Patty Huang

Children with special health care needs: Patterns of safety restraint use, seating position, and risk of injury in motor vehicle crashes

OBJECTIVES. Special health care needs associated with behavioral conditions may influence a childs safety in motor vehicle crashes. The aim of this study was to describe and compare variation in restraint use, seating position, and injury risk in motor vehicle crashes among children with and without special health care needs likely to affect behavior. PATIENTS AND METHODS. This study uses data collected between December 1, 1998, and November 30, 2002, in a cross-sectional study of children <16 years of age who were involved in crashes of State Farm–insured vehicles in 15 states. Parent reports via a validated telephone survey were used to define precrash special health care needs, restraint status, seating position, and the occurrence of clinically significant injuries by using a previously validated survey instrument. RESULTS. Complete data were collected for 14654 children aged 4 to 15 years, representing 171633 children in crashes. Of these, 152 children were reported to have a special need likely to affect behavior, representing 1883 children. A greater proportion of children with special needs likely to affect behavior were appropriately restrained, particularly among children aged 4 to 8 years. Drivers of children with special needs likely to affect behavior were more often restrained and more often were the child passengers parent. There were no differences in the rates of front-row seating. There was no significant association between the presence of a special need likely to affect behavior and risk of injury, after adjustment for child/driver characteristics and crash severity. CONCLUSIONS. Despite a greater proportion of children with special needs likely to affect behavior using proper vehicle restraint, their injury risk was similar to that of children without these special needs. Primary care pediatricians providing best practices for vehicle safety should consider the unique riding experience and risk of injury among children with special health care needs likely to affect behavior.

Developmental and behavioral disorders grown-up-intellectual disability.

CASE VIGNETTES John was diagnosed with mild intellectual disability (ID) in kindergarten when he was having trouble learning letters and numbers and was engaging in disruptive behaviors. He had a psycho-educational assessment that demonstrated a full scale IQ score of 58 and an Adaptive Behavior Composite standard score of 63 on the Vineland Adaptive Behavior Scales. He was initially educated in a regular classroom with special education support, but as he fell further behind his classmates’ academic skills, he spent increasing time in special education classrooms while going to mainstream classrooms for art and music. His parents attempted to arrange activities with typically developing peers but have found this to be increasingly difficult as he has gotten older. He is now 16 and entering his second year of high school. His parents have multiple concerns. Do they need to plan for John to live with them? Will John be able to be employed? John says he does not like school and he wants to work, but is this a good idea? If it is a good idea, how does one help him get a job? What is John’s adult life going to be like?

Longitudinal study of driver licensing rates among adolescents and young adults with autism spectrum disorder

Driving may increase mobility and independence for adolescents with autism without intellectual disability (autism spectrum disorder); however, little is known about rates of licensure. To compare the proportion of adolescents with and without autism spectrum disorder who acquire a learner’s permit and driver’s license, as well as the rate at which they progress through the licensing system, we conducted a retrospective cohort study of 52,172 New Jersey residents born in the years 1987–1995 who were patients of the Children’s Hospital of Philadelphia healthcare network ⩾12 years of age; 609 (1.2%) had an autism spectrum disorder diagnosis. Electronic health records were linked to New Jersey’s driver licensing database (2004–2012). Kaplan–Meier curves and log-binomial regression models were used to determine the age at and rate of licensure, and estimate adjusted risk ratios. One in three adolescents with autism spectrum disorder acquired a driver’s license versus 83.5% for other adolescents and at a median of 9.2 months later. The vast majority (89.7%) of those with autism spectrum disorder who acquired a permit and were fully eligible to get licensed acquired a license within 2 years. Results indicated that a substantial proportion of adolescents with autism spectrum disorder do get licensed and that license-related decisions are primarily made prior to acquisition of a permit instead of during the learning-to-drive process.

Chapter 23 – Young Drivers

Publisher Summary Traffic crashes are the leading cause of injury among teenagers. The causative agents of this crisis are multifold, as research clearly suggests that teenagers represent a unique population of drivers who are influenced by a myriad of physical, social, developmental, behavioral, and environmental factors. One of the key challenges in ensuring road traffic safety among the young, from infancy to young adulthood, is that one must anticipate and design according to the range of safety behaviors, which for children rapidly evolve according to physical, social, emotional, and cognitive developmental stages. The substantial increase in motor vehicle crash injury risk emerges as teens begin to drive and take rides with peers. In adolescence, teen drivers start as learners who are highly dependent on adult supervisors who teach, serve as role models, help to manage the behavior of any passengers within the car, and provide a second “set of eyes” looking for hazards on the road. Within just a year of their first driving experience, most teens are licensed as independent drivers with the primary responsibility for the driving task as well as managing passenger behavior and interacting with other road users. Successful development of driving skills, expertise, and competencies, including psychomotor, cognitive, and perceptual proficiencies, requires a balance between safety limits and the freedom to explore and test the teens ability. Although novice teen drivers can acquire basic operational driving skills, a watershed of new research reveals that biological and cognitive factors inherent to the adolescent developmental period may affect the capacity of young persons to perform safe-driving behaviors effectively.

Current Best Practices for Assessing and Treating Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

PurposeThis article provides updated information about the diagnosis and assessment of attention-deficit/hyperactivity disorder (ADHD), multimodal interventions, strategies for combining behavioral and pharmacological interventions, and approaches for treating ADHD when it occurs with other conditions.Recent findingsADHD is a common neurodevelopmental disorder with a well-documented genetic and neurobiological basis. The assessment of ADHD is grounded in criteria delineated in DSM-5 and includes an assessment of ADHD symptoms, symptom-related impairments, and comorbid conditions. Evidence-based interventions for ADHD include medication, in particular stimulants, and behavioral treatments, including behavioral parent training, classroom behavioral intervention, peer behavioral intervention, and organization skills training. Strategies for combining and sequencing behavioral and medication treatments need to take into account family preferences, problem severity, intervention accessibility, safety considerations, and family level of engagement and motivation. Disparities in ADHD service use as a function of socioeconomic and minority status point to the need for system reforms to improve access to care for all children and adolescents.SummaryEvidence-based interventions for ADHD need to be more accessible for children and families, and strategies need to integrate the efforts of health providers, mental health professionals, and educators.

847 Longitudinal study of driver licensing and motor vehicle crash rates among teens with autism

Background Two-thirds of teens with ASD without intellectual disability (ID) reported that they plan to drive but deficits in attention, cognition, and executive function may impact their ability to drive safely. Almost nothing is known about licensure and crash rates among these teens. We conducted a longitudinal study within a large paediatric healthcare network to compare the rate of obtaining a driver’s license and risk of motor vehicle crash involvement among teens who have ASD without ID and a comparable group of teens who do not. Methods We linked two unique data sources: (1) electronic health records for 68,592 New Jersey (NJ) residents born 1987–1995 who were patients of the CHOP network within 4 years of driving-eligible age; and (2) a database containing the full licensing and crash history of all NJ drivers through June 2012. Subjects were classified as having ASD using ICD-9-CM diagnosis codes and known chronic conditions from their EHR; those with ID were excluded. Licensing rates and crash risk were compared for 682 patients with ASD and 62,719 without ASD using Cox regression to estimate adjusted hazard ratios (HR). Results Subjects had a median [interquartile range] of 6 [2, 17] CHOP visits, were 16.7 [14.7, 18.5] years old at their last visit, and were 20.8 [18.8, 22.9] at the end of the study. Although teens with ASD were much less likely (39% vs. 84%) to obtain a driver’s permit by age 21, the majority (91%) of those who obtained a permit went on to become licensed. Overall, the crash rate for subjects with ASD was lower than for those without ASD (21% vs 33%) with an adjusted HR of 0.75 (95% CI: 0.55, 1.03). Conclusions This is the first study to report objective license and crash data for a cohort of teens with ASD. These findings suggest families decide about independent driving primarily before teens get behind the wheel. Future studies will examine parent-teen interactions and account for driving exposure in effect estimates.