Longitudinal study of adverse driving outcomes among adolescents with ADHD

描述(由申请人提供)：这项拟议的研究将是第一项规模最大、也是第一项真正的纵向研究，重点研究在被诊断为注意力缺陷/多动障碍(ADHD)的儿童的普通人群中，在整个青春期和青年时期(16-25岁)不良驾驶结果的风险。ADHD是最常见的儿童障碍之一。对于大多数受影响的儿童来说，ADHD的决定性症状-注意力不集中、多动和冲动-一直持续到青春期，许多人可能在青春期获得驾照。在注意力不集中/注意力分散和不安全驾驶行为的青少年中，车祸是导致死亡和残疾的主要原因，这可能会增加患有ADHD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，这些研究有很大的方法局限性，而且大多是在2000年之前进行的，当时电子设备的分心还不太普遍，而且分级驾驶执照制度--限制年轻新手司机暴露在危险条件下--得到广泛实施。我们仍然对患有ADHD的青少年何时获得执照、他们是否比其他青少年更频繁地从事不安全的驾驶行为(例如，超速、鲁莽驾驶、不使用安全带)以及ADHD影响撞车风险的具体机制知之甚少。这项至关重要的研究将提供必要的证据基础，为针对ADHD新手司机的医疗、行为、技术和政策干预提供信息。这项研究的目的是：比较患有和不患有ADHD的青少年的驾照轨迹；检查ADHD对被引用和撞车风险的影响，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；以及确定ADHD的影响是否因性别、年龄、驾驶经验和诊断患有共病心理健康状况(即破坏性行为、焦虑或情绪障碍)而异。此外，这将是第一项考察长期使用ADHD药物与ADHD青少年驾驶结果之间关系的观察性研究。两个独特而丰富的数据源将结合在一起：(1)超过1,600名ADHD儿童和10,000名非ADHD儿童的电子健康记录信息，他们在1987-1995年间出生，是费城儿童医院新泽西(NJ)初级保健网络的患者；(2)一个链接的数据库，其中包含截至2013年12月每个新泽西州司机的完整执照、引证和撞车历史。这项研究将支持我们的长期目标，即开发干预措施，为ADHD青少年量身定做执照和学习驾驶过程，并确保他们的安全驾驶行为。这也将是第一项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的一项方法学进步，将提供一种新的方法来调查其他医疗条件/事件对交通结果的影响。

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.