Longitudinal study of adverse driving outcomes among adolescents with ADHD

工程摘要 ADHD是最常见的儿童疾病之一，通常持续到成年，在此期间， 许多人都有驾驶执照。驾驶能力对个人参与现代社会的活动很重要。 这是社会的一部分，因为它增强了独立性以及社会和经济机会。然而，机动车碰撞 是青少年死亡的主要原因驾驶中的关键技能，包括执行功能， ADHD患者中经常受到损害。因此，迫切需要进行研究，以建立科学基础- 注意力缺陷多动障碍青少年驾驶风险的评估，以便采取基于证据的对策来降低撞车风险。 可以开发。我们最初的R 01项目确定，对于新获得许可的青少年， 患有ADHD的司机比没有ADHD的同龄司机高30%-40%（咖喱2017和2019）。R01 更新直接解决了下一个逻辑上的关键差距：理解为什么青少年司机的撞车风险会增加 注意力缺陷多动症我们的总体目标是找出增加青少年驾驶者驾驶风险的具体因素， 多动症。我们将通过三个具体目标来实现这一目标。在目标1中，我们将确定远端因素（车辆外部 环境），增加了ADHD青少年不良驾驶结果的风险。在目标2中，我们将确定近端- 增加风险的危险因素（车辆环境内）。最后，在目标3中，我们将研究（在 ADHD）与ADHD相关因素之间的关联--包括药物使用、目前的ADHD损害、 以及同时发生的破坏性行为障碍和不良驾驶结果。关于我们 1，我们将对1,000对青少年父母进行前瞻性队列研究（500名患有ADHD，500名没有ADHD）。 参与者将完成从学习者阶段到第一阶段的基线和四波调查 15个月独立驾驶调查数据将与通过 智能手机数据记录器和现有的国家级管理数据的移动违规和崩溃。到 为了实现目标2和3，我们将进行一项自然驾驶研究，其中包括90名来自研究1的青少年，因为他们 获得中级许可证（10个没有ADHD，40个有ADHD和处方ADHD药物，40个有 注意力缺陷多动障碍（ADHD），而不是处方ADHD药物。创新的车载技术在青少年的车辆将继续- 在获得驾照的前12个月内，对驾驶模式、行为和表现进行全面监控。我们还将 利用创新的生态瞬时评估收集许可证前3个月的每日药物使用情况- 通过文本提示符来显示方法。这将使我们能够进行第一次检查如何多动症的药物治疗 使用影响真实世界的自然驾驶性能。我们期待着丰富的基础信息生成- 该项目将为患有多动症的青少年提供有关驾驶风险的关键知识。该项目将 产生积极影响，使我们能够开始处理采取有针对性的干预措施的迫切需要 在学习驾驶期间，为患有ADHD的青少年及其家人提供最佳的安全性， 独立司机

Project Abstract ADHD is one of the most common childhood disorders and often persists into adolescence—a period in which many individuals get licensed to drive. 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 the leading cause of death among teens. Skills that are critical in driving, including executive functioning, are frequently impaired in individuals with ADHD. Thus, research is critically needed to establish the scientific foun- dation for driving risks among teens with ADHD so that evidence-based countermeasures to reduce crash risk can be developed. Our initial R01 project established that the risk of crash involvement for newly licensed teen drivers with ADHD is 30%-40% higher than same-aged drivers without ADHD (Curry 2017 and 2019). This R01 renewal directly addresses the next logical critical gap: understanding why crash risk is elevated for teen drivers with ADHD. Our overall objective is to identify specific factors that heighten driving risks for teen drivers with ADHD. We will accomplish this with three specific aims. In Aim 1 we will identify distal factors (outside vehicle environment) that heighten risk of adverse driving outcomes for teens with ADHD. In Aim 2 we will identify prox- imal factors (within vehicle environment) that heighten risk. Finally, in Aim 3 we will examine (among drivers with ADHD) the association between ADHD-related factors—including medication use, current ADHD impairment, and the presence of co-occurringdisruptivebehavioral disorder—andadversedriving outcomes. To achieveAim 1, we will conduct a prospective cohort study of 1,000 teen-parent dyads (500 with ADHD, 500 without ADHD). Participants will complete a baseline and four wave surveys that span from the learner phase through the first 15 months of independent driving. Survey data will be linked to objective driving outcomes captured via a smartphone data logger and existing state-level administrative data on moving violations and crashes. To achieve Aims 2 and 3, we will conduct a naturalistic driving study that will include 90 teens from Study 1 as they obtain an intermediate license (10 without ADHD, 40 with ADHD and prescribed ADHD medication, 40 with ADHD and not prescribed ADHD medication). Innovative in-vehicle technology in teens' vehicles will continu- ously monitor driving patterns, behaviors, and performance for the first 12 months of licensure. We will also collect daily medication use for the first 3 months of licensure utilizing innovative ecological momentary assess- ment methods via text prompts. This will enable us to conduct the first examination of how ADHD medication use influences real-world naturalistic driving performance. We expect that the rich foundational information gen- erated from this project will provide critical knowledge about driving risks for teens with ADHD. The project will make a positive impact in that it will enable us to begin addressing the pressing need for targeted interventions for teens with ADHD and their families during the learning-to-drive period—ultimately optimizing their safety as independent drivers.