Longitudinal study of adverse driving outcomes among adolescents with ADHD

项目摘要 ADHD是最常见的儿童障碍之一，通常会持续到青春期--这段时期 很多人都拿到了驾照。驾驶能力对一个人参与现代社会很重要 社会，因为它增强了独立性以及社会和经济机会。然而，机动车撞车事故 是青少年死亡的主要原因。在驾驶中至关重要的技能，包括执行功能，是 在ADHD患者中经常受损。因此，迫切需要研究来建立科学基础-- 对青少年ADHD患者的驾驶风险进行评估，以循证对策降低撞车风险 可以被开发出来。我们最初的R01项目确定了新获得执照的青少年发生撞车事故的风险 患有ADHD的司机比没有ADHD的同龄司机高30%-40%(Curry 2017和2019)。本R01 续签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 患有多动症。我们的总体目标是确定增加青少年司机驾驶风险的特定因素 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)会增加ADHD青少年不良驾驶后果的风险。在目标2中，我们将确定Prox- 增加风险的IMAL因素(在车辆环境中)。最后，在目标3中，我们将检查(在具有 ADHD)ADHD相关因素之间的联系--包括药物使用、当前ADHD损害、 以及同时出现破坏性行为障碍--以及逆境驱动结果。实现目标 我们将对1000名青少年父母进行前瞻性队列研究(500名患有ADHD，500名没有ADHD)。 参与者将完成从学员阶段到第一阶段的基线和四个波浪式调查 15个月的独立驾驶。调查数据将与通过 智能手机数据记录器和现有的州级移动违规和撞车管理数据。至 实现目标2和3，我们将进行一项自然主义驾驶研究，包括研究1中的90名青少年，因为他们 获得中级执照(10名没有ADHD，40名有ADHD和ADHD处方药，40名有ADHD ADHD和未开出的ADHD药物)。青少年汽车的创新车载技术将继续- 严格监控驾照前12个月的驾驶模式、行为和表现。我们还将 利用创新的生态即时评估收集许可前3个月的每日用药情况- 通过文本提示输入方法。这将使我们能够进行ADHD药物治疗的第一次检查 使用会影响真实世界的自然主义驾驶性能。我们期待着丰富的基础信息生成- 该项目将为患有ADHD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，因为这将使我们能够开始解决有针对性干预的迫切需要 对于患有ADHD的青少年及其家人来说，在学习驾驶期间-最终优化他们的安全性 独立驱动程序。

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.