How does attention deficit hyperactivity disorder affect children’s road-crossing? A case-control study

Abstract

Objective: Children diagnosed with attention-deficit/hyperactivity disorder (ADHD) may have particularly high pedestrian injury risk given their deficits in attention, inhibition, and concentration. The aims of this study were a) to assess differences in pedestrian skill between children with ADHD and typically-developing children and b) to examine relations between pedestrian skill and attention, inhibition, and executive function among children with ADHD as well as among typically-developing children.

Methods: A sample of 50 children with mean age of 9 years participated, 56% of them diagnosed with ADHD. Children completed IVA + Plus, an auditory-visual test evaluating impulse response control and attention and then engaged in a Mobile Virtual Reality (MVR) pedestrian task to assess pedestrian skills. Parents completed the Barkley’s Deficits in Executive Functions Scale-Child & Adolescents (BDEFS-CA) to rate children’s executive function. Children with ADHD engaged in the experiment off any ADHD medications.

Results: Independent samples t-tests indicated significant differences between the two groups in all IVA + Plus and BDEFS_CA scores, supporting the clinical diagnoses of ADHD and the distinction between the two groups. Independent samples t-tests also indicated differences in pedestrian behavior: Children in the ADHD group had significantly higher numbers of unsafe crossings in the MVR environment. Partial correlations within samples stratified by ADHD status indicated that for both groups of children, there were positive correlations between unsafe pedestrian crossings and executive dysfunction. There were no relations between IVA + Plus attentional measures and unsafe pedestrian crossings in either group. A linear regression model predicting unsafe crossings was significant, with children with ADHD more likely to cross in a risky manner after controlling for executive dysfunction and child age.

Conclusions: ADHD children exhibited riskier street-crossing behavior in the MVR, confirming an increased risk of pedestrian injury among children with ADHD compared to typically-developing children. Risky crossing among the typically-developing children and ADHD was related to deficits in executive function. Implications are discussed in relation to parenting and professional practice.

Keywords:

• Executive function
• pedestrian safety
• ADHD
• mobile virtual reality
• injury
• child safety

Acknowledgments

We thank all those supported us in doing the research. The help of Hamid Zolfaghari in collecting a portion of the data and Seyyed Hamid Reza Taghavi in editing the references is appreciated.

Disclosure statement

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no conflicts of interest to disclose.

Data availability statement

Data will be available from the corresponding author upon reasonable request.

Additional information

Funding

Dr. Schwebel’s work on this project was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under Award Number R01HD088415.