Simulated Driving Performance, Self-Reported Driving Behaviors, and Mental Health Symptoms in Adolescent Novice Drivers

Simulator Driving Abilities, Executive Functions, and Adaptive Behavior Among Adolescents With Complex Attention Deficit Hyperactivity Disorder

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.

Effectiveness of a Driving and Community Mobility Intervention for Teens and Young Adults With Autism Spectrum Disorder

IMPORTANCE

Driving and community mobility (DCM) is key to supporting independence in teens and young adults (TYA) with autism spectrum disorder (ASD).

OBJECTIVE

To determine whether an intervention focused on DCM can effectively improve DCM knowledge and skills in TYA.

DESIGN

A pretest-posttest design using the same intervention and outcome measures.

SETTING

University research setting.

PARTICIPANTS

Thirty-eight participants with ASD completed the program (M age = 17.76 yr, SD = 3.58). Twenty-six (68%) were male, and 12 (32%) were female.

INTERVENTION

A 5-day intensive intervention using group and individualized strategies, including driving simulation, focused on improving performance skills needed for DCM.

OUTCOME AND MEASURES

Total and category scores of the Performance Analysis of Driving Ability (P-Drive) were analyzed using a repeated-measures analysis of variance measuring time (pretest vs. posttest), gender, and year of intervention. Paired t tests were used to determine the outcomes of the Canadian Occupational Performance Measure (COPM), anxiety measure and perception survey.

RESULTS

Results indicated a significant main effect for time (p < .001) and year (p < .036), but not gender (p < .26), with no significant interaction effects, supporting the fidelity of the intervention. The COPM showed significant changes (p ≤ .001) in both performance and satisfaction, as well as a reduction in anxiety (p = .008).

CONCLUSIONS AND RELEVANCE

Outcomes suggest that the intervention successfully improved DCM knowledge and skills for TYA. This adds new evidence that an occupational therapy intervention specific to TYA with ASD is effective in developing independence in DCM. Plain-Language Summary: Driving is the primary mode of community mobility in North America and other Western countries. Adults with autism spectrum disorder (ASD) who have a means of community mobility have a chance of employment that is 5 times greater than that for those who do not. Driving and community mobility are key to supporting independence among teens and young adults with ASD. However, teens and young adults with ASD have significantly lower rates of getting a driver's license. The results of this study show that occupational therapy practitioners can play a critical role in addressing driving and community mobility. Occupational therapy interventions that are specifically designed for and unique to each teen and young adult with ASD can effectively improve driving and community mobility skills and increase independence.

Attention-deficit/hyperactivity disorder and risk-taking: A three-level meta-analytic review of behavioral, self-report, and virtual reality metrics

Meta-analytic methods were used to examine ADHD-related risk-taking in children and adults, and to compare the magnitude of risk taking across behavioral, self-report, and virtual reality metrics. Potential moderators of effect size heterogeneity were also examined via a three-level multi-level approach and a hybrid meta-analytic/systematic review approach. Aggregated effect sizes obtained from 56 behavioral-task studies (82 effect sizes; ADHD_N = 2577; TD_N = 2606), 51 self-report studies (130 effect sizes; ADHD_N = 18,641; TD_N = 113,163), and 8 virtual reality studies (16 effect sizes; ADHD_N = 382; TD_N = 436) suggest that children and adults with ADHD exhibit moderately more risk-taking compared to children and adults without the disorder. Notably, the aggregated effect size obtained from virtual reality simulations (Hedges', g = 0.43) was 30-40% larger than effect sizes obtained from self-report and behavioral task metrics (Hedges' g = 0.31 and 0.27), respectively. Suboptimal Decision Making was the only significant moderator identified via multi-level modeling; however, comparison of subgroup effect sizes revealed potential moderating effects of ADHD presentation and trial-by-trial feedback on behavioral tasks. Collectively, findings suggest that ADHD is reliably associated with small to moderate magnitude greater risk-taking behavior and virtual reality simulations appear be the most sensitive currently available metric.

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

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

Use of theory to guide development and application of sensor technologies in Nursing

Sensor technologies for health care, research, and consumers have expanded and evolved rapidly. Many technologies developed in commercial or engineering spaces, lack theoretical grounding and scientific evidence to support their need, safety, and efficacy. Theory is a mechanism for synthesizing and guiding knowledge generation for the discipline of nursing, including the design, implementation, and evaluation of sensors and related technologies such as artificial intelligence and machine learning. In this paper, three nurse scientists summarize their presentations at the Council for the Advancement of Nursing Science 2019 Advanced Methods Conference on Expanding Science of Sensor Technology in Research discussing the theoretical underpinnings of sensor technologies development and use in nursing research and practice. Multiple theories with diverse epistemological roots guide decision-making about whether or not to apply sensors to a given use; development of, components of, and mechanisms by which sensor technologies are expected to work; and possible outcomes.

Risk-Taking Behavior in Attention Deficit/Hyperactivity Disorder (ADHD): a Review of Potential Underlying Mechanisms and of Interventions

PURPOSE OF REVIEW

Attention deficit/hyperactivity disorder (ADHD) is associated with several forms of risk-taking behavior (RTB). This paper aims to examine the scope of ADHD-related RTB, to highlight potential underlying mechanisms of this association, and to review initial evidence for interventions aimed to treat ADHD-related RTB.

RECENT FINDINGS

Multiple lines of evidence indicate that ADHD is associated with real-life RTB across several domains (e.g., reckless driving, substance use, and unprotected sex), which is corroborated by evidence on laboratory risk-taking tasks. Several individual differences, some of them informed by decision theory, e.g., comorbid disorders, parental monitoring, and perceived enlarged benefits of RTB, may explain the link between ADHD and RTB. A number of studies showed that interventions designed for ADHD may reduce RTB. ADHD is linked to RTB across several domains. Decision theory may serve as a conceptual framework for understanding the underlying mechanisms, and thus may inform future research.