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，重点研究在诊断为注意力缺陷/多动障碍（ADHD）的儿童的一般人群中，检查整个青春期和青年期（16-25岁）不良驾驶结果的风险。多动症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的典型症状——注意力不集中、多动和冲动——会持续到青春期，而这个时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，这可能会增加患有多动症的青少年的不良健康风险。在受影响更严重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，这些研究在方法上有很大的局限性，而且大多是在2000年之前进行的，当时电子设备的干扰不那么普遍，而且在毕业驾驶执照制度（限制年轻新手驾驶员接触危险条件）广泛实施之前。对于患有多动症的青少年何时获得驾照，他们是否比其他青少年更频繁地从事不安全驾驶行为（如超速、鲁莽驾驶、不系安全带），以及多动症影响撞车风险的具体机制，我们仍然知之甚少。这项至关重要的研究将为针对ADHD新手驾驶员的医疗、行为、技术和政策干预提供必要的证据基础。这项研究的目的是：比较有和没有多动症的青少年的许可轨迹；检查ADHD对引证和车祸风险的影响，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车祸中的作用；并确定ADHD的影响是否因性别、年龄、驾驶经验和诊断为共病精神健康状况（即破坏性行为、焦虑或情绪障碍）而异。此外，这将是第一个观察性研究，以检查长期ADHD药物使用与ADHD青少年的驱动结果之间的关系。两个独特而丰富的数据来源将结合在一起：(1)1987-1995年间出生的1600多名ADHD儿童和10000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初级保健网络的患者；(2)一个链接数据库，其中包含截至2013年12月每位新泽西州司机的完整许可、引用和撞车历史记录。这项研究将支持我们的长期目标，即开发干预措施，量身定制许可和学习驾驶过程，并确保ADHD青少年的安全驾驶行为。这也将是第一个将儿童的医疗记录与他们作为年轻司机的未来结果联系起来的研究——这是年轻司机研究领域方法论上的进步，将为调查其他医疗状况/事件对交通结果的影响提供一种新的方法。

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.