Improving parenting capacity to promote safe driving for adolescents with ADHD

描述（由申请人提供）：从多项前瞻性研究中有明确的、趋同的证据，这些研究对诊断良好的ADHD青少年进行了研究，并与非ADHD青少年进行了比较，发现ADHD青少年司机发生的事故更多（Fischer等人，2007; Nada-Raja等人，1997; Thompson等人，2007;韦斯等人，1979; Woodward等人，2000），导致更高的成本（Fischer等人，2007）、损伤（Woodward等人，2000年）和死亡（兰伯特，1995年）。患有多动症的青少年司机也更有可能因交通罚单或鲁莽驾驶、无证驾驶、肇事逃逸事故以及吊销或吊销执照而被传讯（参见Barkley &考克斯，2007）。现有的研究表明，父母对青少年驾驶员的监督和限制是防止负面驾驶结果的最有效干预措施之一（例如，Simons-Morton等人，2007年）。对于患有ADHD的儿童，促进父母有效监督和干预青少年驾驶的能力的干预措施可能需要加强，并需要多种治疗成分。目前的建议旨在比较青少年司机的标准照顾（驾驶员教育课程和驾驶实践）到支持青少年有效进入道路（STEER）计划，该计划包括家长-青少年干预，青少年技能建设，有效青少年管理策略的家长培训，家长-青少年联合谈判会议，驾驶模拟器练习，家长对客观驾驶行为的监控，以及通过应急管理策略（即，父母-青少年合同）。为了促进青少年和家长的参与，干预之前将进行动机访谈。该提案的具体目的是调查的有效性的转向程序相对于标准的护理组在一项随机临床试验（N=172）的客观驾驶结果和养育能力的措施。 公共卫生相关性：这项研究具有重大的公共卫生效益，因为它将是第一个针对ADHD青少年驾驶行为的行为矫正治疗的随机对照试验。相对于典型的青少年，患有ADHD的人最容易出现一些负面的驾驶结果，包括事故，伤害和死亡。此外，这项研究将加强了解如何增加父母的监控和限制设置的能力，改善青少年驾驶行为的创新技术以及典型的测量策略。

DESCRIPTION (provided by applicant): There is clear, converging evidence from multiple prospective studies with well-diagnosed adolescents with ADHD and comparison, non-ADHD adolescents, that teen drivers with ADHD have more accidents (Fischer et al., 2007; Nada-Raja et al., 1997; Thompson et al., 2007; Weiss et al., 1979; Woodward et al., 2000) that result in greater costs (Fischer et al., 2007), injuries (Woodward et al., 2000), and fatalities (Lambert, 1995). Adolescent drivers with ADHD are also more likely to be cited for a traffic citation or reckless driving, driving without a license, having hit-and-run accidents, and having a revoked or suspended license (see Barkley & Cox, 2007 for a review). Available research indicates parental monitoring and limit-setting for adolescent drivers is one of the most effective interventions for preventing negative driving outcomes (e.g., Simons-Morton et al., 2007). For children with ADHD, interventions to promote parenting capacity to effectively oversee and intervene in teen driving will likely need to be intensive and require multiple treatment components. The present proposal aims to compare the standard care for teen drivers (driver's education classes and driving practice) to the Supporting a Teen's Effective Entry to the Roadway (STEER) program, that includes a parent- teen intervention, adolescent skill building, parent training on effective adolescent management strategies, joint parent-teen negotiations sessions, practice on a driving simulator, parental monitoring of objective driving behaviors, and the targeting of safe teen driving via contingency management strategies (i.e., parent-teen contracts). To facilitate teen and parent engagement the intervention will be preceded by a motivational interview. The specific aims of the proposal are to investigate the efficacy of the STEER program relative to a standard care group in a randomized clinical trial (N=172) on measures of objective driving outcome and parenting capacity. PUBLIC HEALTH RELEVANCE: This study holds substantial public health benefit as it will be the first randomized controlled trial for the behavior modification treatment of driving behavior for adolescents with ADHD. Relative to typical adolescents, those with ADHD are most at-risk for a number of negative driving outcomes including accidents, injury, and death. In addition, the study will enhance the understanding of how increasing the parenting capacity for monitoring and limit setting improves adolescent driving behavior as measured by innovative technologies as well as by typical measurement strategies.