Improving parenting capacity to promote safe driving for adolescents with ADHD

描述（由申请人提供）：从对确诊为ADHD的青少年和非ADHD青少年进行的多项前瞻性研究中，有明确、一致的证据表明，患有ADHD的青少年司机发生更多事故（Fischer等人，2007；Nada-Raja等人，1997；Thompson等人，2007；Weiss等人，1979；Woodward等人，2000），导致更高的成本（Fischer等人，2007）、伤害（Woodward等人，2000）和死亡（Lambert, 1995）。患有多动症的青少年司机也更有可能因为交通罚单或鲁莽驾驶、无证驾驶、肇事逃逸事故以及吊销或暂停执照而被传唤（见Barkley & Cox， 2007年的评论）。现有研究表明，父母对青少年司机的监控和限制是预防不良驾驶后果最有效的干预措施之一（例如，simmons - morton等人，2007年）。对于患有多动症的儿童，为了提高父母的能力，有效地监督和干预青少年驾驶，干预措施可能需要加强，需要多种治疗成分。本研究旨在比较青少年司机的标准护理（驾驶教育课程和驾驶实践）与支持青少年有效进入道路（STEER）计划，该计划包括父母-青少年干预、青少年技能培养、有效青少年管理策略的父母培训、父母-青少年联合谈判会议、驾驶模拟器练习、父母对客观驾驶行为的监控。以及通过应急管理策略（即家长-青少年合同）以青少年安全驾驶为目标。为了促进青少年和家长的参与，干预之前将进行一次动机性访谈。该提案的具体目的是在一项随机临床试验（N=172）中调查STEER计划相对于标准护理组的有效性，以衡量客观驱动结果和养育能力。

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.