medication non-adherence among young drivers diagnosed with ADHD: A driving simulator study. Contemp Clin Trials Commun 2018; 11:149-155. [PMID: 30101205 PMCID: PMC6082792 DOI: 10.1016/j.conctc.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/28/2018] [Accepted: 07/24/2018] [Indexed: 10/29/2022] Open
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Aduen PA, Kofler MJ, Sarver DE, Wells EL, Soto EF, Cox DJ. ADHD, depression, and motor vehicle crashes: A prospective cohort study of continuously-monitored, real-world driving. J Psychiatr Res 2018; 101:42-49. [PMID: 29547761 PMCID: PMC5889746 DOI: 10.1016/j.jpsychires.2018.02.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 02/05/2018] [Accepted: 02/28/2018] [Indexed: 11/19/2022]
Abstract
ADHD is associated with automobile crashes, traffic fatalities, and serious road trauma, but it is unclear whether this risk is (a) driven by ADHD symptoms specifically, and (b) unique to ADHD or transdiagnostic across psychiatric disabilities, such as depression, that also have concentration problems as core symptoms. The current study provides the first prospective, continuously-monitored evaluation of crash risk related to ADHD symptoms, including the first on-road comparison of ADHD with another high-prevalence psychiatric disability (depression). A probability-based sample of 3226 drivers from six U.S. sites, including subsamples with self-reported ADHD (n = 274) and depression (n = 251), consented to have their vehicles outfitted with sophisticated data acquisition technologies to continuously monitor real-world, day-to-day driving from 'engine-on to engine-off' for 1-2 years (Mean = 440 consecutive days/driver, Mean = 9528 miles/driver). Crashes and near-crashes were objectively identified via software-based algorithms and double-coded manual validation (blinded to clinical status). Miles driven, days monitored, age, gender, education, and marital status were controlled. ADHD symptoms portended 5% increased crash risk per increase in symptom severity score (IRR = 1.05). This risk corresponded to approximately 1 biennial crash and 1 annual near-crash per driver with ADHD; crash risk doubled for drivers reporting ADHD symptom severity near the sample's maximum. Analyses based on self-reported clinical status indicated similarly elevated rates for ADHD (IRR = 1.46) and depression (IRR = 1.34) that may be related, in part, to both groups' inattention/concentration symptoms. Risk was not attenuated by ADHD usual treatment, but varied according to antidepressant medication status. Previous studies have significantly underestimated the risk for traffic crashes conveyed by ADHD and depression.
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Affiliation(s)
- Paula A Aduen
- University of Virginia, Curry School of Education, United States
| | - Michael J Kofler
- Florida State University, Department of Psychology, United States.
| | - Dustin E Sarver
- University of Mississippi Medical Center, Center for Advancement of Youth, United States
| | - Erica L Wells
- Florida State University, Department of Psychology, United States
| | - Elia F Soto
- Florida State University, Department of Psychology, United States
| | - Daniel J Cox
- University of Virginia Health Sciences Center, Center for Behavioral Medicine Research, United States
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Eensoo D, Paaver M, Vaht M, Loit HM, Harro J. Risky driving and the persistent effect of a randomized intervention focusing on impulsivity: The role of the serotonin transporter promoter polymorphism. ACCIDENT; ANALYSIS AND PREVENTION 2018; 113:19-24. [PMID: 29407665 DOI: 10.1016/j.aap.2018.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/29/2017] [Accepted: 01/16/2018] [Indexed: 06/07/2023]
Abstract
Road traffic accidents are a serious public health issue, and real-life traffic offences are an excellent indicator of the behavioural tendencies of impulsivity and risk-taking. We have previously reported on short-term efficacy of a brief intervention in driving schools to reduce traffic risks (Paaver et al., Accid. Anal. Prev., 2013; 50, 430-437), and have now addressed the question of whether does the impact of the intervention last for a few years, and whether traffic behaviour and the intervention effect are associated with the serotonin transporter polymorphism (5-HTTLPR) genotype as the central serotonin system is strongly associated with impulse control. Participants of the study were 1866 novice car-drivers (mean age 23.0, SD = 7.2 years). Data on traffic violations were obtained four years after intervention from the police database and on traffic collisions from the national traffic insurance database. DNA samples were available for 767 participants and 5-HTTLPR genotypes were classified using the triallelic model. For the observation period after the intervention, speeding, drunk driving and involvement in traffic accidents were significantly lower in the intervention group. 5-HTTLPR genotype was associated with traffic behaviour: The S'-allele carriers had significantly lower odds for speeding offences and traffic accidents. The lower prevalence of S'-allele carriers among those who had committed speeding offences was statistically significant in females, while the lower prevalence of having been involved in a traffic accident was rather observed in males. Statistically significant intervention effects were observed only in the L'/L' homozygotes who had higher prevalence of traffic incidents. Conclusively, the brief intervention in traffic schools had a significant impact on traffic safety within subsequent four years, and traffic behaviour was associated with the serotonin transporter genotype. These findings suggest that subjects who are less likely to self-regulate their driving habits while gaining experience would benefit from training of impulsivity recognition.
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Affiliation(s)
- Diva Eensoo
- Division of Public Health, Department of Family Medicine and Public Health, University of Tartu, Estonia
| | - Marika Paaver
- Department of Psychiatry, University of Tartu, Estonia
| | - Mariliis Vaht
- Division of Neuropsychopharmacology, Department of Psychology, University of Tartu, Estonia
| | - Helle-Mai Loit
- National Institute for Health Development, Tallinn, Estonia
| | - Jaanus Harro
- Division of Neuropsychopharmacology, Department of Psychology, University of Tartu, Estonia.
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The effect of concentric constriction of the visual field to 10 and 15 degrees on simulated motor vehicle accidents. PLoS One 2018. [PMID: 29538425 PMCID: PMC5851605 DOI: 10.1371/journal.pone.0193767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose Traffic accidents are associated with the visual function of drivers, as well as many other factors. Driving simulator systems have the advantage of controlling for traffic- and automobile-related conditions, and using pinhole glasses can control the degree of concentric concentration of the visual field. We evaluated the effect of concentric constriction of the visual field on automobile driving, using driving simulator tests. Methods Subjects meeting criteria for normal eyesight were included in the study. Pinhole glasses with variable aperture sizes were adjusted to mimic the conditions of concentric visual field constrictions of 10° and 15°, using a CLOCK CHART®. The test contained 8 scenarios (2 oncoming right-turning cars and 6 jump-out events from the side). Results Eighty-eight subjects were included in the study; 37 (mean age = 52.9±15.8 years) subjects were assigned to the 15° group, and 51 (mean = 48.6±15.5 years) were assigned to the 10° group. For all 8 scenarios, the number of accidents was significantly higher among pinhole wearing subjects. The average number of all types of accidents per person was significantly higher in the pinhole 10° group (4.59±1.81) than the pinhole 15° group (3.68±1.49) (P = 0.032). The number of accidents associated with jump-out scenarios, in which a vehicle approaches from the side on a straight road with a good view, was significantly higher in the pinhole 10° group than in the pinhole 15° group. Conclusions Concentric constriction of the visual field was associated with increased number of traffic accidents. The simulation findings indicated that a visual field of 10° to 15° may be important for avoiding collisions in places where there is a straight road with a good view.
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Bron TI, Bijlenga D, Breuk M, Michielsen M, Beekman ATF, Kooij JJS. Risk factors for adverse driving outcomes in Dutch adults with ADHD and controls. ACCIDENT; ANALYSIS AND PREVENTION 2018; 111:338-344. [PMID: 29274569 DOI: 10.1016/j.aap.2017.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/21/2017] [Accepted: 12/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To identify risk factors for adverse driving outcomes and unsafe driving among adults with and without ADHD in a Dutch sample. METHODS In this cross-sectional study, validated self-report questionnaires were used to compare driving history and current driving behavior between 330 adults diagnosed with ADHD and 330 controls. RESULTS Adults with ADHD had significantly more adverse driving outcomes when compared to controls. Having an ADHD diagnosis significantly increased the odds for having had 3 or more vehicular crashes (OR = 2.72; p = .001). Driving frequency, male gender, age, high anxiety levels, high hostility levels, and alcohol use all significantly influenced the odds for unsafe driving behavior, for having had 12 or more traffic citations, and/or for having had 3 or more vehicular crashes. CONCLUSIONS Alcohol use, and high levels of anxiety and hostility are highly prevalent among adults with ADHD, and they mediate the risk for negative driving outcomes in this group.
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Affiliation(s)
- Tannetje I Bron
- PsyQ Program and Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands.
| | - Denise Bijlenga
- PsyQ Program and Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands.
| | - Minda Breuk
- PsyQ Program and Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands.
| | - Marieke Michielsen
- PsyQ Program and Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands.
| | - Aartjan T F Beekman
- Department of Psychiatry and EMGO+ Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - J J Sandra Kooij
- PsyQ Program and Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands; Department of Psychiatry and EMGO+ Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Geffen J, Forster K. Treatment of adult ADHD: a clinical perspective. Ther Adv Psychopharmacol 2018; 8:25-32. [PMID: 29344341 PMCID: PMC5761907 DOI: 10.1177/2045125317734977] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/21/2017] [Indexed: 12/22/2022] Open
Abstract
Adult attention deficit/hyperactivity disorder (ADHD) has moved from the blurred edge of clinical focus to clear recognition as a prevalent and significant disorder in its own right. It is a relatively common comorbidity which if identified and treated may open the door to better outcomes for hard-to-treat patients. Conversely, failure to identify and treat adult ADHD is linked to negative outcomes. The recognition of the importance of adult ADHD in a subset of our patients challenges us to overcome our anxiety about this diagnosis and prevent the societal marginalization of vulnerable patients. Adult ADHD responds well to integrated pharmacological and psychotherapeutic intervention. Its treatment responsiveness reduces disability and allows the comorbidity which is typically present to be addressed. Mastering this challenge can make the diagnosis and treatment of adult ADHD a rewarding experience.
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Affiliation(s)
- Josh Geffen
- Toowong Specialist Clinic, 2/54 Jephson St, Toowong, Brisbane, Queensland, 4066, Australia
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Chutko LS, Surushkina SY, Yakovenko EA, Anisimova TI, Antokhin EY, Kryukova EY. Cognitive control impairment in adult with attention deficit/hyperactivity disorder. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:31-35. [DOI: 10.17116/jnevro201811812131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Pollak Y, Shalit R, Aran A. Risk taking and adult attention deficit/hyperactivity disorder: A gap between real life behavior and experimental decision making. Psychiatry Res 2018; 259:56-62. [PMID: 29028525 DOI: 10.1016/j.psychres.2017.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 11/25/2022]
Abstract
Adults with attention deficit/hyperactivity disorder (ADHD) are prone to suboptimal decision making and risk taking. The aim of this study was to test performance on a theoretically-based probabilistic decision making task in well-characterized adults with and without ADHD, and examine the relation between experimental risk taking and history of real-life risk-taking behavior, defined as cigarette, alcohol, and street drug use. University students with and without ADHD completed a modified version of the Cambridge Gambling Test, in which they had to choose between alternatives varied by level of risk, and reported their history of substance use. Both groups showed similar patterns of risk taking on the experimental decision making task, suggesting that ADHD is not linked to low sensitivity to risk. Past and present substance use was more prevalent in adults with ADHD. These finding question the validity of experimental probabilistic decision making task as a valid model for ADHD-related risk-taking behavior.
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Affiliation(s)
- Yehuda Pollak
- The Seymour Fox School of Education. The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Reut Shalit
- The Seymour Fox School of Education. The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Aran
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
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Chang Z, Quinn PD, Hur K, Gibbons RD, Sjölander A, Larsson H, D’Onofrio BM. Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes. JAMA Psychiatry 2017; 74:597-603. [PMID: 28492937 PMCID: PMC5539840 DOI: 10.1001/jamapsychiatry.2017.0659] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Motor vehicle crashes (MVCs) are a major public health problem. Research has demonstrated that individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to experience MVCs, but the effect of ADHD medication treatment on the risk of MVCs remains unclear. OBJECTIVE To explore associations between ADHD medication use and risk of MVCs in a large cohort of patients with ADHD. DESIGN, SETTING, AND PARTICIPANTS For this study, a US national cohort of patients with ADHD (n = 2 319 450) was identified from commercial health insurance claims between January 1, 2005, and December 31, 2014, and followed up for emergency department visits for MVCs. The study used within-individual analyses to compare the risk of MVCs during months in which patients received ADHD medication with the risk of MVCs during months in which they did not receive ADHD medication. EXPOSURES Dispensed prescription of ADHD medications. MAIN OUTCOMES AND MEASURES Emergency department visits for MVCs. RESULTS Among 2 319 450 patients identified with ADHD, the mean (SD) age was 32.5 (12.8) years, and 51.7% were female. In the within-individual analyses, male patients with ADHD had a 38% (odds ratio, 0.62; 95% CI, 0.56-0.67) lower risk of MVCs in months when receiving ADHD medication compared with months when not receiving medication, and female patients had a 42% (odds ratio, 0.58; 95% CI, 0.53-0.62) lower risk of MVCs in months when receiving ADHD medication. Similar reductions were found across all age groups, across multiple sensitivity analyses, and when considering the long-term association between ADHD medication use and MVCs. Estimates of the population-attributable fraction suggested that up to 22.1% of the MVCs in patients with ADHD could have been avoided if they had received medication during the entire follow-up. CONCLUSIONS AND RELEVANCE Among patients with ADHD, rates of MVCs were lower during periods when they received ADHD medication. Considering the high prevalence of ADHD and its association with MVCs, these findings warrant attention to this prevalent and preventable cause of mortality and morbidity.
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Affiliation(s)
- Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Center for Health Statistics, The University of Chicago, Chicago, Illinois
| | - Patrick D. Quinn
- Center for Health Statistics, The University of Chicago, Chicago, Illinois,Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Kwan Hur
- Center for Health Statistics, The University of Chicago, Chicago, Illinois
| | - Robert D. Gibbons
- Center for Health Statistics, The University of Chicago, Chicago, Illinois
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Psychological and Brain Sciences, Indiana University, Bloomington
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