An integrated approach to establish the scientific foundation for driving among adolescents with autism

项目摘要 从青春期到成年期的转变对自闭症患者来说尤其具有挑战性。 精神障碍(ASD)。驾驶汽车的能力具有极大的潜力，可以提高青少年的独立性和灵活性 自闭症--最终改善长期福祉和健康。我们知道1/3的自闭症患者是 21岁前获得驾照，但这些家庭对驾驶的兴趣与 真正在开车的青少年。对于独立驾驶的自闭症青少年来说，已知的技能障碍 对于安全驾驶至关重要，可能会使他们面临更高的机动车碰撞风险--这是导致死亡的主要原因 在青少年中。考虑到安全地鼓励独立的重要性和增加 对于负面驾驶结果的风险，对患有自闭症的青少年驾驶的研究是至关重要的。我们的长期目标是 开发量身定制的资源和干预措施，在自闭症青少年及其家人 过渡到驾驶期，并优化他们作为独立司机的安全性和积极的长期健康 结果。这项研究项目的总体目标是提供急需的证据，以直接告知 为患有自闭症的青少年和年轻人开发这些驾驶支架。我们将开展一个综合系列活动 三项研究：(1)确定家庭驾驶决策的潜在因素和结果；(2)表征 有执照的青少年自闭症司机的驾驶模式、行为和表现；以及(3)确定 青少年自闭症司机的负面驾驶结果。在目标1中，我们将首先进行定性访谈， 驾驶教育人员、医疗保健提供者以及患有自闭症的青少年及其父母。结果将直接通知 在一项对500多名患有自闭症父母双亲的青少年进行的纵向队列研究中使用了定量调查 旨在确定青少年和他们的父母如何决定开车，并评估开车是否与 更高的生活质量指标比率。在目标2中，我们将描述驾驶模式、行为和 40名新获得执照的自闭症青少年在前12个月连续监测他们的驾驶表现 通过创新的车载技术获得许可。我们将估计驾驶暴露的流行率(例如，里程 和不安全的驾驶行为(如超速、使用手机)对患有自闭症的青少年进行比较 不安全驾驶事件与未患自闭症的青少年样本的比率来自先前的自然主义驾驶研究。在……里面 目标3，我们将使用儿童电子的独特关联数据仓库进行一项回溯性队列研究 健康记录和州交通安全数据，以比较机动车碰撞和交通罚单的风险 在获得执照的前四年，有执照的青少年司机和没有ASD的少年司机。这项研究的创新之处在于 这是第一个调查患有自闭症青少年在现实世界中驾驶结果的纵向研究计划。 我们期望这一项目产生的结果将导致确定推动干预措施的新目标。 为患有自闭症的青少年提供有关决策过程重要方面的知识 为家庭过渡到驾驶期间，并最终提高自闭症司机的安全。

Project Abstract The transition from adolescence to adulthood is particularly challenging for individuals with autism spectrum disorders (ASD). The ability to drive a vehicle has great potential to increase independence and mobility for teens with ASD—ultimately improving long-term well-being and health. We know that 1 in 3 individuals with ASD are licensed by age 21, but there is a notable gap between these families' interest in driving and the percentage of teens who are actually driving. For teens with ASD who do drive independently, impairments in skills known to be critical for safe driving may put them at heightened risk of a motor vehicle crash—the leading cause of death among teens. Given both the importance of safely encouraging independence and the potential for increased risk for negative driving outcomes, research on driving among teens with ASD is critical. Our long-term goal is to develop tailored resources and interventions that support teens with ASD and their families during the transition-to-driving period and optimize both their safety as independent drivers and positive long-term health outcomes. The overall objective of this research project is to provide much-needed evidence to directly inform development of these driving supports for teens and young adults with ASD. We will conduct an integrated series of three studies to: (1) identify underlying factors and outcomes of families' driving decisions; (2) characterize the driving patterns, behaviors, and performance of licensed teen drivers with ASD; and (3) establish the risk of negative driving outcomes among teen drivers with ASD. In Aim 1, we will first conduct qualitative interviews with driver educators, healthcare providers, and teens with ASD and their parents. Results will then directly inform quantitative surveys employed in a longitudinal cohort study of more than 500 teen with ASD-parent dyads that aims to determine how teens and their parents decide to drive and assess whether driving is associated with higher rates of quality of life measures. In Aim 2, we will characterize the driving patterns, behaviors, and performance of 40 newly licensed teens with ASD by continuously monitoring their driving for the first 12 months of licensure via innovative in-vehicle technology. We will estimate the prevalence of driving exposure (e.g., miles driven) and unsafe driving behaviors (e.g., speeding, cell phone use) among teens with ASD and compare the rates of unsafe driving events to a sample of teens without ASD derived from a prior naturalistic driving study. In Aim 3, we will conduct a retrospective cohort study using a unique linked data warehouse of childhood electronic health records and state traffic safety data to compare the risk of motor vehicle crashes and traffic citations for licensed teen drivers with and without ASD over the first four years of licensure. This study is innovative in that it is the first longitudinal research program to investigate real-world driving outcomes among teens with ASD. We expect that results generated from this project will lead to identification of new targets of driving interventions and programs for teens with ASD, provide knowledge about important aspects of the decision-making process for families during the transition-to-driving period, and ultimately improve the safety of drivers with ASD.