ADHD road safety concerns

26^th July 2011 - Whether it was advice from Tufty in the past or the Green Cross Code now, the advice has always been to look both ways before crossing the road, but this road safety advice may not be enough for children with attention deficit hyperactivity disorder (ADHD).

These children are at increased risk of being struck by a car when crossing the street because they sometimes make incorrect decisions about when to cross and how long it will take to get to the other side, according to a new study in the journal Pediatrics.

Previous research

The new study backs up a 2003 UK report for the Department for Transport which found that children with ADHD were found to be over-represented among child casualties from pedestrian and cycling accidents. The risk of fatal pedestrian accidents among adults with learning difficulties appeared to be two to three times greater than among the general population.

Scottish government road safety advice for children with ADHD highlights the usual practical roadside pedestrian outings and training may "present unacceptable risks for these children because of their excessive, incessant movement and sudden, inappropriate behaviours". It cites studies which suggested that role play may be a more appropriate way of teaching road safety to children with ADHD.

ADHD

The NHS says ADHD affects between 3-9% of school age children and young people in the UK. ADHD is  a behavioural disorder marked by impulsiveness, hyperactivity and inattention. 

Children with untreated ADHD are at risk of injury, substance abuse, poor school performance and emotional and social problems.

The study findings

"I came in thinking that kids with ADHD probably won't look left and right before they cross, but they did display appropriate curbside behaviour," says Dr Despina Stavrinos, an assistant professor in the University of Alabama Injury Control Research Center in the US. The big difference, however occurred in the outcome of the crossing.

The 78 children in the study were aged between seven and 10. Researchers tested the children's road crossing skills using a simulated street scene with vehicles approaching from the left and right. All the children looked left and right before crossing and waited to cross. However, the 39 children with ADHD did experience more "close calls" with oncoming traffic and had less time to spare when they reached the other side of the street.

This highlights deficits in "executive functioning", or the ability to make and carry out plans, Stavrinos says.

Whether or not treating ADHD with medication would affect behaviour is not known, but studies of drivers with ADHD have shown that treatment can improve driving performance.

Many children with ADHD take their medication in the morning, and it begins to wear off at the end of the day when they are more likely to be crossing the street as they walk home from school, Stavrinos points out. "Many parents also give kids medication holidays [medication free periods] during the summer, which is when they are outside more."