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Prevention

Mental Health Treatments Could Make Many Teen Drivers Safer

Targeted treatments aimed at combating attention hyperactivity disorder (ADHD) and other mental health disorders could help make many teenage drivers safer on the road, a new study indicates.

It’s already known that drivers aged 16 to 19 are three times more likely to get into fatal accidents than their older counterparts, and the prevalence of such accidents is in some cases related to mental health disorders, including a lifetime history of ADHD.

The new study analyzed data from 60 teens who completed a simulated driving assessment, and several questionnaires linked mistakes behind the wheel to self-reported symptoms of ADHD and other conditions.

The findings, from investigators Catherine McDonald and colleagues from Penn Medicine, the Center for Injury Research and Prevention (CIRP) at the Children’s Hospital of Philadelphia (CHOP), and Utah State University, were published in the journal Nursing Research.

“Previous studies have shown increases in crash risk related to an ADHD diagnosis,” said McDonald, an assistant professor of nursing at Penn Medicine. “We wanted to tease apart the nuances behind that. Is it about risk-taking, skill, or performance deficits? Is it about decision-making? In the capacity of a simulator as well as self-reported behaviors, we wanted to see if our data could get at the why of what is happening around driving behaviors.”

The research team began by recruiting 16- and 17-year-olds in Pennsylvania who had had their driver’s licenses no more than 90 days. At the outset, participants rated how closely numerous statements aligned with how they felt and thought. For example, one question assessing symptoms of ADHD asked if they had trouble keeping their mind on what people say. Another, about conduct disorder, asked if they bullied or threatened others.

Participants also completed a questionnaire about depressive symptoms and another about their driving behaviors on the road, such as tendency to speed, use of cell phones, and number of passengers they carried. In conjunction, parents assessed their child for ADHD symptoms and other mental-health problems.

“We know that about five percent of older adolescents meet criteria for ADHD, so we weren’t expecting too many in our sample to meet the threshold for diagnosis,” McDonald said. “For that reason, we looked at symptom measures instead. That gives us an idea of the severity of symptoms, even if they are not high enough to meet the criteria for a full diagnosis.”

Next, all participants completed an assessment in the driving simulator at CIRP. During the experimental drives, teens were exposed to different crash scenarios–a rear-end collision or a hidden hazard, for instance—that were avoidable if they drove safely. By the end of the simulated assessment, they had been presented with 21 potential crash situations. The researchers analyzed the simulator data on a variety of the participants’ actions, including how they behaved at stimulated stop signs, in which lane they drove, where they looked on the road, and how they applied the brake in potentially dangerous circumstances.

McDonald and colleagues noticed a clear link: The more inattention symptoms a teen reported, the more mistakes that driver made in the simulator. McDonald said that knowing this offers a clear opening for health-care providers. “Inattention was associated with more errors in the simulator, and self-reported symptoms of hyperactivity and conduct disorder were related to more self-reported risky driving behaviors,” she said. “This presents an opportunity to help intervene with patients and their families, to talk about the child’s whole health and mental well-being and how it might relate to driving behaviors.”

The researchers acknowledge several limitations to the work. For one, the study cohort was predominantly white and thus not representative of the young-driver population overall. Second, McDonald and colleagues didn’t seek out participants already diagnosed with disorders such as ADHD but rather assessed for symptoms once an adolescent agreed to participate. Finally, they could not measure all contributors to risky driving and performance errors. McDonald said she hopes to mitigate these limitations in future research.

“We would like to learn more about the relationship of mental-health symptoms to driving behavior in a sample with higher rates and severity of ADHD,” McDonald said, “so we can examine the impact of inattention and hyperactivity-impulsivity symptom severity across the full range of these dimensions.”

That next step could help move the research toward its ultimate goal: tailoring interventions for teens drivers at risk in different ways.

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