Although children with attention-deficit/hyperactivity disorder, combined type (ADHD-C) behave largely the same as other children when crossing the street, they chose to cross in riskier situations, researchers found.
The findings suggest that executive dysfunction might at least partly explain why kids with ADHD-C have a higher pedestrian injury risk than those with typical development, and those with other developmental disabilities, according to Despina Stavrinos, PhD, of the University of Alabama at Birmingham, and colleagues.
"Future efforts may focus on remediating executive deficits, which may, in turn, prevent pedestrian injuries in this at-risk population," the researchers reported online ahead of the August issue of Pediatrics.
To explore reasons for the greater pedestrian injury risk in children with ADHD-C, Stavrinos and colleagues recruited 78 children, ages 7 to 10. Half had ADHD-C and half -- matched by age, gender, and ethnicity -- had typical development. Most of the participants (71%) were boys.
The children with ADHD all had at least six inattentive and six hyperactivity/impulsive symptoms reported by their parents on the Disruptive Behavior Rating Scale. Those taking medication were required to stop taking it for 24 hours before the study.
The researchers assessed the children's pedestrian behaviors using an interactive, virtual environment, looking at what the children did before crossing the street, at the time they decided to cross, and during the crossing. All of the participants completed one 90-minute session during which they performed 15 simulated street crossings.
The children with ADHD-C chose less safe environments in which to cross than the other children (P<0.05), with smaller gaps in traffic and less time to spare between reaching the end of the crosswalk and the next car driving by. There were no differences in other aspects of the crossing process.
"Children with ADHD-C seem to display appropriate curbside pedestrian behavior but fail to process perceived information adequately to permit crossing safely," Stavrinos and colleagues wrote.
Although the children with ADHD-C had greater executive dysfunction, inattention, and oppositionality (resistance to following requests), only executive dysfunction was a significant mediator of the relationship between ADHD-C and crossing safety (P<0.05).
"Crossing the street safely requires the ability to plan and to inhibit responses such as darting into the street under unsafe conditions, both abilities controlled by the executive system and shown as central impairments in children with ADHD-C," the researchers wrote.
They noted that it is possible to intervene to prevent pedestrian injuries, even among children with ADHD-C.
"Pediatricians can play an important role in preventing childhood pedestrian injuries by screening for ADHD symptoms in their patients and monitoring the children who are identified as at risk to reduce later risk for injury," they wrote.
"Transportation engineers have initiated successful injury-prevention efforts through environmental and automobile modifications, but the future of interventions also must come via behavior modification," which could be achieved through training using virtual reality, they wrote.
The researchers noted two primary limitations to their study: the lack of a control group of children with other developmental disabilities and possible selection bias, in which undiagnosed and untreated children with ADHD were excluded and patients from high socioeconomic status groups were underrepresented.
The study was supported, in part, by grants from the Society for Public Health Education, National Science Foundation, Center for Child Injury Prevention Studies, and Society for Pediatric Psychology. Development of the virtual environment was partially supported by the University of Alabama at Birmingham Injury Control Research Center through a grant from the National Center for Injury Prevention and Control and a cooperative agreement with the Federal Highway Administration.
The authors reported that they had no conflicts of interest.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner