Motor vehicle driving in high incidence psychiatric disability: comparison of drivers with ADHD, depression, and no known psychopathology

Driver's Licensure and Driving Outcomes Among Youths With Mood Disorders

Importance

Mood disorders are prevalent among adolescents and young adults, and their onset often coincides with driving eligibility. The understanding of how mood disorders are associated with youth driving outcomes is limited.

Objective

To examine the association between the presence of a mood disorder and rates of licensing, crashes, violations, and suspensions among adolescents and young adults.

Design, Setting, and Participants

This cohort study was conducted among New Jersey residents who were born 1987 to 2000, age eligible to acquire a driver's license from 2004 to 2017, and patients of the Children's Hospital of Philadelphia network within 2 years of licensure eligibility at age 17 years. The presence of a current (ie, ≤2 years of driving eligibility) mood disorder was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Rates of licensure and driving outcomes among youths who were licensed were compared among 1879 youths with and 84 294 youths without a current mood disorder from 2004 to 2017. Data were analyzed from June 2022 to July 2023.

Main Outcomes and Measures

Acquisition of a driver's license and first involvement as a driver in a police-reported crash and rates of other adverse driving outcomes were assessed. Survival analysis was used to estimate adjusted hazard ratios (aHRs) for licensing and driving outcomes. Adjusted rate ratios (aRRs) were estimated for driving outcomes 12 and 48 months after licensure.

Results

Among 86 173 youths (median [IQR] age at the end of the study, 22.8 [19.7-26.5] years; 42 894 female [49.8%]), there were 1879 youths with and 84 294 youths without a mood disorder. A greater proportion of youths with mood disorders were female (1226 female [65.2%]) compared with those without mood disorders (41 668 female [49.4%]). At 48 months after licensure eligibility, 75.5% (95% CI, 73.3%-77.7%) and 83.8% (95% CI, 83.5%-84.1%) of youths with and without mood disorders, respectively, had acquired a license. Youths with mood disorders were 30% less likely to acquire a license than those without a mood disorder (aHR, 0.70 [95% CI, 0.66-0.74]). Licensed youths with mood disorders had higher overall crash rates than those without mood disorders over the first 48 months of driving (137.8 vs 104.8 crashes per 10 000 driver-months; aRR, 1.19 [95% CI, 1.08-1.31]); licensed youths with mood disorders also had higher rates of moving violations (aRR, 1.25 [95% CI, 1.13-1.38]) and license suspensions (aRR, 1.95 [95% CI, 1.53-2.49]).

Conclusions and Relevance

This study found that youths with mood disorders were less likely to be licensed and had higher rates of adverse driving outcomes than youths without mood disorders. These findings suggest that opportunities may exist to enhance driving mobility in this population and elucidate the mechanisms by which mood disorders are associated with crash risk.

Association of Depression and Antidepressant Use With Driving Behaviors in Older Adults: A LongROAD Study

Older adults aged 70 and older who drive have higher crash death rates per mile driven compared to middle aged (35-54 years) adults who drive in the US. Prior studies have found that depression and or antidepressant medication use in older adults are associated with an increase in the vehicular crash rate. Using data from the prospective multi-site AAA Longitudinal Research on Aging Drivers Study, this analysis examined the independent and interdependent associations of self-reported depression and antidepressant use with driving behaviors that can increase motor vehicle crash risk such as hard braking, speeding, and night-time driving in adults over age 65. Of the 2951 participants, 6.4% reported having depression and 21.9% were on an antidepressant medication. Correcting for age, race, gender, and education level, participants on an antidepressant had increased hard braking events (1.22 [1.10-1.34]) but self-reported depression alone was not associated with changes in driving behaviors.

Examining Patterns and Predictors of ADHD Teens' Skill-Learning Trajectories During Enhanced FOrward Concentration and Attention Learning (FOCAL+) Training

OBJECTIVE

Examine patterns and predictors of skill learning during multisession Enhanced FOrward Concentration and Attention Learning (FOCAL+) training.

BACKGROUND

FOCAL+ teaches teens to reduce the duration of off-road glances using real-time error learning. In a randomized controlled trial, teens with ADHD received five sessions of FOCAL+ training and demonstrated significant reductions in extended glances (>2-s) away from the roadway (i.e., long-glances) and a 40% reduced risk of a crash/near-crash event. Teens' improvement in limiting long-glances as assessed after each FOCAL+ training session has not been examined.

METHOD

Licensed teen (ages 16-19) drivers with ADHD (n = 152) were randomly assigned to five sessions of either FOCAL+ or modified standard driver training. Teens completed driving simulation assessments at baseline, after each training session, and 1 month and 6 months posttraining. Naturalistic driving was monitored for one year.

RESULTS

FOCAL+ training produced a 53% maximal reduction in long-glances during postsession simulated driving. The number of sessions needed to achieve maximum performance varied across participants. However, after five FOCAL+ training sessions, number of long-glances was comparable irrespective of when teens achieved their maximum performance. The magnitude of reduction in long-glances predicted levels of long-glances during simulated driving at 1 month and 6 months posttraining but not naturalistic driving outcomes. FOCAL+ training provided the most benefit during training to teens who were younger and had less driving experience.

CONCLUSION

FOCAL+ training significantly reduces long-glances beginning at the 1st training session.

APPLICATION

Providing five FOCAL+ training sessions early on during teen driving may maximize benefit.

Cricothyrotomy Online: Quality Assessment of Educational Videos on YouTube

BACKGROUND

Medical learners may use YouTube® videos to prepare for procedures. Videos are convenient and readily available, but without any uploading standards, their accuracy and quality for education are uncertain. We assessed the quality of emergency cricothyrotomy videos on YouTube through an expert panel of surgeons with objective quality metrics.

METHODS

A YouTube® search for "emergency cricothyrotomy" was performed and results were filtered to remove animations and lectures. The 4 most-viewed videos were sent to a panel of trauma surgeons for evaluation. An educational quality (EQ) score was generated for each video based on its ability to explain the procedure indications, orient the viewer to the patient, provide accurate narration, provide clear views of procedure, identify relevant instrumentation and anatomy, and explain critical maneuvers. Reviewers were also asked if safety concerns were present and encouraged to give feedback in a free-response field.

RESULTS

Four surgical attendings completed the survey. The median EQ score was 6 on a 7-point scale (95% CI [6, 6]). All but one of the individual parameters had a median EQ score of 6 (95% CI: indications [3, 7], orientation [5, 7], narration [6, 7], clarity [6, 7], instruments [6, 7], anatomy [6, 6], critical maneuvers [5, 6]). Safety received a lower EQ score (5.5, 95% CI [2, 6]).

CONCLUSIONS

The most-viewed cricothyrotomy videos were rated positively by surgical attendings. Still, it is necessary to know if medical learners can distinguish high from low quality videos. If not, this suggests a need for surgical societies to create high-quality videos that can be reliably and efficiently accessed on YouTube®.

An updated safety review of the current drugs for managing ADHD in children

INTRODUCTION

Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent condition that causes persistent problems with attention and/or hyperactivity-impulsivity and often results in significant impairment when left untreated. Medications for this disorder continue to evolve and provide new treatment options. Ongoing review of related medication safety and tolerability remains an important task for prescribers.

AREAS COVERED

This manuscript provides an updated safety review of medications used to treat ADHD in children and adolescents. PubMed and OneSearch online databases were utilized to search for literature relevant to the topic of ADHD medications and safety. Clinical trials of medications used to treat ADHD, systematic reviews and meta-analyses, and articles covering specific safety issues (adverse or unfavorable events) such as cardiovascular effects, seizures, impact on growth, depression, suicidal ideation, substance use disorders, psychosis, and tics are described.

EXPERT OPINION

Available pharmacologic treatments for ADHD have favorable efficacy, safety and tolerability and allow many patients to achieve significant improvement of their symptoms. Despite the availability of multiple stimulant and non-stimulant formulations, some individuals with ADHD may not tolerate available medications or attain satisfactory improvement. To satisfy unmet clinical needs, ADHD pharmaceutical research with stimulant and nonstimulant formulations targeting dopamine, norepinephrine, and novel receptors is ongoing.

Driving Behaviour in Depression Based on Subjective Evaluation and Data from a Driving Simulator

Road traffic collisions are a major issue for public health. Depression is characterized by mental, emotional and executive dysfunction, which may have an impact on driving behaviour. Patients with depression (N = 39) and healthy controls (N = 30) were asked to complete questionnaires and to drive on a driving simulator in different scenarios. Driving simulator data included speed, safety distance from the preceding vehicle and lateral position. Demographic and medical information, insomnia (Athens Insomnia Scale, AIS), sleepiness (Epworth Sleepiness Scale, ESS), fatigue (Fatigue Severity Scale, FSS), symptoms of sleep apnoea (StopBang Questionnaire) and driving (Driver Stress Inventory, DSI and Driver Behaviour Questionnaire, DBQ) were assessed. Gender and age influenced almost all variables. The group of patients with depression did not differ from controls regarding driving behaviour as assessed through questionnaires; on the driving simulator, patients kept a longer safety distance. Subjective fatigue was positively associated with aggression, dislike of driving, hazard monitoring and violations as assessed by questionnaires. ESS and AIS scores were positively associated with keeping a longer safety distance and with Lateral Position Standard Deviation (LPSD), denoting lower ability to keep a stable position. It seems that, although certain symptoms of depression (insomnia, fatigue and somnolence) may affect driving performance, patients drive more carefully eliminating, thus, their impact.

A Systematic Review of the Risks of Motor Vehicle Crashes Associated with Psychiatric Disorders

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.

ADHD and dangerous driving in emerging adults: The moderating role of family climate for road safety

Dangerous driving accounts for 95% of driving fatalities among emerging adults. Emerging adult drivers exhibiting symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) are at greater risk for motor vehicle crashes and engaging in unsafe driving practices; however, not all individuals with ADHD symptoms exhibit such risk. Several studies have found that drivers' perceptions of their family's values and priorities related to driving practices predict driving outcomes among emerging adults; these factors have not been examined in the context of ADHD symptomology. We examined family climate for road safety as a moderator of ADHD symptoms and dangerous driving behaviors in a sample of college students. A total of 4,392 participants completed surveys measuring self-reported ADHD symptoms, dangerous driving behavior, and family climate for road safety. Results indicated that higher levels of parental feedback weakened the relation between ADHD symptoms and aggressive driving; higher levels of parental monitoring strengthened this relationship. Higher levels of parental monitoring strengthened the association between ADHD symptoms and negative emotion while driving. When participants perceived their parents as having high levels of noncommitment to road safety, the association between ADHD symptoms and self-reported risky driving increased. Higher levels of open communication about unsafe driving attenuated the relation between ADHD and risky driving. Overall, some but not all components of family climate for road safety appear to affect the relation between ADHD symptoms and dangerous driving in the expected direction.

Mental health conditions and unsafe driving behaviors: A naturalistic driving study on ADHD and depression

INTRODUCTION

Road injuries remain a persistent public health concern across the world. The task of driving is complicated by mental health conditions, which may affect drivers' executive functioning and cognitive resource allocation. This study examines whether attention-deficit/hyperactivity disorder (ADHD) and depression are associated with unsafe driving behaviors.

METHOD

Generalized linear mixed models were employed to estimate the association of self-reported ADHD and depression with 18 unsafe driving behavior types found prior to at-fault crashes and near-crashes using a large-scale naturalistic driving dataset. Driver demographics, cognitive traits, environmental factors, and driver random effects were included to reduce confounding and biases.

RESULTS

Controlling for other covariates, people with self-reported ADHD were more likely to have performed improper braking or stopping (OR = 4.89, 95% CI 1.82-13.17) prior to an at-fault crash or near-crash, while those with self-reported depression did not have a significant association with any unsafe driving behavior.

CONCLUSIONS

After accounting for demographic, cognitive, and environmental covariates, individuals with ADHD and depression were not prone to purposefully aggressive or reckless driving. Instead, drivers with self-reported ADHD may unintentionally execute unsafe driving behaviors in particular driving scenarios that require a high level of cognitive judgment.

PRACTICAL APPLICATIONS

These findings can inform the curriculum design of driver's education programs that help learners with mental health conditions gain practice in certain road scenarios, for example, more practice on preemptively reducing speed instead of making sudden brakes and smooth turning on curved roads for students with ADHD. Furthermore, specific advanced driver assistance systems may prove particularly helpful for drivers with ADHD, such as detection of leading objects and curve speed warning.

An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder

Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.

Attention deficit hyperactivity disorder and the age pattern of adult mortality

We draw upon the life-course perspective and examine whether Attention Deficit Hyperactivity Disorder (ADHD) moderates the age pattern of adult mortality using data from the 2007 and 2012 National Health Interview Survey Sample Adult File linked to National Death Index data through 2015. Overall, 7.0% of respondents died by 2015. Discrete-time hazard analysis indicates that the log odds of mortality were significantly lower among 18 and 19 year old adults ever diagnosed with ADHD and significantly higher among 46 to 64 year old adults ever diagnosed with ADHD, with a crossover occurring at age 33. Results were similar among men and women. It is not known specifically which risks drive changes in the risk of mortality documented among persons with ADHD during the transition to adulthood, the increased risk of mortality in midlife, or whether some risks operate more or less at particular ages. Additional research can lead to targeted, age- and life-course stage-focused interventions for specific risks and contribute to the reduction of ADHD-related mortality.

Children With ADHD Are at Risk for a Broad Array of Adverse Adult Outcomes That Cross Functional Domains: Results From a Population-Based Birth Cohort Study

OBJECTIVE

To identify patterns ("classes") of outcomes for adults with and without childhood ADHD.

METHOD

Subjects were 232 childhood ADHD cases and 335 non-ADHD referents from a 1976 to 1982 birth cohort. We used latent class analyses to identify classes based on a broad array of adult psychosocial outcomes and determined the proportion of subjects with childhood ADHD within each class.

RESULTS

A three class solution provided optimal model fit; classes were termed "good," "intermediate," and "poor" functioning. Subjects with childhood ADHD comprised 62.8% of the "poor," 53.5% of the "intermediate," and 24.9% of the "good" functioning class. The "poor" functioning class was distinguished by increased likelihood of legal trouble and substance use disorders and included more individuals with childhood ADHD and psychiatric disorder than the "intermediate" class (45.5% vs. 30.6%).

CONCLUSION

Children with ADHD are at risk for adverse adult outcomes in multiple domains and co-morbid childhood psychiatric disorders increase risk.

Time-to-Collision Estimations in Young Drivers with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

Individuals with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) may exhibit driving difficulties due to cognitive impairments such as time perception difficulties, a construct related to the perception of time-to-collision (TTC). This study examined the timing abilities of drivers with ASD and ADHD. Sixty participants (n_ADHD = 20, n_ASD = 20, n_TD = 20) completed a time reproduction task and a TTC estimation task in a driving simulator. Results indicated drivers with ASD were less precise in time reproduction across all time intervals and over-reproduced time at shorter intervals. Drivers with ASD produced larger TTC estimates when driving at a faster speed compared to typically developing drivers. Drivers with ASD, but not ADHD, appear to present difficulties in time estimation abilities.

Motor Vehicle Collisions during Adolescence: The Role of Alexithymic Traits and Defense Strategies

International literature has shown that adolescents represent the population most at risk of fatal and nonfatal motor vehicle collisions (MVCs). Adolescents’ alexithymic traits and significant use of immature defense strategies have been seen to play a key role. This study aimed to investigate the possible mediation role played by defense strategies use in the relationship between alexithymia and MVCs. Our sample consisted of 297 adolescents divided into four subgroups, based on the number of visits to the emergency department due to an MVC. We assessed adolescents’ alexithymic traits and defense strategies use through self-report instruments. Results showed that males reported a higher rate of MVCs than females. Higher rates of MVCs are associated with more alexithymic traits and maladaptive defense strategies use. Adolescents’ Acting Out and Omnipotence use significantly mediated the relationship between alexithymia and MVCs. Our findings suggest the recidivism of MVCs as an attempt to cope with emotional difficulties, with important clinical implications.

Applications of brain imaging methods in driving behaviour research

Applications of neuroimaging methods have substantially contributed to the scientific understanding of human factors during driving by providing a deeper insight into the neuro-cognitive aspects of driver brain. This has been achieved by conducting simulated (and occasionally, field) driving experiments while collecting driver brain signals of various types. Here, this sector of studies is comprehensively reviewed at both macro and micro scales. At the macro scale, bibliometric aspects of these studies are analysed. At the micro scale, different themes of neuroimaging driving behaviour research are identified and the findings within each theme are synthesised. The surveyed literature has reported on applications of four major brain imaging methods. These include Functional Magnetic Resonance Imaging (fMRI), Electroencephalography (EEG), Functional Near-Infrared Spectroscopy (fNIRS) and Magnetoencephalography (MEG), with the first two being the most common methods in this domain. While collecting driver fMRI signal has been particularly instrumental in studying neural correlates of intoxicated driving (e.g. alcohol or cannabis) or distracted driving, the EEG method has been predominantly utilised in relation to the efforts aiming at development of automatic fatigue/drowsiness detection systems, a topic to which the literature on neuro-ergonomics of driving particularly has shown a spike of interest within the last few years. The survey also reveals that topics such as driver brain activity in semi-automated settings or neural activity of drivers with brain injuries or chronic neurological conditions have by contrast been investigated to a very limited extent. Potential topics in driving behaviour research are identified that could benefit from the adoption of neuroimaging methods in future studies. In terms of practicality, while fMRI and MEG experiments have proven rather invasive and technologically challenging for adoption in driving behaviour research, EEG and fNIRS applications have been more diverse. They have even been tested beyond simulated driving settings, in field driving experiments. Advantages and limitations of each of these four neuroimaging methods in the context of driving behaviour experiments are outlined in the paper.

Longitudinal associations between internalizing symptoms and driving avoidance in newly licensed adolescents

BACKGROUND

Extensive literature assesses risky adolescent driving, but nothing examines what makes teens avoid driving. Many assume teenagers are eager to drive, but evidence suggests internalizing symptoms lead some to avoid driving.

AIMS

This study tested whether depressive and anxious symptomology predicted longitudinal driving avoidance in novice teen drivers.

MATERIALS AND METHODS

N = 56 16-year-olds (52% female; 48% Black/African American) completed three observations over 6 months. At Time 1, participants reported depressive (Center for Epidemiological Studies Depression 10-item Scale) and anxious (Generalized Anxiety Disorder 7-item Scale) symptomologies, and driving avoidance (Driving Habits Questionnaire [DHQ]), repeating DHQ at Times 2 and 3. Multiple linear regression tested whether symptomologies predicted avoidance at licensure. Linear mixed models tested associations between symptomologies and avoidance over time.

RESULTS

High anxiety predicted greater avoidance at baseline and over 6 months. Depressive symptoms did not predict avoidance.

DISCUSSION

Findings warrant an assessment of anxious adolescents' barriers to driving and avoidance impacts on crash risk.

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

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

Development and psychometric properties of the ADHD-SCL-90-R screening scale for adult ADHD

OBJECTIVE

Adult attention-deficit/hyperactivity disorder (ADHD) is a prevalent disorder with serious impairments, but it often remains undetected. The aim of the study was to develop an ADHD screening scale from the Symptom Check-List-90-R (SCL-90-R) and describe its psychometric properties. The item selection was based on the ADHD-specific Conners' Adult ADHD Rating Scale (CAARS-S:L).

METHOD

In total, 412 subjects of an ADHD Special Consultations Unit were investigated, who completed the SCL-90-R, CAARS-S:L, and ADHD Self-Rating Behavior Questionnaire.

RESULTS

The ADHD-SCL-90-R Screening Scale consisted of 16 items with a four-factor structure, including Inattention/Memory Problems, Hyperactivity/Restlessness, Impulsivity/Emotional Lability, and Problems with Self-Concept. It showed excellent internal consistency (Cronbachs α = .90) and good convergent validity (r = .57-.59). Sensitivity was 78%, specificity was 56%, and the discriminatory power was acceptable (area under the curve = 0.74).

CONCLUSION

The newly developed ADHD-SCL-90-R Screening Scale showed good psychometric properties, and it has a versatile application in clinical practice.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

CLINICAL TRIAL REGISTRATION INFORMATION

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

Driving Accidents, Driving Violations, Symptoms of Attention-Deficit-Hyperactivity (ADHD) and Attentional Network Tasks

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.

Psychosocial Factors and Tobacco Use Among Commercial Truck Drivers

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.

Traffic Violations among Young People with Attention-Deficit Hyperactivity Disorder

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.

ADHD, depression, and motor vehicle crashes: A prospective cohort study of continuously-monitored, real-world driving

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.

Dosage of methylphenidate and traumatic brain injury in ADHD: a population-based study in Taiwan

Preventive effect of stimulants on the risk of brain injuries had been reported. The aim of this study is to determine the extent to which methylphenidate (MPH) prescription moderates the risk of traumatic brain injuries (TBI) in individuals with attention-deficit/hyperactivity disorder (ADHD). Individuals with a recent diagnosis of ADHD between January 1997 and December 2013 (n = 163,618) were identified from Taiwan's National Health Insurance Research Database. A total of 124,438 adolescents and children with ADHD and without prior TBI diagnoses were included and evaluated for subsequent TBI. Methylphenidate prescription duration was subgrouped by the annual average cumulative defined daily dose (DDD): 0, >0 to ≤28, > 28 to ≤84, and >84. We identified 11,463 diagnoses of TBI among 124,438 adolescents and children with ADHD. A Cox regression model was used to investigate whether MPH prescription influenced the risk for TBI after adjusting for sex, age, level of urbanization, seizure, autism and sedative-anxiolytics use. A reduced TBI incidence was observed with MPH prescription DDDs > 84. The protective effect of MPH against TBI persisted after adjusting for confounding factors [hazard ratio (HR) = 0.49; 95% confidence interval (CI): 0.47-0.51]. There was also statistically significant difference in risk for TBI in subjects receiving > 0 to ≤28 or >28 to ≤84 DDDs of MPH treatment (HR = 0.88, 95% CI = 0.83-0.92; HR = 0.76, 95% CI = 0.72-0.80, respectively) when compared with subjects not receiving treatment with MPH. Treatment with MPH for greater than 84 DDDs reduced the risk for TBI among children with ADHD.

MAXILLOFACIAL TRAUMA, ETIOLOGY AND PROFILE OF PATIENTS: AN EXPLORATORY STUDY

Objective:

To describe the profile of patients with facial trauma admitted in a hospital located in a metropolitan area of Northeast Brazil.

Methods:

A cross-sectional and exploratory study was performed. A total of 244 cases were in agreement with the eligibility criteria. The variables include the sociodemographic characteristics of patients, etiology, type of trauma, treatment modalities, length of stay in a hospital and quarter of care. Descriptive statistics and Cluster Analysis were performed.

Results:

The average age of patients was 31.16 years (SD = 15.17 years) and average hospitalization was 6.32 days (SD = 7.75 days). It was verified the automatic formation of four clusters with different profiles of patients. The variables which most contributed to the external differentiation between clusters were: length of stay in a hospital (p <0.001), etiology (p <0.001), type of facial trauma (p <0.001), presence of associated trauma (p <0.001), treatment modalities (p <0.001) and quarter of care (p <0.001).

Conclusion:

The most of patients were men, victims of traffic accidents, which suffered fracture of zygomatic complex and underwent surgery. Level of Evidence III, Retrospective Study.

Psychopathology and traffic violations in subjects who have lost their driving license

BACKGROUND

The persistence of risky behaviors while driving and traffic accidents despite campaigns to increase awareness suggest that there may be underlying causes that maintain proneness to traffic violations. The aim of the current study was to assess: a) the prevalence of psychopathology in a sample of people who have lost their driving license due to former traffic violations and b) the discriminatory capacity of each psychopathological disorder to differentiate among people with high and low proneness to perform risky behaviors while driving.

METHODS

383 participants in a course to recover their driving license after its loss due to previous traffic violations were included. The International Neuropsychiatric Interview (M.I.N.I.) according to DSM-IV was used to assess psychopathology.

RESULTS

Between 67% and 76.2% of the participants had been affected by a lifetime psychopathological disorder until the moment of assessment. The most prevalent diagnoses were substance abuse including alcohol (52.5-62.7%), ADHD (19.7-28.5%), depression (7.9-14.4%) and anxiety (3.6-12.4%). Substance abuse and ADHD also showed the strongest set of associations with specific risk behaviors, but ADHD emerged as the most discriminant disorder to distinguish between those people at high and low risk of while driving.

CONCLUSIONS

The results of the current study suggest that addressing psychopathology explicitly to prevent risky behaviors and recidivism while driving would provide benefits in this area.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Prevalence of driving under the influence of psychoactive substances and road traffic crashes among Brazilian crack-using drivers

BACKGROUND

Substance use disorders are associated with the increased risk of driving under the influence (DUI), but little is known about crack-cocaine and its relationship with road traffic crashes (RTC).

METHOD

A multicenter sample of 765 crack-cocaine users was recruited in six Brazilian capitals in order to estimate the prevalence of DUI and RTC involvement. Legal, psychiatric, and drug-use aspects related with traffic safety were evaluated using the Addiction Severity Index - 6th version (ASI-6) and the Mini International Neuropsychiatric Interview.

RESULTS

Seventy-six (28.3%) current drivers reported accident involvement following crack-cocaine use. Among drivers (n=269), 45.7% and 30.5% reported DUIs in the past 6 months and 30 days, respectively. Drivers reporting DUI's in the past month (n=82) had higher scores in the "psychiatric", "legal", and "family problems" subscales from the ASI-6, and lower scores in the "family social support" subscale in comparison to those without a history of DUIs (n=187). An overall high prevalence of psychiatric comorbidity and substance consumption was observed. Participants with 5+ years of crack-cocaine use were more likely to have been in a RTC (RR=1.52, 95%IC: 1.02-2.75), independently of marijuana use, binge drinking and psychiatric comorbidities.

CONCLUSION

The high prevalence of RTC and DUI involvement among crack-using drivers supports the idea that they are at a high risk group regarding traffic safety. Years of crack consumption seem to be associated with RTC involvement. Also, the presence of psychiatric comorbidities, poly-drug use, and cognitive impairment usually associated with crack addiction could yield additional risk of accidents.

Attention Deficit Hyperactivity Disorder and adult mortality

This study examines the relationship between self-reported ADHD and adult mortality over a four-year period, and whether ADHD is associated with underlying cause of death (accidents versus all others). If ADHD increases mortality risk through accidents, then interventions may be designed and implemented to reduce risk and prevent premature death. We estimate descriptive statistics and multivariate logistic regression models using data from the 2007 U.S. National Health Interview Survey (NHIS) Sample Adult File linked to National Death Index (NDI) data through 2011 (N=23,352). Analyses are weighted and standard errors are adjusted for the complex sampling design. We find that the odds of dying are significantly higher among those with ADHD than among those without ADHD net of exogenous sociodemographic controls (adjusted odds ratio=1.78, 95% confidence interval=1.01, 3.12). Although marginally non-significant, accidental death is more common among those with ADHD than among those without ADHD (13.2% versus 4.3%, p=0.052). Few population-representative studies examine the relationship between ADHD and adult mortality due to data limitations. Using NHIS data linked to the NDI, we are only able to observe a few deaths among adults with ADHD. However, ADHD is associated with significantly higher odds of dying for adults and results suggest that accidents may be an underlying cause of death more often for decedents with ADHD. Future research should further examine the mechanisms linking ADHD to adult mortality and the extent to which mortality among persons with ADHD is preventable. Regular measurement of ADHD among adults in the NHIS is warranted.

Safe driving and executive functions in healthy middle-aged drivers

The introduction of the point system driver's license in several European countries could offer a valid framework for evaluating driving skills. This is the first study to use this framework to assess the functional integrity of executive functions in middle-aged drivers with full points, partial points or no points on their driver's license (N = 270). The purpose of this study is to find differences in executive functions that could be determinants in safe driving. Cognitive tests were used to assess attention processes, processing speed, planning, cognitive flexibility, and inhibitory control. Analyses for covariance (ANCOVAS) were used for group comparisons while adjusting for education level. The Bonferroni method was used for correcting for multiple comparisons. Overall, drivers with the full points on their license showed better scores than the other two groups. In particular, significant differences were found in reaction times on Simple and Conditioned Attention tasks (both p-values < 0.001) and in number of type-III errors on the Tower of Hanoi task (p = 0.026). Differences in reaction time on attention tasks could serve as neuropsychological markers for safe driving. Further analysis should be conducted in order to determine the behavioral impact of impaired executive functioning on driving ability.

Adolescent Perceptions of Outgrowing Childhood Attention-Deficit Hyperactivity Disorder: Relationship to Symptoms and Quality of Life

OBJECTIVE

Parental and self-perceptions about outgrowing attention-deficit hyperactivity disorder (ADHD) likely impact treatment decisions; however, little is known about these perceptions. The aim of this study was to assess adolescent and parent perceptions of outgrowing childhood ADHD and evaluate how these perceptions relate to ADHD symptoms and quality of life (QoL).

METHOD

Cross-sectional survey of adolescents (13-18 years) with a childhood diagnosis of ADHD and their parents. Participants were contacted by mail and completed questionnaires about: perceptions of outgrowing ADHD, current ADHD symptoms (the Conners' Scales), and QoL (PedsQL). ANCOVAs were conducted to assess the relationship between the perception of outgrowing ADHD and: (1) current ADHD symptoms and (2) QoL, controlling for co-morbidities and medication use.

RESULTS

115 adolescent-parent dyads were enrolled. Mean age was 15.5 ± 1.7 years, 73% were male, and 63% were taking ADHD medication. Only 16% of adolescents and 9% of parents reported outgrowing ADHD, with little correlation between parent and adolescent responses (kappa 0.3). Adolescents who reported Yes or Don't Know to outgrowing ADHD, compared to those who reported No, had lower scores on the inattention (IA) and hyperactivity (H) scales of both parent report and adolescent self-report Conners' scales and higher scores on the adolescent self-report PedsQL.

CONCLUSION

A majority of adolescents do not endorse outgrowing their ADHD diagnosis, but those that do demonstrate fewer ADHD symptoms and better QoL than those who don't, suggesting that adolescents have insight about their level of impairment and should have a valued role in making treatment decisions.

Driving and attention deficit hyperactivity disorder

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

Adult attention-deficit hyperactivity disorder, risky behaviors, and motorcycle injuries: a case-control study

BACKGROUND

The aim of this study was to assess the association of motorcycle traffic injuries with motorcycle riding behavior and subtypes of attention-deficit hyperactivity disorder (ADHD) while controlling for individual correlates of motorcycle traffic injuries.

METHODS

A case-control study was carried out in 298 patients with motorcycle trauma along with 151 control patients admitted to the Shohada and Imam Reza university hospitals as the two referral specialty centers in the East Azarbyjan Province of Iran in 2013. The Persian version of the Motorcycle Riding Behavior Questionnaire and the Persian version of Conner's Adult ADHD Rating Scales (the self-report short version) were used to assess riding behavior and screen for adult ADHD, respectively. The scale has four subscales, comprising subscale A (inattention), subscale B (hyperactivity, impulsivity), subscale C (A + C), and subscale D (ADHD index). The statistical analysis was done using Stata version 11.

RESULTS

All subjects were male and aged 13-79 years. Approximately 54% of the participants were married and 13% had academic education. Approximately 18% of the motorcycle riders stated that their motorcycle riding was only for fun purposes. More than two thirds of the participants did not have a motorcycle riding license. Variables found to be significantly associated with motorcycle injuries in bivariate analysis included age, marital status, educational level, having a motorcycle riding license, using a helmet while riding, daily amount of riding, riding just for fun, riding behavior score, and ADHD scale scores. It was found in multivariate analysis that if the ADHD index (subscale D) score was used to assess the association of ADHD with motorcycle injuries, a protective role for ADHD was observed. However, the two other subscales showed a different predictive pattern for subscale A versus subscale B, with only subscale B increasing the likelihood of motorcycle traffic injuries. The score based on motorcycle rider behavior was found to be associated with motorcycle injuries. Other variables that were significant in multivariate models were the purpose of riding, educational level, economic status, and marital status.

CONCLUSION

ADHD and riding behavior scores affect the likelihood of motorcycle traffic injuries among motorcycle riders independent of other injury indicators, and include education, purpose of riding, and economic status.

Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study

BACKGROUND

Injuries represent the largest disease burden and most common cause of death in children. Attention deficit hyperactivity disorder (ADHD) is associated with increased mortality, with accidents being the most common cause of death in ADHD. However, it is not known whether pharmacological treatment has any modifying effect on the risk of injuries in children and adolescents with ADHD.

METHODS

Using Danish national registers, we followed a cohort of 710 120 individuals, including 4557 individuals diagnosed with ADHD before age 10 years. Using a quasi-experimental, difference-in-difference design, we estimated the odds ratios (ORs) for injuries and the mean change in prevalence rates of injuries and emergency ward visits before and after treatment, with matched untreated children with ADHD at the same age serving as controls.

FINDINGS

Children with ADHD were more likely to sustain injuries, compared with children without ADHD, at age 10 years (adjusted OR=1·29, 95% CI 1·22-1·37) and at age 12 years (adjusted OR=1·30, 1·23-1·37). From age 5 to 10 years, the prevalence of injuries in children with ADHD who were treated with ADHD drugs decreased from 19% to 14%, compared with a prevalence of about 17% in non-treated children with ADHD. This corresponded to an adjusted difference-in-difference reduction in prevalence of injuries at age 10 years of 31·5% (8·2-54·8) and 43·5% (18·1-69·0) at age 12 years due to treatment. Pharmacological treatment also reduced the prevalence of emergency ward visits at age 10 years (28·2%, 6·3-50·1) and age 12 years (45·7%, 25·8-65·7).

INTERPRETATION

Children with ADHD had an increased risk of injuries compared with other children. Treatment with ADHD drugs reduced the risk of injuries by up to 43% and emergency ward visits by up to 45% in children with ADHD. Taken together with previous findings of accidents being the most common cause of death in individuals with ADHD, these results are of major public health importance.

FUNDING

The Lundbeck Foundation, the Danish Council for Independent Research, Centre For Integrated Register-based Research at Aarhus University, the Region of Southern Denmark Research Foundation, and Wørzner's Foundation.