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

Hospitalization and Mortality for Insured Patients in the United States with COVID-19 with and without Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neuropsychiatric condition that may be associated with negative health outcomes. This retrospective cohort study reveals the odds of hospitalization and mortality based on ASD for a population of insured patients with COVID-19. The odds of hospitalization and mortality for people with ASD were found to be greater than individuals without ASD when adjusted for sociodemographic characteristics. Hospitalization and mortality was associated with a dose-response increase to comorbidity counts (1 to 5+). Odds of mortality remained greater for those with ASD when adjusting for comorbid health conditions. ASD is a risk factor for COVID-19 mortality. Comorbid health conditions play a particular role in increasing the odds of COVID-19 related hospitalization and death for ASD patients.

Reducing Driving Risk Factors in Adolescents with Attention Deficit Hyperactivity Disorder (ADHD): Insights from EEG and Eye-Tracking Analysis

Adolescents with attention deficit hyperactivity disorder (ADHD) face significant driving challenges due to deficits in attention and executive functioning, elevating their road risks. Previous interventions targeting driving safety among this cohort have typically addressed isolated aspects (e.g., cognitive or behavioral factors) or relied on uniform solutions. However, these approaches often overlook this population's diverse needs. This study introduces the "Drive-Fun" innovative intervention (DFI), aimed at enhancing driving skills among this vulnerable population. The intervention was tested in a pilot study including 30 adolescents aged 15-18, comparing three groups: DFI, an educational intervention, and a control group with no treatment. Assessments included a driving simulator, EEG, and Tobii Pro Glasses 2. Evaluation was conducted pre- and post-intervention and at a 3-month follow-up. Results indicated that the DFI group significantly improved in the simulated driving performance, attentional effort, and focused gaze time. The findings underscore that holistic strategies with personalized, comprehensive approaches for adolescents with ADHD are particularly effective in improving driving performance. These outcomes not only affirm the feasibility of the DFI but also highlight the critical role of sensor technologies in accurately measuring and enhancing simulator driving performance in adolescents with ADHD. Outcomes suggest a promising direction for future research and application.

Simulator Driving Abilities, Executive Functions, and Adaptive Behavior Among Adolescents With Complex Attention Deficit Hyperactivity Disorder

OBJECTIVE

To examines the driving skills, executive functions, and adaptive behavior of adolescents diagnosed with Attention-deficit/hyperactivity disorder (ADHD) combined with emotional difficulties and/or learning disabilities (complex ADHD), compared to adolescents without ADHD.

METHOD

A cross-sectional study including 30 adolescents with complex ADHD and 33 adolescents without ADHD aged 15 to 18 years. Driving skills on a simulator, executive functions, and adaptive behavior were evaluated.

RESULTS

Adolescents without ADHD demonstrated significantly higher total scores on the driving simulator, indicating better driving performance compared to adolescents with complex ADHD. In the complex ADHD group, after controlling for different Conners Comprehensive Behavior Rating Scale-Self Report scales, driving simulator scores were partially correlated with executive functions.

CONCLUSION

These findings emphasize the unique needs of adolescents with complex ADHD. Given the significance of driving in today's society, it is crucial to consider the development of intervention programs to support this population's driving skills.

Risky driving behavior among individuals with Autism, ADHD, and typically developing persons

INTRODUCTION

Many individuals with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) often experience difficulty with driving, including difficulty with obtaining a driver's license as well as driving safely and efficiently. Such difficulties negatively impact their ability to function independently and participate in daily activities that require driving. ASD and ADHD commonly occur co-morbidly and share many overlapping clinical features. Few studies have directly compared the nature of difficulties in driving safety outcomes between ASD and ADHD. The overarching goal of the current study was to characterize and compare self-reported driving behavior among young autistic drivers, ADHD drivers, and typically developing (TD) drivers.

METHOD

Fifty-four participants (14 ASD, 20 ADHD, 20 TD); ages 16-30) completed the Autism Spectrum Quotient and ADHD Adult Rating scale as a method of screening of symptoms. All three groups then completed the Driving Behavior Questionnaire (DBQ), which measured self-reported driving violations, driving errors, and overall risky driving behavior. The three groups of ASD, ADHD, and TD individuals were then compared regarding symptomology and driving behavior differences.

RESULTS

One-way ANOVAs indicated group differences in DBQ total scores and DBQ errors. Drivers with ADHD reported significantly greater overall risky driving behaviors and driving errors compared to ASD and TD drivers. There were no significant differences between ASD and TD drivers in reported risky driving behaviors and errors. Linear regressions indicated that among all drivers, self-reported ADHD symptoms were significantly associated with higher levels of self-reported overall risky driving and driving errors, regardless of diagnostic group.

DISCUSSION

Risky driving and driving errors may be more closely related to symptoms that are characteristic of ADHD. This has implications for individuals with ADHD and autistic individuals who often show or report higher rates of ADHD symptoms. Future studies should compare driving skills of ASD and ADHD drivers using objective measures of driving performance, such as driving simulators or on-road tests.

Behind the Wheel: Unraveling the Impact of Experience Over Age Over the First 18 Months of Licensure

OBJECTIVE

This study examined how driving attention develops with age and driving.

METHODS

In this observational longitudinal study, 190 adolescents (53% female, 73% Black) were enrolled across four groups: 16- and 18-year olds with and without driving experience. They underwent driving simulation with eye-tracking technology seven times over 18 months. By using a combination of factorial and longitudinal designs, the study examined the individual and combined effects of age and driving experience on driving attention over time.

RESULTS

Licensed participants had higher odds of glancing at safety-critical events initially (OR = 15.01, 95% CI: 1.36-165.53), but these odds decreased at higher driving speeds (b = -0.17, p<.01). Average glance length decreased over time (b = -0.26, p=.01), but less so in licensed participants (b=0.14, p=.01). Several visual behaviors were influenced by environmental and driving factors.

CONCLUSIONS

Motor vehicle crashes (MVCs) are burdensome and costly to society. This study focused on the role of inattention in MVCs, particularly during the risky period of adolescence. Findings indicated that driving experience, as determined by licensure, had a considerable impact on visual behavior in both the short term (within two weeks of obtaining a license) and over the first 18 months of independent driving. Overall, these findings suggest that licensed adolescents are more likely to identify potential hazards on the road and navigate safely. To ensure effective guidance, pediatric psychologists and other professionals should consider the unique circumstances, needs, and concerns of individual patients.

Inappropriate driving behavior exhibited by drivers with the tendency of developmental disabilities

The purpose of this study was to clarify what kind of driving behavior that attributes from the disabilities is troublesome for drivers with developmental disabilities, what driving actions they are aware of as being hard to deal with, and what near-miss incidents and accidents they have experienced. This paper is composed of three studies. Study 1 is the observation of driving behavior of drivers with developmental disabilities on public roads. Study 2 is the interview survey on drivers with developmental disabilities. Study 3 is the interview survey on family members of drivers with developmental disabilities. It is confirmed that in Survey 1 "stopping the car just before the entrance of a busy parking lot of a store" and "driving too much on the right or left side, but not at the center of the lane" are some of the characteristics of drivers with developmental disorder, in Survey 2 more than half the survey subjects feel anxiety about "right turn at an intersection without a green allow signal", "merging and changing lanes" and "placing a car in the garage". When asking about inappropriate behaviors of the drivers with developmental disorder to the family members who are also specialists of developmental disorder in Survey 3, more than half of them brought up the issues including "having narrow field of alert vision and not aware of his/her surroundings", "driving without predicting what is going to happen", "not good at doing more than one thing at the same time", and "easily getting distracted by any movement and noise in his/her surroundings".

Assessing and Promoting Independence in Young Adults with Autism Spectrum Disorder

OBJECTIVE

Quality of life, independence, and employment outcomes are poor for young adults with autism spectrum disorder (YA-ASD). This study explored the desires and experiences of YA-ASD as they transition into adulthood.

METHODS

Fifteen YA-ASD, age 18 to 25 years, were recruited from autism spectrum disorder centers, participant registries, and social media advertising. Interested individuals completed a survey and individual interview. Semistructured interview guides included questions about transition experiences, current independence, and future goals. Interview transcripts were analyzed using thematic analysis.

RESULTS

The desire of young adults with autism spectrum disorder for independence was shown within 4 themes. YA-ASD described their vision of adulthood along with their need for improved skills in driving, living independently, and decision-making.

CONCLUSION

The findings indicate YA-ASD desire to be independent but lack the specific support services to get there.

Executive Function Brain Network Activation Predicts Driving Hazard Detection in ADHD

Drivers with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are at increased risk of experiencing driving difficulties. An important aspect of driving safety and skill involves hazard detection. This functional magnetic resonance imaging study examined the neural responses associated with driving hazard detection in drivers with ASD, ADHD, and typically developing (TD) drivers. Forty participants (12 ASD, 15 ADHD, 13 TD) ages 16-30 years completed a driving simulator task in which they encountered social and nonsocial hazards; reaction time (RT) for responding to hazards was measured. Participants then completed a similar hazard detection task in the MRI scanner so that neural response to hazards could be measured. Activation of regions of interest considered part of the executive function (EF) and theory of mind (ToM) networks were examined and related to driving simulator behavior. Results showed that stronger activation of the EF network during social hazard processing, including the bilateral dorsolateral prefrontal cortex and posterior parietal cortex, was associated with faster RT to social hazards among drivers with ADHD, but not among drivers with ASD. This provides the first evidence of a relationship between EF network brain activation and driving skills in ADHD and suggests that alterations in this network may underlie driving behavior. In comparison, the current study did not observe a relationship between ToM network activation and RT to social hazards in any group. This study lays the groundwork for relating neural activation to driving behavior among individuals with NDDs.

Time-to-Collision Estimations in Young Drivers with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

Individuals with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) may exhibit driving difficulties due to cognitive impairments such as time perception difficulties, a construct related to the perception of time-to-collision (TTC). This study examined the timing abilities of drivers with ASD and ADHD. Sixty participants (n_ADHD = 20, n_ASD = 20, n_TD = 20) completed a time reproduction task and a TTC estimation task in a driving simulator. Results indicated drivers with ASD were less precise in time reproduction across all time intervals and over-reproduced time at shorter intervals. Drivers with ASD produced larger TTC estimates when driving at a faster speed compared to typically developing drivers. Drivers with ASD, but not ADHD, appear to present difficulties in time estimation abilities.

Comparison of Motor Vehicle Crashes, Traffic Violations, and License Suspensions Between Autistic and Non-Autistic Adolescent and Young Adult Drivers

OBJECTIVE

One-third of autistic individuals obtain a driver's license by age 21 years; however, prior studies suggest they may be at heightened risk for motor vehicle crashes. We compared objective rates of crashes, traffic violations, and license suspensions for newly licensed autistic and non-autistic adolescents.

METHOD

This retrospective cohort study included New Jersey residents born from 1987 through 2000 who were patients of the Children's Hospital of Philadelphia health care network. Electronic health records were linked with statewide driver licensing and crash databases. Autism status was classified via International Classification of Diseases (ICD) diagnostic codes; individuals with intellectual disability were excluded. We compared rates among 486 autistic and 70,990 non-autistic licensed drivers over their first 48 months of driving. Furthermore, we examined the proportion of crashes attributed to specific driver actions and crash types.

RESULTS

Compared with non-autistic drivers, autistic drivers were estimated to have lower average monthly rates of crash involvement (adjusted rate ratio (adjRR) = 0.89, 95% CI = 0.75-1.05), moving violations (adjRR = 0.56, 95% CI = 0.48-0.67), and suspensions (adjRR = 0.32, 95% CI = 0.18-0.58). Among drivers involved in a crash, autistic drivers were half as likely to crash because of unsafe speed, but substantially more likely to crash because of their failure to yield to a vehicle/pedestrian and while making left-turns or U-turns.

CONCLUSION

Newly licensed autistic adolescent drivers have similar to lower estimated rates of adverse driving outcomes; the extent to which these can be attributed to different driving patterns is a critical point for future investigation. There were several notable differences in the characteristics of these crashes, which directly inform interventions to improve driving safety of autistic adolescent drivers.

A Cognitive Behavioral Intervention for Driving for Autistic Teens and Adults: A Pilot Study

Background

For many autistic individuals approaching adulthood, interventions to promote skills toward independence are lacking. Driving is an important ability to cultivate as it may be a critical step to attaining independence, securing and maintaining work, and fostering relationships. Only about one third of able autistic individuals drive independently, and fear to drive is a common reason for not driving.

Methods

This initial pilot study was a 3-month open trial to investigate the feasibility, acceptability, and initial estimates of outcomes for the newly developed Cognitive Behavioral Intervention for Driving (CBID) intervention, a manualized curriculum to enhance executive functioning (EF) and emotional regulation (ER) skill development for driving, combined with individualized commentary-based driving simulator practice, in autistic teens and adults within a community research environment. Nineteen participants received the CBID intervention in 1.5-hour group sessions for 10 weeks, across two cohorts, with approximately five individualized driving simulator sessions. Data were collected on anxiety symptoms, driving cognitions, driving attitudes, and simulated driving performance at pre- and post-intervention assessments.

Results

Program completion rate was 81%. Participants and parents rated both the intervention and simulator practice sessions with high satisfaction. All the participants (100%) reported both a positive attitude change (interest toward driving) and a desire to drive in the future at the post-intervention assessment. Significant changes occurred for driving cognitions, attitudes, and behaviors, and 47% of participants obtained a driver's permit or license by 2 months post-intervention.

Conclusions

For autistic individuals, the CBID intervention appeared to directly impact the pursuit toward driving goals by both increasing driving attitudes and behaviors and reducing anxiety/apprehension. This highlights the need for driving intervention programs designed specific to autistic teens/adults that focus on EF and ER skills coupled with individualized simulator practice. CBID could be provided in community services to increase the number of autistic individuals driving.

Lay summary

Why was this study done?: Driving contributes greatly to independence in many teens and adults. Anxiety can act as a barrier to that independence by affecting driving attitudes, ability and performance. Autistic individuals are often affected by anxiety, executive functioning, and emotion regulation challenges. Previous studies show that virtual reality training and Cognitive Behavioral Therapy (CBT), separately, can reduce driving anxiety in autistic individuals and support driving skills. However, to date, no studies have developed and tested a manualized intervention specific to driving that combines such methods.What was the purpose of this study?: The goal of this study was to develop and test a group intervention, called Cognitive Behavioral Intervention for Driving (CBID), combined with individualized, coached driving simulator practice to help reduce fears and increase cognitions, attitudes and performance towards driving. The study examined the following questions: 1) Do autistic individuals actively participate in CBID? 2) Do autistic participants like CBID? and 3) Are autistic participants more prepared to drive after taking part in CBID than they were before they participated in the program?What did the researchers do?: After developing the CBID intervention with community member involvement, the researchers ran 2 intervention groups and individualized driving simulator sessions to a total of 19 enrolled participants. The group intervention focused on strengthening executive functioning and emotion regulation skills in 1.5 hour sessions over 10 weeks and 5, 1 hour driving simulator sessions. Researchers compared data on participant anxiety levels, driving cognitions, attitudes, and performance before and after the intervention.What were the results of the study?: Most of the participants completed the program (81%) and all (100%) rated satisfaction with the group and simulator practice. All (100%) of the participants changed attitudes towards driving. Participants had higher levels of positive thoughts about driving, better attitudes towards wanting to drive and less driving errors (like speeding, collisions, crossing lanes) on the driving simulator after completing CBID. Almost half (47%) of participants obtained a driver's permit or license by 2 months after the intervention.What do these findings add to what was already known?: This study adds a new option of an integrated approach, CBID, for addressing driving anxiety or apprehension. It provides initial findings of the value of incorporating executive functioning skills with traditional cognitive behavior therapy for enhancing driving readiness.What are the potential weaknesses in the study?: This study contained a small sample size that was mostly white male participants. This limits generalizing the results to a representative diverse population. It also did not have a control group or use randomization which means that results can't be interpreted as causal at this time. There was no information about participants obtaining permit/licensure later than 2 months after CBID so it is unclear if some participants require more time to pursue a license. There was no follow up to understand if participants continued to feel comfortable driving overtime.How will these findings help autistic adults now or in the future?: This study showed that it's possible to combine virtual reality training and Cognitive Behavioral Therapy into one driving readiness program. The new CBID program may help autistic adults by addressing multiple aspects of what they need to be ready to drive. Since the study used previously tested strategies, enrolled a community sample, manualized the program, and used a services approach, it was designed for broad distribution to other community settings.

Neuropsychological predictors of driving hazard detection in autism spectrum disorder and ADHD

Driving is a neuropsychologically complex task; this can present challenges for individuals with neurodevelopmental disorders (NDDs) such asautism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Deficits in theory of mind (ToM) and executive function (EF) are common features of ASD and ADHD, respectively, and may influence driving processes such as hazard perception. No studies have directly examined the neuropsychological contributions to hazard detection among drivers with ASD compared to ADHD.In the current study, 48 participants ages 16-30 years (13 ASD, 17 ADHD, 18 typically developing (TD)) completed a driving simulator task in which they encountered hazards in the driving environment. Hazards varied in whether they were social (contained a human component) or nonsocial (were physical objects) to examine the contribution of ToM and social processing to hazard response. Additionally, participants completed a neuropsychological battery targeting ToM and EF/attention skills (cognitive tasks and self-report measures).Within the ASD group, participants responded relatively slower to social compared to nonsocial hazards; no effect of hazard type was observed in the ADHD or TD groups. Additionally, measures of ToM and EF were correlated with driving performanceamong ASD participants; within the ADHD group, only self-reported behavior regulation was associated with driving performance. Broadly, this suggests that cognitive factors such as ToM and EF impact driving hazard performance in ASD and ADHD. The results of the study have implications for developing driving intervention programs for individuals with NDDs.

Support for distracted driving laws: An analysis of adolescent drivers from the Traffic Safety Culture Index from 2011 to 2017

INTRODUCTION

Adolescent drivers are often the focus of traffic safety legislation as they are at increased risk for crash-related injury and death. However, the degree to which adolescents support distracted driving laws and factors contributing to their support are relatively unknown. Using a large, nationally weighted sample of adolescent drivers in the United States, we assessed if perceived threat from other road users' engagement in distracted driving, personal engagement in distracted driving behaviors, and the presence of state distracted driving laws was associated with support for distracted driving laws.

METHODS

The sample included 3565 adolescents (aged 16-18) who participated in the Traffic Safety Culture Index survey from 2011 to 2017. A modified Poisson regression model with robust errors was fit to the weighted data to examine support for distracted driving laws. Models included age, gender, year, state distracted driving laws, personal engagement in distracted driving behavior, and perceived threat from other road users' engaging in distracted driving.

RESULTS

Approximately 87% of adolescents supported a law against texting and emailing compared to 66% who supported a universal handheld cellphone law. Support for distracted driving legislation was associated with greater perceived threat of other road users engaging in distracted driving while accounting for personal engagement in distracted driving, state distracted driving laws, and developmental covariates.

DISCUSSION

Greater understanding of the factors behind legislative support is needed. Public health interventions focused on effectively translating the risks of cellphone use while driving and effective policy will further improve the traffic safety culture.

Localization and Diagnosis of Attention-Deficit/Hyperactivity Disorder

In this paper, a random-forest-based method was proposed for the classification and localization of Attention-Deficit/Hyperactivity Disorder (ADHD), a common neurodevelopmental disorder among children. Experimental data were magnetic resonance imaging (MRI) from the public case-control dataset of 3D images for ADHD-200. Each MRI image was a 3D-tensor of 121×145×121 size. All 3D matrices (MRI) were segmented into the slices from each of three orthogonal directions. Each slice from the same position of the same direction in the training set was converted into a vector, and all these vectors were composed into a designed matrix to train the random forest classification algorithm; then, the well-trained RF classifier was exploited to give a prediction label in correspondence direction and position. Diagnosis and location results can be obtained upon the intersection of these three prediction matrices. The performance of our proposed method was illustrated on the dataset from New York University (NYU), Kennedy Krieger Institute (KKI) and full datasets; the results show that the proposed methods can archive more accuracy identification in discrimination of ADHD, and can be extended to the other practices of diagnosis. Moreover, another suspected region was found at the first time.

A study of the association between cognitive abilities and dietary intake in young women

BACKGROUND

Cognitive abilities comprise activities that relate to receiving and responding to information from the environment, internal processing, making complex decisions, and then responding to this in the context of behavior.

AIM

The current study investigated the association between dietary intake and seven aspects of cognitive abilities among healthy young women.

METHODS

The study was carried out among 182 women aged 18-25 years. A valid and reliable food frequency questionnaire containing 65 food items was used to estimate dietary intake. Neuropsychological function and cognitive abilities of participants were determined using standard questionnaires.

RESULTS

Significant differences were found in depression, anxiety, stress, physical, and mental health-related quality of life as well as daytime sleepiness for the participants in different quartiles of cognitive abilities score (p<0.05). Participants in the fourth quartile of cognitive abilities score consumed significantly higher energy, carbohydrate, protein, calcium, iron, zinc, vitamin A, thiamin, and riboflavin compared to those in the lowest quartile (p<0.05). There were strong correlations between total cognitive abilities score and dietary sodium, calcium, phosphorus, and thiamin (p<0.05). Using stepwise multiple linear regression analysis, iron and thiamin were statistically significant factors for the prediction of cognitive abilities.

CONCLUSIONS

These findings demonstrate that neurocognitive function is related to dietary macro and micronutrients including energy, carbohydrate, protein, calcium, iron, zinc, vitamin A, thiamin, and riboflavin on cognitive performance among young women without memory deficit.

Correction: Bishop, H. et al. Driving among Adolescents with Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder. Safety 2018, 4, 40

The published version of the paper [...]