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MacKenzie HM, Flores-Sandoval C, Bateman EA, McIntyre A, Barua U, Mehta S, Bayley M, Teasell R. Evidence-Based Review of Randomized Controlled Trials of Interventions for the Management of Behavioral Issues in Individuals With Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:369-381. [PMID: 39256158 DOI: 10.1097/htr.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE To present an evidence-based review of randomized controlled trials (RCTs) evaluating interventions for the management of behavioral issues post moderate to severe traumatic brain injury (MSTBI), as part of an extensive database that has been conceptualized as a living systematic review. METHODS Systematic searches were conducted in MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO, up to and including December 2022, for articles published in the English language, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of RCT was assessed using the Physiotherapy Evidence Database (PEDro) scale, and level of evidence was assigned using a modified Sackett scale. RESULTS Forty-six RCTs examining interventions and outcome measures related to behavioral issues post-MSTBI were included. These studies collectively enrolled 3,267 participants. The majority of RCTs were conducted in the United States (n = 27; 58.7%) and 28 (60.9%) were conducted after 2010. Of these, 27 RCTs examined non-pharmacological interventions and 19 examined pharmacological interventions. Effective pharmacological treatments included amantadine and dexmedetomidine. Effective non-pharmacological interventions included sensory stimulation in the acute phase, anger self-management programs, peer mentoring, problem-solving, and emotional regulation. Psychotherapy showed conflicting evidence. CONCLUSION This evidence-based review provides a comprehensive overview of the research landscape of RCTs addressing behavior post-MSTBI. The findings from these RCTs may be valuable for health care professionals, researchers, and policymakers involved in the field of TBI and behavior.
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Affiliation(s)
- Heather M MacKenzie
- Author Affiliations: Parkwood Institute Research, Lawson Health Research Institute (Dr MacKenzie, Dr Flores-Sandoval, Dr Bateman, Barua, Dr Mehta); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario (Dr MacKenzie, Dr Bateman, Dr Mehta); Parkwood Institute, St. Joseph's Health Care London, London (Dr MacKenzie, Dr Flores-Sandoval, Dr Bateman); Arthur Labatt School of Nursing, Western University, London, Ontario (Dr McIntyre); Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto (Dr Bayley); KITE Research Institute, University Health Network, Toronto (Dr Bayley); and University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario (Dr Bayley)
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Lee CSC, Chen TT, Gao Q, Hua C, Song R, Huang XP. The Effects of Theta/Beta-based Neurofeedback Training on Attention in Children with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-analysis. Child Psychiatry Hum Dev 2023; 54:1577-1606. [PMID: 35471754 DOI: 10.1007/s10578-022-01361-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
Neurofeedback training is a common treatment option for attention deficit hyperactivity disorder (ADHD). Given theta/beta-based neurofeedback (T/B NF) training targets at the electrophysiological characteristics of children with ADHD, benefits for attention may be expected. PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science were searched through December 31, 2020. Studies were evaluated with Risk of Bias tools. Within-group effects based on Pre- and Post-treatment comparisons of the Intervention Group, and Between-group effects based on the between-group differences from Pre-treatment to Post-treatment were calculated. Nineteen studies met selection criteria for systematic review, 12 of them were included in meta-analysis. Within-group effects were medium at Post-treatment and large at Follow-up. Between-group analyses revealed that T/B NF was superior to waitlist control and physical activities, but not stimulant medication. Results showed that T/B NF has benefits for attention in children with ADHD, however, cautions should be taken when interpreting the findings.
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Affiliation(s)
- Clara S C Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Ting-Ting Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Qingwen Gao
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Chunzhuo Hua
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Rui Song
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Xiu-Ping Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Chaulagain A, Lyhmann I, Halmøy A, Widding-Havneraas T, Nyttingnes O, Bjelland I, Mykletun A. A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder. Eur Psychiatry 2023; 66:e90. [PMID: 37974470 PMCID: PMC10755583 DOI: 10.1192/j.eurpsy.2023.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. METHODS We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. RESULTS The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. CONCLUSIONS Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.
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Affiliation(s)
- Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
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Epstein JN, Garner AA, Kiefer AW, Peugh J, Tamm L, MacPherson RP, Simon JO, Fisher DL. Trial of Training to Reduce Driver Inattention in Teens with ADHD. N Engl J Med 2022; 387:2056-2066. [PMID: 36449421 PMCID: PMC10929260 DOI: 10.1056/nejmoa2204783] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Teens with attention deficit-hyperactivity disorder (ADHD) are at increased risk for motor vehicle collisions. A computerized skills-training program to reduce long glances away from the roadway, a contributor to collision risk, may ameliorate driving risks among teens with ADHD. METHODS We evaluated a computerized skills-training program designed to reduce long glances (lasting ≥2 seconds) away from the roadway in drivers 16 to 19 years of age with ADHD. Participants were randomly assigned in a 1:1 ratio to undergo either enhanced Focused Concentration and Attention Learning, a program that targets reduction in the number of long glances (intervention) or enhanced conventional driver's education (control). The primary outcomes were the number of long glances away from the roadway and the standard deviation of lane position, a measure of lateral movements away from the center of the lane, during two 15-minute simulated drives at baseline and at 1 month and 6 months after training. Secondary outcomes were the rates of long glances and collisions or near-collisions involving abrupt changes in vehicle momentum (g-force event), as assessed with in-vehicle recordings over the 1-year period after training. RESULTS During simulated driving after training, participants in the intervention group had a mean of 16.5 long glances per drive at 1 month and 15.7 long glances per drive at 6 months, as compared with 28.0 and 27.0 long glances, respectively, in the control group (incidence rate ratio at 1 month, 0.64; 95% confidence interval [CI], 0.52 to 0.76; P<0.001; incidence rate ratio at 6 months, 0.64; 95% CI, 0.52 to 0.76; P<0.001). The standard deviation of lane position (in feet) was 0.98 SD at 1 month and 0.98 SD at 6 months in the intervention group, as compared with 1.20 SD and 1.20 SD, respectively, in the control group (difference at 1 month, -0.21 SD; 95% CI, -0.29 to -0.13; difference at 6 months, -0.22 SD; 95% CI, -0.31 to -0.13; P<0.001 for interaction for both comparisons). During real-world driving over the year after training, the rate of long glances per g-force event was 18.3% in the intervention group and 23.9% in the control group (relative risk, 0.76; 95% CI, 0.61 to 0.92); the rate of collision or near-collision per g-force event was 3.4% and 5.6%, respectively (relative risk, 0.60, 95% CI, 0.41 to 0.89). CONCLUSIONS In teens with ADHD, a specially designed computerized simulated-driving program with feedback to reduce long glances away from the roadway reduced the frequency of long glances and lessened variation in lane position as compared with a control program. During real-world driving in the year after training, the rate of collisions and near-collisions was lower in the intervention group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT02848092.).
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Affiliation(s)
- Jeffery N Epstein
- From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center (J.N.E., J.P., L.T., J.O.S.), and the University of Cincinnati College of Medicine (J.N.E., J.P., L.T.) - both in Cincinnati; the Department of Psychology, Saint Louis University, St. Louis (A.A.G.); the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill (A.W.K., R.P.M.); and the Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, and Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge - both in Massachusetts (D.L.F.)
| | - Annie A Garner
- From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center (J.N.E., J.P., L.T., J.O.S.), and the University of Cincinnati College of Medicine (J.N.E., J.P., L.T.) - both in Cincinnati; the Department of Psychology, Saint Louis University, St. Louis (A.A.G.); the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill (A.W.K., R.P.M.); and the Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, and Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge - both in Massachusetts (D.L.F.)
| | - Adam W Kiefer
- From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center (J.N.E., J.P., L.T., J.O.S.), and the University of Cincinnati College of Medicine (J.N.E., J.P., L.T.) - both in Cincinnati; the Department of Psychology, Saint Louis University, St. Louis (A.A.G.); the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill (A.W.K., R.P.M.); and the Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, and Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge - both in Massachusetts (D.L.F.)
| | - James Peugh
- From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center (J.N.E., J.P., L.T., J.O.S.), and the University of Cincinnati College of Medicine (J.N.E., J.P., L.T.) - both in Cincinnati; the Department of Psychology, Saint Louis University, St. Louis (A.A.G.); the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill (A.W.K., R.P.M.); and the Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, and Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge - both in Massachusetts (D.L.F.)
| | - Leanne Tamm
- From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center (J.N.E., J.P., L.T., J.O.S.), and the University of Cincinnati College of Medicine (J.N.E., J.P., L.T.) - both in Cincinnati; the Department of Psychology, Saint Louis University, St. Louis (A.A.G.); the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill (A.W.K., R.P.M.); and the Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, and Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge - both in Massachusetts (D.L.F.)
| | - Ryan P MacPherson
- From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center (J.N.E., J.P., L.T., J.O.S.), and the University of Cincinnati College of Medicine (J.N.E., J.P., L.T.) - both in Cincinnati; the Department of Psychology, Saint Louis University, St. Louis (A.A.G.); the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill (A.W.K., R.P.M.); and the Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, and Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge - both in Massachusetts (D.L.F.)
| | - John O Simon
- From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center (J.N.E., J.P., L.T., J.O.S.), and the University of Cincinnati College of Medicine (J.N.E., J.P., L.T.) - both in Cincinnati; the Department of Psychology, Saint Louis University, St. Louis (A.A.G.); the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill (A.W.K., R.P.M.); and the Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, and Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge - both in Massachusetts (D.L.F.)
| | - Donald L Fisher
- From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center (J.N.E., J.P., L.T., J.O.S.), and the University of Cincinnati College of Medicine (J.N.E., J.P., L.T.) - both in Cincinnati; the Department of Psychology, Saint Louis University, St. Louis (A.A.G.); the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill (A.W.K., R.P.M.); and the Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, and Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge - both in Massachusetts (D.L.F.)
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Lee CS, Ng KH, Chan PC, Peng X. Effectiveness of mindfulness parent training on parenting stress and children’s ADHD-related behaviors: A systematic review and meta-analysis. Hong Kong J Occup Ther 2022; 35:3-24. [PMID: 35847187 PMCID: PMC9279872 DOI: 10.1177/15691861211073826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background/Objective Literature shows that there is a circular relationship between children’s ADHD-related
behaviors and parenting stress. This systematic review and meta-analysis aimed to
understand if mindfulness parent trainings have benefits for both parenting stress and
the problem behaviors in children with ADHD. Methods Five databases, CINAHL, Embase, PsycINFO, PubMED, and Web of Science, were searched.
Within-group effects at post-treatment and follow-up assessment, and between-group
effects at post-treatment were analyzed. Effect sizes (Hedges’ g) were also
calculated. Results Ten studies (5 RCTs and 5 non-RCTs) met the selection criteria and were selected for
systematic review, and nine of them were included for meta-analysis. Among these 10
studies, five studies involved mindfulness training for both parents and children, while
the other five studies involved mindfulness training for parents only. Within-group
effects at post-treatment were small-to-large for all outcomes. Hedges’ g ranged between
−0.17 [95% CI (−0.98, 0.64)] and 4.70 [95% CI (3.59, 5.81)] for parenting stress; 0.17
[95% CI (−0.03, 0.37)] and 4.03 [95% CI (2.97, 5.09)] for children’s problem behaviors;
and 0.20 [95% CI (−0.10, 0.50)] and 2.98 [95% CI (2.16, 3.80)] for children’s ADHD
symptoms. Between-group comparisons showed mindfulness parent training was superior to
other active controls on all outcomes. Conclusion Findings suggest that mindfulness parent training may be beneficial for parenting
stress and children’s ADHD-related behaviors, and due to the small number of studies
reviewed, cautions should be taken when interpreting the results.
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Affiliation(s)
- Clara S.C. Lee
- Departemnt of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Ka-hin Ng
- Departemnt of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Phyllis C.K. Chan
- Departemnt of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Xianwei Peng
- Departemnt of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Driving among Adolescents with Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder. SAFETY 2018. [DOI: 10.3390/safety4030040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Over the past several decades there has been a surge of research on the contextual, biological, and psychological factors associated with transportation safety in adolescence. However, we know much less about the factors contributing to transportation safety among adolescents who do not follow a typical developmental trajectory. Adolescents with developmental disabilities (DD) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) have a wide range of behavioral and psychological deficits that may make the complex task of driving even more challenging. Because these adolescents often retain characteristic symptoms of their disorder into adulthood, it may impede their ability to achieve important milestones during the developmental transition from adolescent to adult. As the motivating force behind autonomous living and employment, the capacity for independent transportation is paramount to an adolescent’s overall success. This critical review will draw from the current body of literature on adolescent drivers with developmental disabilities to determine (1) areas of impairment; (2) safety risk factors; and (3) effective interventions for improving driving safety in this vulnerable population of adolescent drivers between the ages of 15–22. This review will also identify important unanswered research questions, and summarize the current state of the literature.
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Bruce CR, Unsworth CA, Dillon MP, Tay R, Falkmer T, Bird P, Carey LM. Hazard perception skills of young drivers with Attention Deficit Hyperactivity Disorder (ADHD) can be improved with computer based driver training: An exploratory randomised controlled trial. ACCIDENT; ANALYSIS AND PREVENTION 2017; 109:70-77. [PMID: 29040873 DOI: 10.1016/j.aap.2017.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/05/2017] [Accepted: 10/03/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Young drivers with Attention Deficit Hyperactivity Disorder (ADHD) are at higher risk of road traffic injuries than their peers. Increased risk correlates with poor hazard perception skill. Few studies have investigated hazard perception training using computer technology with this group of drivers. OBJECTIVES *Determine the presence and magnitude of the between-group and within- subject change in hazard perception skills in young drivers with ADHD who receive Drive Smart training. *Determine whether training-facilitated change in hazard perception is maintained over time. METHODS This was a feasibility study, randomised control trial conducted in Australia. The design included a delayed treatment for the control group. Twenty-five drivers with a diagnosis of ADHD were randomised to the Immediate Intervention or Delayed Intervention group.The Immediate Intervention group received a training session using a computer application entitled Drive Smart. The Delayed Intervention group watched a documentary video initially (control condition), followed by the Drive Smart computer training session. The participant's hazard perception skill was measured using the Hazard Perception Test (HPT). FINDINGS After adjusting for baseline scores, there was a significant betweengroup difference in post-intervention HPT change scores in favour of the Immediate Intervention group. The magnitude of the effect was large. There was no significant within-group delayed intervention effect. A significant maintenance effect was found at 6-week follow-up for the Immediate Intervention group. CONCLUSIONS The hazard perception skills of participants improved following training with large effect size and some maintenance of gain. A multimodal approach to training is indicated to facilitate maintenance. A full-scale trial is feasible.
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Affiliation(s)
- C R Bruce
- Occupational Therapy, School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - C A Unsworth
- Occupational Therapy, School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia; Occupational Therapy, School of Health, Medical and Applied Sciences, CQUniversity, 120 Spencer St, Melbourne, VIC 3000, Australia; Jönköping University, Gjuterigatan 5, Box 1026, 551 11, Jönköping, Sweden; School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - M P Dillon
- Prosthetics and Orthotics, School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - R Tay
- School of Business IT & Logistcs, RMIT University, Melbourne, VIC 3000 Australia.
| | - T Falkmer
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; Rehabilitation Medicine Unit, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre, SE-581 83, Linköping, Sweden.
| | - P Bird
- The Gosforth Clinic, PO Box 680, Maroochydore QLD 4558, Australia.
| | - L M Carey
- Occupational Therapy, School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia; The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, 245 Burgundy Street, Heidelberg, Melbourne, VIC 3084, Australia.
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Unsworth CA, Baker AM, So MH, Harries P, O’Neill D. A systematic review of evidence for fitness-to-drive among people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder. BMC Psychiatry 2017; 17:318. [PMID: 28859696 PMCID: PMC5579945 DOI: 10.1186/s12888-017-1481-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 08/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited evidence exists regarding fitness-to-drive for people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder (herein simply referred to as 'mental health conditions'). The aim of this paper was to systematically search and classify all published studies regarding driving for this population, and then critically appraise papers addressing assessment of fitness-to-drive where the focus was not on the impact of medication on driving. METHODS A systematic search of three databases (CINAHL, PSYCHINFO, EMBASE) was completed from inception to May 2016 to identify all articles on driving and mental health conditions. Papers meeting the eligibility criteria of including data relating to assessment of fitness-to-drive were critically appraised using the American Academy of Neurology and Centre for Evidence-Based Medicine protocols. RESULTS A total of 58 articles met the inclusion criteria of driving among people with mental health conditions studied, and of these, 16 contained data and an explicit focus on assessment of fitness-to-drive. Assessment of fitness-to-drive was reported in three ways: 1) factors impacting on the ability to drive safely among people with mental health conditions, 2) capability and perception of health professionals assessing fitness-to-drive of people with mental health conditions, and 3) crash rates. The level of evidence of the published studies was low due to the absence of controls, and the inability to pool data from different diagnostic groups. Evidence supporting fitness-to-drive is conflicting. CONCLUSIONS There is a relatively small literature in the area of driving with mental health conditions, and the overall quality of studies examining fitness-to-drive is low. Large-scale longitudinal studies with age-matched controls are urgently needed in order to determine the effects of different conditions on fitness-to-drive.
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Affiliation(s)
| | - Anne M. Baker
- Australian Catholic University, Melbourne, Australia
| | - Man H. So
- Central Queensland University, Melbourne, Australia
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De Crescenzo F, Cortese S, Adamo N, Janiri L. Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review. EVIDENCE-BASED MENTAL HEALTH 2017; 20:4-11. [PMID: 27993933 PMCID: PMC10699262 DOI: 10.1136/eb-2016-102415] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/20/2016] [Accepted: 11/25/2016] [Indexed: 12/14/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is characterised by a persistent and impairing pattern of inattention and/or hyperactivity/impulsivity and it is one of the most common neuropsychiatric conditions. Evidence about interventions of adults with ADHD is growing rapidly and clinicians need a reliable summary of all the best available information in order to better inform their daily practice. We searched MEDLINE, PubMed, PsycINFO and Cochrane databases until 31 May 2016 for systematic reviews about pharmacological and non-pharmacological treatments in adults with ADHD and carried out a meta-review to address clinically relevant questions. We identified a total of 40 papers. Psychostimulants-such as methylphenidate, dexamphetamine, mixed amphetamine salts and lisdexamfetamine-and non-psychostimulants-such as atomoxetine-were the most studied agents. Overall, pharmacological treatments were significantly more efficacious than placebo (standardised mean difference (SMD) 0.45, 95% CI 0.37 to 0.52), albeit less well accepted (OR 1.18, 95% CI 1.02 to 1.36) and tolerated (OR 2.29, 95% CI 1.97 to 2.66). The effects of pharmacological treatment for individuals with co-occurring ADHD and substance use disorder are still uncertain. The evidence for the efficacy and effectiveness of non-pharmacological treatments of ADHD in adults, as well as the combination of pharmacological and non-pharmacological strategies, is only preliminary. In conclusion, while available evidence addressed mainly the efficacy and tolerability of psychostimulants and non-psychostimulants for ADHD core symptoms in the short term, we still need further empirical support for the non-pharmacological and multimodal treatments. A comprehensive evidence-informed hierarchy of ADHD drugs based on their efficacy and tolerability is not yet available but it should be the next research priority in the field.
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Affiliation(s)
- Franco De Crescenzo
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
| | - Samuele Cortese
- Department of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, and Solent NHS Trust, Southampton, UK
- Langone Medical Center, New York University Child Study Center, New York City, New York, USA
| | - Nicoletta Adamo
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Luigi Janiri
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
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Winston FK, Puzino K, Romer D. Precision prevention: time to move beyond universal interventions. Inj Prev 2015; 22:87-91. [PMID: 26271260 DOI: 10.1136/injuryprev-2015-041691] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Flaura K Winston
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA Department of Pediatrics, Perelman School of Medicine, Philadelphia, Pennsylvania, USA Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA
| | | | - Daniel Romer
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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