Viewpoints of pedestrians with and without cognitive impairment on shared zones and zebra crossings

The nature of the risk faced by pedestrians with neurodevelopmental disorders: A systematic review

Pedestrians represent one of the most vulnerable road user groups worldwide. Children and adult pedestrians with neurodevelopmental disorders may be at greater risk due to deficits in a range of domains, such as attention, social communication, motor control and executive function. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychological Association, 2013), neurodevelopmental disorders include individuals with a diagnosis of Autism Spectrum Disorders, Attention Deficit Hyperactivity Disorder, Specific Learning Disorder, Motor Difficulties, Communication Disorders and Intellectual Disabilities. The purpose of this systematic review and meta-analysis was to explore existing literature relating to determine the nature of the risk faced by pedestrians with neurodevelopmental disorders. Relevant databases including Web of Science, PhysInfo and CINAHL were searched up to July 2019. All peer reviewed journals that presented data focusing on neurodevelopmental disorders and some aspect of road crossing or roadside behaviour that included a control or comparison group were included. A total of 149 abstracts were assessed and 17 met the inclusion criteria. The identified papers could be grouped into four areas: (1) rate of injury; (2) assessment of risk; (3) eye gaze and understanding of road layout and (4) gap choice. No papers exploring the risk factors at the roadside for individuals with Specific Learning Disorders or Communication Disorders were identified. Overall, the review provide evidence for an elevated risk of injury for individuals with ADHD at the roadside, potentially as a consequence of poor temporal gap choice, although there was evidence that this risk could be mediated by executive dysfunction rather than ADHD symptomology. Furthermore, poor temporal gap choice was found in children with DCD but it remains unclear as to whether this risk translates to the roadside. Finally, both children and adults with ASD and children with ID were found to demonstrate differences in behaviour / understanding at the roadside. In general, co-occurrence between neurodevelopmental disorders has been largely ignored in the current literature relating to pedestrian risk and future research could consider this along with executive functioning.

The Lived Experience of Crossing the Road When You Have Developmental Coordination Disorder (DCD): The Perspectives of Parents of Children With DCD and Adults With DCD

Pedestrians are one of the most vulnerable groups at the roadside, furthermore, previous research has demonstrated perceptual-motor limitations in individuals with DCD which may put these individuals at even more at risk in the context of road crossing. However, it is unclear whether this is the lived experience of these individuals at the roadside. Furthermore, difficulties with road crossing and safety have been found in other neurodevelopmental disorders but the impact this might have on an individual with co-occurring difficulties is unknown. Therefore, we utilized a questionnaire to survey the lived experience of adults with DCD and parents of children with DCD with the specific objectives of describing behaviors exhibited by adults and children with DCD (the latter reported by parents) at the roadside and to determine the how these individuals perceive road crossing actions. For each of these we compared different co-occurrence groups. We also had one final objective which was not focused on road crossing but more on the general perception of accidents and unrealistic optimism. Individuals with co-occurrences which have previously been linked to unsafe crossing behaviors (i.e., ADHD, ASD, and LD) reported a greater regularity of dangerous looking behavior (forgetting to look, running without looking) and visibility (crossing between cars, crossing when you can't see), these adults and the parents of these children were seemingly aware of the risky nature of these behaviors. When asked "why" crossing ability might be different, perceptual and motor difficulties alongside heightened awareness of risk and lowered awareness of risk were all cited by participants. Unrealistic optimism was not an explanation for the risky behavior in adults with DCD and in fact, these adults demonstrated a clear understanding of the likelihood of accidents. The findings of this study suggest that road crossing is perceived to be more challenging for both children and adults with DCD and this needs to be taken into account when considering remediation for this group.