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Epstein JN, Garner AA, Kiefer AW, Peugh J, Tamm L, Lynch JD, MacPherson RP, Simon JO, Fisher DL. Examining Patterns and Predictors of ADHD Teens' Skill-Learning Trajectories During Enhanced FOrward Concentration and Attention Learning (FOCAL+) Training. HUMAN FACTORS 2024:187208241237863. [PMID: 38459952 DOI: 10.1177/00187208241237863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
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.
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Affiliation(s)
- Jeffery N Epstein
- Cincinnati Children's Hospital Medical Center, USA
- University of Cincinnati College of Medicine, USA
| | | | | | - James Peugh
- Cincinnati Children's Hospital Medical Center, USA
- University of Cincinnati College of Medicine, USA
| | - Leanne Tamm
- Cincinnati Children's Hospital Medical Center, USA
- University of Cincinnati College of Medicine, USA
| | | | | | - John O Simon
- Cincinnati Children's Hospital Medical Center, USA
| | - Donald L Fisher
- University of Massachusetts Amherst, USA
- Volpe National Transportation Systems Center, USA
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Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
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Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
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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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de Freitas BHBM, Gaíva MAM, Diogo PMJ, Bortolini J. Relationship between adolescent lifestyle and emotional and behavioral problems. Arch Psychiatr Nurs 2022; 43:92-97. [PMID: 37032023 DOI: 10.1016/j.apnu.2022.12.012] [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: 03/08/2022] [Revised: 11/19/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
This study aimed at verifying the relationship between lifestyle and emotional and behavioral problems in adolescents. This is an observational and cross-sectional study developed with adolescents from a capital city in the Brazilian Amazon. Data collection was performed using an electronic form containing items from the Fantastic Lifestyle and Strengths and Difficulties Questionnaire instruments. For data analysis, the bootstrap t-Test and calculation of Cohen's d statistic value were performed to assess the effect size of the difference between means. A total of 479 adolescents participated in the study. There was a high relationship between emotional and behavioral problems and lifestyle (p < 0.01; d = 1.36), especially regarding emotional problems (p < 0.01; d = 1.09), hyperactivity (p < 0.01; d = 0.92) and peer problems (p < 0.01; d = 0.78). The lifestyle attributes that were highly related to emotional and behavioral problems were insight (p < 0.01; d = 1.30), sleep, seatbelt, stress and safe sex (p < 0.01; d = 0.93), type of behavior (p < 0.01; d = 0.86) and career (p < 0.01; d = 0.85). It is therefore concluded that there was a high relationship between lifestyle and emotional and behavioral problems among the adolescents surveyed. Thus, it becomes necessary to promote socio-emotional skills and restorative and health-protective lifestyles in this population.
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Affiliation(s)
| | | | | | - Juliano Bortolini
- Department of Statistics, Federal University of Mato Grosso, Cuiabá, MT, Brazil
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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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Caring for adolescents and young adults with attention-deficit/hyperactivity disorder in primary care: seizing opportunities to address youth mental health needs. Curr Opin Pediatr 2022; 34:306-312. [PMID: 35792652 DOI: 10.1097/mop.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide primary care providers (PCPs) with updated practical guidance around the assessment and management of attention-deficit/hyperactivity disorder (ADHD) in adolescents and young adults (AYA). RECENT FINDINGS Of the three different presentations of ADHD delineated in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the Predominantly Inattentive presentation is the most common among AYA. Multiple rating scales exist to assist clinicians in identifying ADHD symptoms and monitoring treatment effects. Importantly, ADHD frequently persists into adulthood with negative impacts in many life domains if left untreated. It is important for PCPs to provide support for AYA as they transition to adulthood, as treatment adherence often drops sharply at that time, and, once treatment is discontinued, it is rarely restarted. Further, clinicians should be aware of the negative psychological, behavioral, and social impacts that COVID-19 has had on AYA with ADHD. SUMMARY AYA with ADHD often seek care first from PCPs. However, diagnosis and management of ADHD among AYA are challenging, and many clinicians feel ill-equipped, creating concern that many youth may go undiagnosed and untreated. Despite these long-standing challenges, recent advances have opened up critical opportunities for PCPs to proactively address ADHD in primary care settings and make a profound impact on youth as they seek to realize their full potential.
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Real-World Crash Circumstances Among Newly Licensed Adolescent Drivers With and Without Attention-Deficit/Hyperactivity Disorder. J Adolesc Health 2022; 71:172-179. [PMID: 35430145 PMCID: PMC9742980 DOI: 10.1016/j.jadohealth.2022.02.008] [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] [Received: 08/16/2021] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Adolescents with attention-deficit/hyperactivity disorder (ADHD) have 30%-40% higher crash rates. However, we still do not understand which factors underlie heightened crash risk and if crash circumstances differ for drivers with ADHD. We compared prevalences of crash responsibility, driver actions, and crash types among adolescent and young adult drivers with and without ADHD who crashed within 48 months of licensure. METHODS In this exploratory retrospective cohort study, we identified patients of Children's Hospital of Philadelphia's (CHOP) New Jersey (NJ) primary care locations who were born between 1987 and 2000, NJ residents, had their last CHOP visit ≥ age 12 years, and acquired a driver's license. We linked CHOP electronic health records to NJ's licensing and crash databases. ADHD diagnosis was based on International Classification of Diseases, Ninth Revision, Clinical Modification/International Classification of Diseases, Tenth Revision, Clinical Modification codes. Prevalence ratios were estimated using generalized estimating equation log-binomial regression. RESULTS We identified 934 drivers with ADHD in 1,308 crashes and 5,158 drivers without ADHD in 6,676 crashes. Within 48 months postlicensure, drivers with ADHD were more likely to be at fault for their crash (prevalence ratio: 1.09 [1.05-1.14]) and noted as inattentive (1.15 [1.07-1.23]). With the exception that drivers with ADHD were less likely to crash while making a left/U-turn, we did not find substantial differences in crash types by diagnosis. Analyses also suggest females with ADHD may have a higher risk of colliding with a nonmotor vehicle and crashing due to unsafe speed than females without ADHD. DISCUSSION The results suggest crash circumstances do not widely differ for drivers with and without ADHD but highlight several factors that may be particularly challenging for young drivers with ADHD.
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Fabiano GA, Tower D, Valente M, Rejman E, Rodriguez Z. An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2022; 26:1199-1211. [PMID: 34911376 DOI: 10.1177/10870547211063644] [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: 11/17/2022]
Abstract
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.
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Affiliation(s)
| | - Devon Tower
- Florida International University, Buffalo, NY, USA
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McDonald CC, Mirman JH. Achieving Transportation Equity: How Can We Support Young People's Autonomy and Health in a Rapidly Changing Society? J Adolesc Health 2022; 70:701-702. [PMID: 35461652 DOI: 10.1016/j.jadohealth.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Catherine C McDonald
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States; Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States; Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Jessica Hafetz Mirman
- Centre for Applied Developmental Psychology (CADP), University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Neuroscience, University of Edinburgh, Edinburgh, United Kingdom; Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
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Schein J, Adler LA, Childress A, Cloutier M, Gagnon-Sanschagrin P, Davidson M, Kinkead F, Guerin A, Lefebvre P. Economic burden of attention-deficit/hyperactivity disorder among children and adolescents in the United States: a societal perspective. J Med Econ 2022; 25:193-205. [PMID: 35068300 DOI: 10.1080/13696998.2022.2032097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To provide a comprehensive evaluation of the economic burden associated with attention-deficit/hyperactivity disorder (ADHD) among children and adolescents from a US societal perspective. MATERIALS AND METHODS Direct healthcare costs of children (5-11 years) and adolescents (12-17 years) with ADHD were obtained using claims data from the IBM MarketScan Research Databases (01/01/2017-12/31/2018). Direct non-healthcare and indirect costs were estimated based on literature and government publications. Each cost component was estimated using a prevalence-based approach, with per-patient costs extrapolated to the national level. RESULTS The total annual societal excess costs associated with ADHD were estimated at $19.4 billion among children ($6,799 per child) and $13.8 billion among adolescents ($8,349 per adolescent). Education costs contributed to approximately half of the total excess costs in both populations ($11.6 billion [59.9%] in children; $6.7 billion [48.8%] in adolescents). Other major contributors to the overall burden were direct healthcare costs ($5.0 billion [25.9%] in children; $4.0 billion [29.0%] in adolescents) and caregiving costs ($2.7 billion [14.1%] in children; $1.6 billion [11.5%] in adolescents). LIMITATIONS Cost estimates were calculated based on available literature and/or governmental publications due to the absence of a single data source for all costs associated with ADHD. Thus, the quality of cost estimates is limited by the accuracy of available data as well as the study populations and methodologies used by different studies. CONCLUSION ADHD in children and adolescents is associated with a substantial economic burden that is largely driven by education costs, followed by direct healthcare costs and caregiver costs. Improved intervention strategies and policies may reduce the clinical and economic burden of ADHD in these populations.
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Affiliation(s)
- Jeff Schein
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | | | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, NV, USA
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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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13
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Makhoul K, Jankovic J. Tourette Syndrome and Driving. Mov Disord Clin Pract 2021; 8:763-768. [PMID: 34307750 PMCID: PMC8287170 DOI: 10.1002/mdc3.13225] [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] [Received: 02/04/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Driving ability may be impaired in patients with various movement disorders, but it has not been studied in patients with Tourette syndrome (TS). CASES We describe a series of 6 patients from our large cohort of TS patients followed in our movement disorders clinic in whom severe tics have had interfered with their driving abilities. The motor tics involved facial muscles and caused visual impairment because of frequent blinking and transient blepharospasm (dystonic tic), but complex limb and truncal tics also seriously impacted their driving. CONCLUSIONS Although majority of patients with TS have no functional impairment, severe motor tics in some patients may adversely affect their driving ability, potentially causing danger to themselves and others. Screening for such troublesome tics should be considered in patients with TS, particularly in teenagers who are being evaluated for driver's licensing.
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Affiliation(s)
- Karim Makhoul
- Department of Neurology, Parkinson's Disease Center and Movement Disorders ClinicBaylor College of MedicineHoustonTexasUSA
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders ClinicBaylor College of MedicineHoustonTexasUSA
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14
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Mazor-Aronovitch K, Pinhas-Hamiel O, Pivko-Levy D, Modan-Moses D, Levek N, Miller S, Yackobovitch-Gavan M, Gruber N, Ben-Ami M, Stern E, Ben-Ari T, Graf-Barel C, Frumkin Ben-David R, Levy-Shraga Y, Landau Z. Dual diagnosis of type 1 diabetes mellitus and attention deficit hyperactivity disorder. Pediatr Diabetes 2021; 22:649-655. [PMID: 33651452 DOI: 10.1111/pedi.13195] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/25/2020] [Accepted: 02/07/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Data regarding glycemic control in children and adolescents with a dual diagnosis of type 1 diabetes mellitus (T1DM) and attention-deficit/hyperactivity disorder (ADHD) are limited. OBJECTIVE To compare various aspects of diabetes control among youth with T1DM, between those with and without ADHD. METHODS In this cross-sectional study of youth with T1DM, 39 had ADHD (mean age 14.1 ± 2.8 years) and 82 did not (control group, mean age 12.6 ± 3.3 years). Health-related quality of life was assessed by a Diabetes Quality of Life (DQOL) questionnaire submitted to their parents. Glycemic data were downloaded from glucometers, pumps, and continuous glucose monitoring systems. HbA1c levels, hospitalizations, and severe hypoglycemic and diabetes ketoacidosis events were retrieved from the medical files. RESULTS Compared to the control group mean HbA1c level of the ADHD group was higher: 8.3 ± 1.1% versus 7.7 ± 1.0% (p = 0.005) and the percent of time that glucose level was in the target range (70-180 mg/dl) was lower: 48 ± 17% versus 59 ± 14% (p = 0.006). Mean glucose and glucose variability were higher in the ADHD group. Youth with ADHD who were not pharmacologically treated had worse HbA1c and more hospitalizations than those who were treated. DQOL did not differ between the control group, the treated ADHD group, and the untreated ADHD-Group. CONCLUSIONS Dual diagnosis of T1DM and ADHD during childhood leads to worse diabetes control, which is more pronounced in the context of untreated ADHD. Healthcare providers should be aware of the difficulties facing youth with T1DM and ADHD in coping with the current intensive treatment of diabetes.
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Affiliation(s)
- Kineret Mazor-Aronovitch
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Juvenile Diabetes Center, Maccabi Healthcare Services, Ra'anana, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Juvenile Diabetes Center, Maccabi Healthcare Services, Ra'anana, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dikla Pivko-Levy
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Unit, Wolfson Medical Center, Holon, Israel
| | - Dalit Modan-Moses
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Levek
- Juvenile Diabetes Center, Maccabi Healthcare Services, Ra'anana, Israel
| | - Shahar Miller
- Department of Software and Information System Engineering, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Michal Yackobovitch-Gavan
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noah Gruber
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Ben-Ami
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Eve Stern
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Tal Ben-Ari
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Unit, Wolfson Medical Center, Holon, Israel
| | - Chana Graf-Barel
- Juvenile Diabetes Center, Maccabi Healthcare Services, Ra'anana, Israel
| | | | - Yael Levy-Shraga
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar Landau
- Juvenile Diabetes Center, Maccabi Healthcare Services, Ra'anana, Israel.,Pediatric Division, Barzilai Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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15
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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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16
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Dessie M, Techane MA, Tesfaye B, Gebeyehu DA. Elementary school teachers knowledge and attitude towards attention deficit-hyperactivity disorder in Gondar, Ethiopia: a multi-institutional study. Child Adolesc Psychiatry Ment Health 2021; 15:16. [PMID: 33827642 PMCID: PMC8028709 DOI: 10.1186/s13034-021-00371-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A child suffering from attention deficit hyperactivity disorder (ADHD) faces many difficulties in social as well as academic performances. School teachers' knowledge and attitude towards ADHD play a vital role in early detection and referral of the child to treatment centers. Few existing reports, however, indicate the alarming rate at which the problem is highly neglected in sub-Saharan Africa. The present study is designed to determine the knowledge, attitude, and factors that affecting elementary school teachers about ADHD. METHODS An institutional-based cross-sectional study design was conducted in Gondar town and other towns nearby Gondar from February 24 to March 24, 2020. Data were collected through structured self -administered questionnaires using the Knowledge of Attention Deficit Disorders Scale and ADHD-specific attitudes measurement tools. Then, it was entered into Epi-info version 7 and exported to SPSS version 20 for analysis. Bivariable and multivariate logistic regressions were fitted to identify factors associated with the knowledge and attitude of elementary school teachers. Variables having a p-value < 0.05 at 95% CI were considered statistically significant. RESULT Of 636 respondents, about 44.8% (95% CI 41.2, 48.4) and 84.1% (95% CI 81.0, 86.8) of elementary school teachers had good knowledge and a favorable attitude towards ADHD, respectively. Having a diploma and above (AOR = 3.028, 95% CI 1.630-5.625), reading ADHD leaflets (AOR = 2.035, 95% CI 1.391, 2.950) and search ADHD on the internet (AOR = 1.793, 95% CI 1.090, 2.950) were significantly associated with teachers knowledge to ADHD; whereas, working experience in teaching a child with ADHD (AOR = 1.852, 95% CI 1.195-2.87) and watching ADHD on mass media (AOR = 1.72, 95% CI 1.056-2.8) were positively predicts teachers attitude towards ADHD. CONCLUSION the proportion of teachers' knowledge towards ADHD was low; in contrast, their attitude was relatively satisfactory. Strengthening teachers' educational upgrading system, frequent and fair distribution of leaflets written to address ADHD, installation of an internet system to the schools, and continuous ADHD awareness creation programs through mass media are highly recommended.
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Affiliation(s)
- Mekdes Dessie
- Department of Nursing, Blue Nile Health Science College, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bizuneh Tesfaye
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Ayelegne Gebeyehu
- Community Health Nursing Unit, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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17
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Abstract
AIMS Although the relationship between attention-deficit/hyperactivity disorder (ADHD) and transport accidents has been shown, there is limited information on the relationship between medication and dose-response effects and transport accident risk. This study aims to determine whether young people with ADHD, including adolescents, are more prone to transport accidents than those without, and the extent to which methylphenidate (MPH) prescription in these patients reduces the risk. METHODS We identified 114 486 patients diagnosed with ADHD from Taiwan's National Health Insurance Research Database from 1997 to 2013. Using a Cox regression model, we compared the risk of transport accidents between ADHD and non-ADHD groups and estimated the effect of MPH on accidents. Furthermore, we applied a self-control case-series analysis to compare the risk of accidents during the medication periods with the same patients' non-medication periods. RESULTS Male ADHD patients had a higher risk of transport accidents than non-ADHD individuals (adjusted hazard ratio [aHR] = 1.24, [95% confidence interval (CI) 1.10-1.39]), especially for those comorbid with epilepsy, oppositional defiant disorder/conduct disorder (ODD/CD), and intellectual disabilities (ID). Female ADHD patients showed no relationship, except for comorbid with autism spectrum disorder (ASD) or ID. We found a reduced risk of transport accidents in patients with ADHD with MPH medication than those without MPH, with a plausible dose-response relationship (aHR of 0.23 to 0.07). A similar pattern was found in self-controlled case-series analysis. CONCLUSIONS Male patients with ADHD, especially those comorbid with epilepsy, ODD/CD, or ID, were at high risk of transport accidents. Female patients, when comorbid with ASD or ID, also exhibited a higher risk of accidents. MPH treatment lowered the accident risk with a dose-response relationship.
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18
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Brunkhorst-Kanaan N, Libutzki B, Reif A, Larsson H, McNeill RV, Kittel-Schneider S. ADHD and accidents over the life span - A systematic review. Neurosci Biobehav Rev 2021; 125:582-591. [PMID: 33582234 DOI: 10.1016/j.neubiorev.2021.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/06/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
Studies have demonstrated an increased risk of accidents and injuries in children, adolescents and adults with attention-deficit/hyperactivity disorder (ADHD). However, little is known about how accident risk may alter over the lifespan. Additionally, it would be important to know if the most common types of accidents and injuries differ in ADHD patients over different age groups. Furthermore, there is increasing evidence of an ameliorating effect of ADHD medication on accident risk. Lastly, the underlying risk factors and causal mechanisms behind increased accident risk remain unclear. We therefore conducted a systematic review focusing on the above described research questions. Our results suggested that accident/injury type and overall risk changes in ADHD patients over the lifespan. ADHD medication appeared to be similarly effective at reducing accident risk in all age groups. However, studies with direct comparisons of accident/injuries and effects of medication at different age groups or in old age are still missing. Finally, comorbidities associated with ADHD such as substance abuse appear to further increase the accident/injury risk.
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Affiliation(s)
- Nathalie Brunkhorst-Kanaan
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt/Main, Germany
| | - Berit Libutzki
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Andreas Reif
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt/Main, Germany
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77 Stockholm, Sweden; Örebro University, School of Medical Sciences, Campus USÖ, S-701 82 Örebro, Sweden
| | - Rhiannon V McNeill
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Margarete-Höppel-Platz 1, D-97082 Würzburg, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt/Main, Germany; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Margarete-Höppel-Platz 1, D-97082 Würzburg, Germany
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19
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Curry AE, Power TJ. Editorial: Paving the Way Toward Improving Safety Among Drivers With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2020; 59:923-925. [PMID: 32147569 PMCID: PMC8919191 DOI: 10.1016/j.jaac.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
The ability to drive is important to an individual's participation in modern society, as it enhances independence and social and economic opportunity. However, motor vehicle crashes are a leading cause of injury-related death in the United States-and the leading cause of death among 15- to 24-year-olds. Thus, it is critical that we sequentially identify who may be at inherently higher crash risk and why their crash risk might be higher, with the ultimate goal of implementing comprehensive approaches to promote safe driving practices and to improve safe mobility.
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Affiliation(s)
- Allison E. Curry
- Center for Injury Research and Prevention,
Children’s Hospital of Philadelphia, Philadelphia, PA,Division of Emergency Medicine, Perelman School of Medicine
at University of Pennsylvania, Philadelphia, PA
| | - Thomas J. Power
- Departments of Pediatrics and Psychiatry, Perelman School
of Medicine at University of Pennsylvania, Philadelphia, PA
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20
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Roy A, Garner AA, Epstein JN, Hoza B, Nichols JQ, Molina BSG, Swanson JM, Arnold LE, Hechtman L. 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. J Am Acad Child Adolesc Psychiatry 2020; 59:952-963. [PMID: 31445873 PMCID: PMC9747063 DOI: 10.1016/j.jaac.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 07/22/2019] [Accepted: 08/15/2019] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Arunima Roy
- The Royal's Institute of Mental Health Research, University of Ottawa, Ontario, Canada
| | | | - Jeffery N Epstein
- University of Cincinnati College of Medicine and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Ohio
| | | | | | | | - James M Swanson
- Child Development Center, School of Medicine, University of California, Irvine
| | | | - Lily Hechtman
- Division of Child Psychiatry, Montreal Children's Hospital, McGill University, Quebec, Canada.
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21
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Chronic Care for Attention-Deficit/Hyperactivity Disorder: Clinical Management from Childhood Through Adolescence. J Dev Behav Pediatr 2020; 41 Suppl 2S:S99-S104. [PMID: 31996572 PMCID: PMC9295618 DOI: 10.1097/dbp.0000000000000772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Impairments generally persist when children diagnosed with attention-deficit/hyperactivity disorder (ADHD) mature into adolescence. To examine changes in ADHD care during the transition from childhood to adolescence, we conducted a retrospective, longitudinal cohort study of patients diagnosed with ADHD before the age of 10 years to assess changes from preadolescence through adolescence in (1) frequency by which primary care providers offer ADHD care to patients, (2) range of concerns assessed during patient encounters, and (3) treatments implemented or recommended. METHODS We identified patients from 3 practices included in a large primary care network who (1) were born between 1996 and 1997, (2) were diagnosed with ADHD before the age of 10 years, and (3) received primary care continuously from age 9 through late adolescence. Clinical care was compared among patients in preadolescence (age 9-11), early adolescence (age 12-14), and late adolescence (age 15-18). RESULTS Children diagnosed with ADHD before the age of 10 years were less likely to have a documented visit for ADHD during late adolescence (41% of patients) compared with preadolescence (63%, p < 0.001). Evidence of monitoring for depression, suicide, and substance abuse increased from preadolescence to adolescence (p < 0.001) and occurred in about 90% of adolescent patients. However, monitoring for risky sexual activity occurred in only about 50% of adolescents. Discussions of medication diversion and driver readiness were essentially not documented. CONCLUSION The findings raise concerns about how primary care providers manage adolescents with a history of ADHD. Improving monitoring of risky sexual behavior and driver readiness and providing patient education about medication diversion are needed.
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22
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Curry AE, Pfeiffer MR, Carey ME, Cook LJ. Catalyzing traffic safety advancements via data linkage: Development of the New Jersey Safety and Health Outcomes (NJ-SHO) data warehouse. TRAFFIC INJURY PREVENTION 2019; 20:S151-S155. [PMID: 31714800 PMCID: PMC7035196 DOI: 10.1080/15389588.2019.1679552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: Our objective is to describe the development of the New Jersey Safety and Health Outcomes (NJ-SHO) data warehouse, a unique and comprehensive data source that integrates various state-level administrative databases in New Jersey to enable the field of traffic safety to address critical, high-priority research questions.Methods: We have obtained full identifiable data from the following statewide administrative databases for the state of New Jersey: (1) driver licensing database; (2) Administration Office of the Courts data on traffic-related citations; (3) police-reported crash database; (4) birth certificate data; (5) death certificate data; and (6) hospital discharge data as well as (7) childhood electronic records from New Jersey residents who were patients of the Children's Hospital of Philadelphia pediatric health care network and (8) census tract-level indicators. We undertook an iterative process to develop a linkage algorithm in LinkSolv 9.0 software using records for individuals born in select birth years (1987 and 1988) and subsequently execute the linkage for the entire study period (2004-2017). Several metrics were used to evaluate the quality of the linkage process.Results: We identified a total of 62,685,619 records and 19,247,363 distinct individuals; 10,352,998 of these individuals had more than one record brought together during the linkage process. Our evaluation of this linkage suggests that the linkage was of high quality.Conclusions: The resulting NJ-SHO data warehouse will be one of the most comprehensive and rich traffic safety data warehouses to date. The warehouse has already been utilized for numerous studies and will be fully primed to support a host of rigorous studies, both in and beyond the field of traffic safety.
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Affiliation(s)
- Allison E Curry
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melissa R Pfeiffer
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
| | - Meghan E Carey
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
| | - Lawrence J Cook
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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23
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Driving and Road Rage Associated with Attention Deficit Hyperactivity Disorder (ADHD): a Systematic Review. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-00183-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Raman S, Engelhard M, Kollins SH. Driving the Point Home: Novel Approaches to Mitigate Crash Risk for Patients With ADHD. Pediatrics 2019; 143:e20190820. [PMID: 31110160 DOI: 10.1542/peds.2019-0820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Scott H Kollins
- Psychiatry and Behavioral Sciences, and
- Psychology and Neuroscience, School of Medicine, Duke University, Durham, North Carolina
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25
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Abstract
OBJECTIVE Motor vehicle collisions are the leading cause of death among teenagers, accounting for approximately 1 in 3 deaths for this age group. A number of factors increase crash risk for teen drivers, including vulnerability to distraction, poor judgment, propensity to engage in risky driving behaviors, and inexperience. These factors may be of particular concern and exacerbated among teens learning to drive with attention deficits. To our knowledge, our study is among the first to systematically investigate the experiences of novice adolescent drivers with attention deficits during the learner period of a Graduated Drivers Licensing program. METHOD Survey and on-road driving assessment (ODA) data were used to examine parent and teen confidence in the teens' driving ability, driving practice frequency, diversity of driving practice environments, and driving errors among teens with attention deficits as defined by attention-deficit/hyperactivity disorder (ADHD) diagnosis or parent-reported trouble staying focused (TSF). RESULTS When teens' driving skill was evaluated at the conclusion of the learner period, teens with ADHD exhibited more driving errors than their typically developing (TD) counterparts (p = 0.034). Teens with TSF were more likely to have their ODA terminated (p = 0.019), had marginally lower overall driving scores (p = 0.098), and exhibited more critical driving errors (p = 0.01) compared with TD teens. CONCLUSION These findings may have implications on the learning-to-drive period for adolescents with attention deficits. Adjustments may need to be made to the learner period for teens with attention deficits to account for attention impairments and to better instill safe driving behavior.
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