Efficacy of a family-focused intervention for young drivers with attention-deficit hyperactivity disorder.

Abstract

Objective Teenage drivers diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at significant risk for negative driving outcomes related to morbidity and mortality. However, there are few viable psychosocial treatments for teens with ADHD and none focus on the key functional area of driving. The Supporting the Effective Entry to the Roadway (STEER) program was evaluated in a clinical trial to determine whether it improved family functioning as a proximal outcome and driving behavior as a distal outcome. Method One hundred seventy-two teenagers with ADHD, combined type, were randomly assigned to STEER or a driver education driver practice program (DEDP). Results Relative to parents in the DEDP condition, parents in STEER were observed to be less negative at post-treatment and 6-month follow-up, but not at 12-month follow-up and there were no significant differences for observed positive parenting. Relative to teens in the DEDP condition, teens in STEER reported lower levels of risky driving behaviors at post-treatment and six-month follow-up, but not at 12-month follow-up. They were not observed to differ on objective observations of risky driving or citations/accidents. Conclusions The STEER program for novice drivers with ADHD was effective in reducing observations of negative parenting behavior and teen self reports of risky driving relative to DEDP; groups did not significantly differ on observations of positive parenting or driving behaviors. Public Health Significance Statement Families with a teenager with ADHD may benefit from engaging in behavioral parent training around the transition to independent driving, especially via reductions in negative parenting. Teenagers with ADHD self-reported fewer risky driving behaviors within the family-focused intervention, but these findings were not replicated on objective observations of driving.

Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes

“…In contrast, research has demonstrated that psychosocial interventions for ADHD have not addressed driving problems. 26 Our results are in line with previous clinical investigations 13 and one population-based study 17 from Sweden and further extend the previous findings in 3 important ways. First, this study is the initial one to date to clarify the association between ADHD medication use and decreased MVCs in a large sample of women with ADHD, and we found that the association in women was as strong as that in men.…”

Driving among Adolescents with Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder

“…Drivers with ADHD demonstrated significant improvements in driving hazard identification response times following a brief computer-based intervention [95]. Other promising approaches for teen drivers for ADHD specifically include the Supporting the Effective Entry to the Roadway program [96,97], which involved driver monitoring using on-board diagnostics coupled with symptom tracking and pharmaceutical interventions which are commonly prescribed to teenagers with ADHD [98].…”

Untitled

“…The most comprehensive study to date that has used a driving simulator as part of an intervention for disadvantaged groups was by Fabiano et al (2016). This was an experimental study with participants diagnosed with ADHD randomly assigned to one of two different treatment groups (there was no control group).…”

“…All of the studies exposed participants to the simulator in small numbers or individual sessions with the exception of the most recent study by Fabiano et al (2016). This approach allows each participant individual time with the simulator.…”

“…There is also inconsistency between presenting the simulator education as a standalone intervention (Brooks et al, 2016;Poulsen, Horswill, Wetton, Hill, & Mui Lim, 2010;Wade et al, 2016;Zider, 1979) or as one component of a larger intervention incorporating other teaching methods. These other methods included motivational interviewing (Fabiano et al, 2011), facilitated driver education textbook study (Brooks et al, 2014) and a more comprehensive program that incorporated driving with a professional driving instructor on the road (Fabiano et al, 2016).…”