Longitudinal study of adverse driving outcomes among adolescents with ADHD

描述（由申请人提供）：拟议的研究将是最大的和第一个真正的纵向研究，重点是检查整个青春期和青年期（16-25岁）的儿童诊断为注意力缺陷/多动障碍（ADHD）的一般人群中不良驾驶结果的风险。ADHD是最常见的儿童疾病之一。对于大多数受影响的儿童来说，ADHD的定义症状-注意力不集中，多动和冲动-持续到青春期，许多人可能会获得驾驶执照。机动车碰撞是青少年死亡和残疾的主要原因，注意力不集中/分心和不安全的驾驶行为是主要原因，这可能会增加ADHD青少年的不良健康风险。在更多受影响的青少年和年轻人中进行的小型研究表明，不良驾驶结果的风险增加。然而，这些研究有显着的方法上的局限性，大多是在2000年之前进行的，当时电子设备的分心不太普遍，并且在毕业驾驶执照制度（限制新手年轻司机暴露于危险条件）广泛实施之前。我们仍然对患有ADHD的青少年何时获得许可知之甚少，他们是否从事不安全的驾驶行为（例如，超速，鲁莽驾驶，不使用安全带）比其他青少年更常见，以及ADHD影响撞车风险的具体机制。这项至关重要的研究将提供必要的证据基础，为针对患有多动症的新手司机的医疗、行为、技术和政策干预提供信息。该研究旨在：比较患有和不患有ADHD的青少年的许可轨迹;检查ADHD对引用和撞车风险的影响，并进一步确定注意力不集中/分心和不安全驾驶行为在这些撞车中的作用;并确定ADHD的影响是否因性别，年龄，驾驶经验和患有共病心理健康状况的诊断而异（即，破坏性行为、焦虑或情绪障碍）。此外，这将是第一项观察性研究，以研究ADHD青少年长期使用ADHD药物与驾驶结果之间的关联。两个独特而丰富的数据源将被合并：（1）1987-1995年出生的1,600多名ADHD儿童和10,000名非ADHD儿童的电子健康记录信息，这些儿童是费城儿童医院新泽西（NJ）初级保健网络的患者;和（2）一个链接的数据库，包含完整的许可证，引用，和崩溃的历史，每个新泽西州的司机到2013年12月。这项研究将支持我们的长期目标，即制定干预措施，为ADHD青少年定制许可和学习驾驶过程，并确保他们的安全驾驶行为。这也将是第一项将儿童的医疗记录与他们作为年轻驾驶员的未来结果联系起来的研究，这是年轻驾驶员研究领域的一种方法学进步，将提供一种新的方法来调查其他医疗条件/事件对交通结果的影响。

DESCRIPTION (provided by applicant): The proposed study will be the largest and first truly longitudinal study focused on examining the risk of adverse driving outcomes throughout adolescence and young adulthood (age 16-25) among a general population of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). ADHD is one of the most common childhood disorders. For the majority of affected children, the defining symptoms of ADHD- inattention, hyperactivity, and impulsivity-persist into adolescence, a time at which many likely get licensed to drive. Motor vehicle crashes are the leading cause of death and disability among adolescents with inattention/distraction and unsafe driving behaviors major causes-creating the potential for heightened adverse health risk for adolescents with ADHD. Small studies among more severely-affected adolescents and young adults suggest an increased risk of adverse driving outcomes. However, these studies have significant methodological limitations and were mostly conducted prior to the year 2000, when distractions from electronic devices were less prevalent and before Graduated Driver Licensing systems-which restrict novice young drivers' exposure to hazardous conditions-were widely implemented. We still know little about when adolescents with ADHD get licensed, whether they engage in unsafe driving behaviors (e.g., speeding, reckless driving, seat belt nonuse) more often than other adolescents, and the specific mechanisms by which ADHD influences crash risk. This crucial study will provide the evidence base needed to inform medical, behavioral, technological, and policy interventions targeted to novice drivers with ADHD. The study aims to: compare licensing trajectories of adolescents with and without ADHD; examine the effect of ADHD on the risk of citations and crashes, and further determine the role of inattention/distraction and unsafe driving behaviors in these crashes; and determine whether the effect of ADHD varies by gender, age, driving experience, and diagnosis with a comorbid mental health condition (i.e., disruptive behavior, anxiety, or mood disorder). Further, it will be the first observational study to examine the association between long-term ADHD medication use and driving outcomes among adolescents with ADHD. Two unique and rich data sources will be combined: (1) electronic health record information for over 1,600 children with ADHD and 10,000 children without ADHD who were born between 1987-1995 and who were patients of The Children's Hospital of Philadelphia's New Jersey (NJ) primary care network; and (2) a linked database that contains the full licensing, citation, and crash history of every NJ driver through December 2013. The study will support our long-term goal of developing interventions that tailor the licensing and learning-to-drive process to, and ensure safe driving behaviors among, teens with ADHD. It will also be the first study to link children's medical records to their future outcomes as young drivers-a methodological advancement in the field of young driver research that will provide a novel method to investigate the effect of other medical conditions/events on traffic outcomes.