Attention Deficit Hyperactivity Disorder
Conditions
Keywords
ADHD, Driving, Behavior modification
Brief summary
There is clear, converging evidence from multiple prospective studies with well-diagnosed adolescents with ADHD and comparison, non-ADHD adolescents, that teen drivers with ADHD have more accidents and other adverse driving outcomes. Available research indicates parental monitoring and limit-setting for adolescent drivers is one of the most effective interventions for preventing negative driving outcomes. For children with ADHD, interventions to promote parenting capacity to effectively oversee and intervene in teen driving will likely need to be intensive and require multiple treatment components. The present proposal aims to compare the standard care for teen drivers (driver's education classes and driving practice) to the Supporting a Teen's Effective Entry to the Roadway (STEER) program, that includes a parent-teen intervention, adolescent skill building, parent training on effective adolescent management strategies, joint parent-teen negotiations sessions, practice on a driving simulator, parental monitoring of objective driving behaviors, and the targeting of safe teen driving via contingency management strategies (i.e., parent-teen contracts). To facilitate teen and parent engagement the intervention will be preceded by a motivational interview. The specific aims of the proposal are to investigate the efficacy of the STEER program relative to a standard care group in a randomized clinical trial (N=172) on measures of objective driving outcome and parenting capacity. It is hypothesized that the STEER program will result in improved outcomes relative to the standard care group at the end of intervention and 6 and 12 month follow-up assessments.
Interventions
DEVICECarChipPro
On board driving monitor
BEHAVIORALDriver's Education
10 Session License to Learn Program.
BEHAVIORALSTEER Program
8-session behavioral parent training and teen social skills/communication training program
OTHERDriving Simulator Practice
Practice Driving on a driving simulator
Sponsors
State University of New York at Buffalo
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
16 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Clinical Diagnosis of ADHD, Combined Type * At least 16 years old * Has a driving Permit
Exclusion criteria
* No parent willing to be involved * Seizure disorder, eating disorder, psychotic disorder, current diagnosis of substance/alcohol dependence * Prior Driver's education class
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Risky Driving Events Assessed by On-Board Driving Monitor | Follow up period after the intervention (1 year) | Frequency count of risky driving events (e.g., abrupt braking, hard acceleration, abrupt swerving) recorded by engine performance monitor installed in the car. Events were counted and a greater frequency indicated more risky driving. The average number of risky driving events, collected over a four-week period at each assessment point were used as the dependent measure. |
| Positive Parenting Observational Data | Follow-up period after the intervention (12 weeks) | Parents and teens discussed two recent issues and these discussions were coded using The Interaction Behavior Code (IBC). The IBC is a behavioral coding system designed to assess global impressions of parent-adolescent problem-solving and communication behavior. Coders were undergraduates who were unaware of both study hypothesis and group assignment. Coders were instructed to rate 32 behavioral items related to positive and negative parenting in terms of their presence or absence of the behaviors (Items 1-22) or the how often specific parenting behaviors occurred for Items 23-32 (no = 0 points, a little = .5 point, and alot = 1 point). Coders scores were summed across the 32 items and scores fore each scale could range from 0-32. Thus for the positive parenting scale, higher scores, ranging from 0-32, indicated improvement. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Driver Training Driver Education Program Practice driving on a driving simulator Provision of the CarChipPro to the family
CarChipPro: On board driving monitor
Driver's Education: 10 Session License to Learn Program.
Driving Simulator Practice: Practice Driving on a driving simulator | 86 |
| STEER Program Driver Education STEER Program
CarChipPro: On board driving monitor
Driver's Education: 10 Session License to Learn Program.
STEER Program: 8-session behavioral parent training and teen social skills/communication training program
Driving Simulator Practice: Practice Driving on a driving simulator | 86 |
| Total | 172 |
Baseline characteristics
| Characteristic | STEER Program | Driver Training | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 86 Participants | 86 Participants | 172 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 16.98 years STANDARD_DEVIATION 0.7 | 16.88 years STANDARD_DEVIATION 0.65 | 16.92 years STANDARD_DEVIATION 0.67 |
| Region of Enrollment United States | 86 Participants | 86 Participants | 172 Participants |
| Sex: Female, Male Female | 23 Participants | 25 Participants | 48 Participants |
| Sex: Female, Male Male | 63 Participants | 61 Participants | 124 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 86 | 0 / 86 |
| serious Total, serious adverse events | 0 / 86 | 0 / 86 |
Outcome results
Primary
Number of Risky Driving Events Assessed by On-Board Driving Monitor
Frequency count of risky driving events (e.g., abrupt braking, hard acceleration, abrupt swerving) recorded by engine performance monitor installed in the car. Events were counted and a greater frequency indicated more risky driving. The average number of risky driving events, collected over a four-week period at each assessment point were used as the dependent measure.
Time frame: Follow up period after the intervention (1 year)
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Driver Training | Number of Risky Driving Events Assessed by On-Board Driving Monitor | 3.20 events | Standard Error 0.58 |
| STEER Program | Number of Risky Driving Events Assessed by On-Board Driving Monitor | 3.95 events | Standard Error 0.73 |
Primary
Positive Parenting Observational Data
Parents and teens discussed two recent issues and these discussions were coded using The Interaction Behavior Code (IBC). The IBC is a behavioral coding system designed to assess global impressions of parent-adolescent problem-solving and communication behavior. Coders were undergraduates who were unaware of both study hypothesis and group assignment. Coders were instructed to rate 32 behavioral items related to positive and negative parenting in terms of their presence or absence of the behaviors (Items 1-22) or the how often specific parenting behaviors occurred for Items 23-32 (no = 0 points, a little = .5 point, and alot = 1 point). Coders scores were summed across the 32 items and scores fore each scale could range from 0-32. Thus for the positive parenting scale, higher scores, ranging from 0-32, indicated improvement.
Time frame: Follow-up period after the intervention (12 weeks)
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Driver Training | Positive Parenting Observational Data | .46 score on a scale | Standard Error 0.01 |
| STEER Program | Positive Parenting Observational Data | .44 score on a scale | Standard Error 0.01 |