Risk factors affecting Driving Behaviour during Adolescence John Brennan, Director Child & Adolescent Mental Health Service Sydney Children’s Hospital

Risk factors affecting Risk factors affecting Driving Behaviour during Driving Behaviour during

AdolescenceAdolescence

John Brennan, Director Child & Adolescent John Brennan, Director Child & Adolescent Mental Health Service Sydney Children’s Mental Health Service Sydney Children’s

Hospital Hospital Associate Professor (UNSW Conjoint)Associate Professor (UNSW Conjoint)

SCH Grand Rounds June 10/2009SCH Grand Rounds June 10/2009

Fatality rates for 12-month period ending May 2009

NSW RTA Data Number of fatalities 448

Rate per 100,000 population¹ 6.4

Rate per 10,000 vehicles² 1

Rate per 100 million vehicle kilometres travelled³0.7

Casualty rates for 12-month period ending April 2009

Number of casualties* 24,149

Rate per 100,000 population¹ 345

Rate per 10,000 vehicles² 54

Rate per 100 million vehicle kilometres travelled³ 38

Number of fatalities for 12 months ending May 2009,

sex of fatality

Distribution of fatalities for 12 months ending May 2009, by age

and road user class

Number of fatalities for 12 months ending May 2009,

age of fatality

Trends for fatalities and motor vehicle travel since 1978

NSW crash statistics show that young people are over-represented as drivers and motorcycle riders in fatal crashes.

People under 26 comprise only 15% of driver licences

but are involved in 36% of road fatalities

Young driver safety

A 17-year-old driver with a P1 licence is about four times more likely to be involved in a fatal crash than a driver aged 26 or older.

Within the over-representation of young people in crashes, males stand out as a concern. Males make up 79% of the drivers under 26 involved in fatal crashes.

Cases of Death USA 2005Cases of Death USA 2005

PATTERNS OF RISK FOR PATTERNS OF RISK FOR ADOLESCENT DRIVERSADOLESCENT DRIVERS

In assessing risk, In assessing risk, age mattersage matters 16-19yrs if data is aggregated, lose important 16-19yrs if data is aggregated, lose important

information about age as a risk factorinformation about age as a risk factor Similar issues when considering older drivers Similar issues when considering older drivers

65+, 75+, 85+65+, 75+, 85+ Distance travelled allows comparison of crash Distance travelled allows comparison of crash

risk, relative to exposurerisk, relative to exposure License data – per person ratesLicense data – per person rates Population data – overall risk for age groupPopulation data – overall risk for age group

(slides refer to US date aggregated across 50 (slides refer to US date aggregated across 50 states)states)

TEENAGE DRIVERS TEENAGE DRIVERS RISK FACTORS RISK FACTORS

(AF WILLIAMS (2003)(AF WILLIAMS (2003)

Teenage driving risks can be considered Teenage driving risks can be considered under 3 headings.under 3 headings.

(a)(a) Situations where risk is elevated for Situations where risk is elevated for all driversall drivers

(b)(b) Situations where risk is elevated for Situations where risk is elevated for teenage drivers relative to older driversteenage drivers relative to older drivers

(c)(c) situations where risk is unique to situations where risk is unique to teenagersteenagers

Teenage drivers: patterns of risk(In The United States)

Allan F. Williams* Journal of Safety Research 34 (2003) 5– 15

The following slides-indicate that younger and The following slides-indicate that younger and older drivers have the highest ratesolder drivers have the highest rates

Younger > older crash ratesYounger > older crash rates Males > femalesMales > females Women > males, per mile drivenWomen > males, per mile driven Fatal crash rates per distance travelled 16yr olds Fatal crash rates per distance travelled 16yr olds

greatestgreatest Older drivers greater fatality rate/mile – as they Older drivers greater fatality rate/mile – as they

are more fragileare more fragile

Note: mileage based rates exaggerates risks for Note: mileage based rates exaggerates risks for younger and older drivers. They are driving younger and older drivers. They are driving shorter distances on more congested shorter distances on more congested roads/younger drivers more night time exposure.roads/younger drivers more night time exposure.

Teenage drivers: patterns of riskAllan F. Williams* Journal of Safety Research 34 (2003) 5–

15Driver crash involvements per million miles travelled, 1995.

Teenage drivers: patterns of riskAllan F. Williams* Journal of Safety Research 34 (2003) 5– 15

Driver fatal crash involvements per million miles travelled, 1995.

Teenage drivers: patterns of riskAllan F. Williams*

Journal of Safety Research 34 (2003) 5– 15

Crashes / licence holderCrashes / licence holder Youngest 16-19 (greatest for all crashes, Youngest 16-19 (greatest for all crashes,

greatest for fatal crashes)greatest for fatal crashes) Young males slightly greater crash rateYoung males slightly greater crash rate

Per capita ratesPer capita rates-- youngest least likely to have a youngest least likely to have a licence solicence so

16yr olds lowest/capita16yr olds lowest/capita-- fatal crashes/16yr olds, and 20-24yr fatal crashes/16yr olds, and 20-24yr have highest have highest per capitaper capita


Driver fatal crash involvements per 100,000 licensed drivers, 2000.

Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15

Driver crash involvements per 1,000 population, 2000.


Journal of Safety Research 34 (2003) 5– 15

Driver fatal crash involvements per 100,000 population, 2000.


Journal of Safety Research 34 (2003) 5– 15Crashes per 10,000 drivers, by months of permit or

licensure, Nova Scotia.

Learner periodLearner period – low risk as parents are supervising – low risk as parents are supervising

Permit periodPermit period – Nova Scotia data; Clear increased risk – Nova Scotia data; Clear increased risk immediately following Licensingimmediately following Licensing


Journal of Safety Research 34 (2003) 5– 15All crashes per million miles, day versus night, by driver

age, 1995.

Night time driving risk – greatest risk especially in younger drivers.Night time driving risk – greatest risk especially in younger drivers.


Journal of Safety Research 34 (2003) 5– 15Fatal crashes per 100 million miles, day versus night,

by driver age, 1995.

Night time greater risk for fatal crashes Night time greater risk for fatal crashes drivers 16-20 even greater relative increase than in daytimedrivers 16-20 even greater relative increase than in daytime


Sixteen- to 17-year-old drivers in all crashes, hour by hour, 1995.


Journal of Safety Research 34 (2003) 5– 15Sixteen- to 17-year-old drivers in fatal crashes, hour by

hour, 1995.

Per trip students are 44 times more likely to be killedPer trip students are 44 times more likely to be killed in a vehicle with a teen driver than whilst riding a school bus.in a vehicle with a teen driver than whilst riding a school bus.

Time of day – fatal crashes two peaks; before and after school Time of day – fatal crashes two peaks; before and after school day for 16/17yr old drivers.day for 16/17yr old drivers.

Teenage DriversTeenage Drivers

AlcoholAlcohol

Low in teenage drivers compared to older Low in teenage drivers compared to older driversdrivers

When young drivers do drink however, theirWhen young drivers do drink however, their

relative increase in risk is greater than relative increase in risk is greater than olderolder

driversdrivers

Alcohol related fatalities have fallenAlcohol related fatalities have fallen

substantially due to changes in law.substantially due to changes in law.

Socio-cultural risk Socio-cultural risk FactorsFactors

Driving is a rite of passage and a developmental Driving is a rite of passage and a developmental milestone for most adolescentsmilestone for most adolescents

Driving can be crucial for many young persons Driving can be crucial for many young persons employment and education employment and education

Driving contributes to normal social Driving contributes to normal social development, self confidence and esteem with development, self confidence and esteem with peerspeers

Adolescents value driving as an opportunity for Adolescents value driving as an opportunity for getting together with other adolescents without getting together with other adolescents without being supervised and scrutinized by adults being supervised and scrutinized by adults

Music, distracting talk, joking around together, Music, distracting talk, joking around together, are considered to be important pleasurable are considered to be important pleasurable aspects of teenage driving experience but can aspects of teenage driving experience but can encourage risk takingencourage risk taking

Crash Risks Unique to Crash Risks Unique to AdolescenceAdolescence

Having passengers in the vehicleHaving passengers in the vehicle-- creates a social situation affecting creates a social situation affecting driving driving behaviourbehaviour-- associated with increased riskassociated with increased risk

It is a very high-risk situation for teenage It is a very high-risk situation for teenage driversdrivers

to have multiple passengers when they are alsoto have multiple passengers when they are alsoteenagers.teenagers. More than 50% of all deaths in crashes of 16-17 More than 50% of all deaths in crashes of 16-17

year old drivers occur when passengers year old drivers occur when passengers younger than 20 years old are present and younger than 20 years old are present and there is no adult in the vehicle.there is no adult in the vehicle.

Teenage Passenger Crash Teenage Passenger Crash fatality Rates:fatality Rates:

Many teens die as passengers in motor Many teens die as passengers in motor vehicles.vehicles.

-- 40% of deaths in 16-19 yr olds 40% of deaths in 16-19 yr olds travelling in passenger vehicles were travelling in passenger vehicles were passengers.passengers.

-- for 16yr olds it is 50% of fatalitiesfor 16yr olds it is 50% of fatalities

-- often travelling with teenage often travelling with teenage driversdrivers


Deaths of passengers in passenger vehicles per 100,000 population, United States, 2000.

Crash Risks Unique to Crash Risks Unique to AdolescenceAdolescence

Crash rates by driver age and number of Crash rates by driver age and number of passenger present per 10,000 trips.passenger present per 10,000 trips. With increasing numbers of passengers the risk for older With increasing numbers of passengers the risk for older

driver fallsdriver falls For teenagers the rate increases exponentially with 1-3 For teenagers the rate increases exponentially with 1-3

plus passengersplus passengers The risk increases for male and female drivers with night The risk increases for male and female drivers with night

time rates being highertime rates being higher The highest risk for male and female teenager drivers is The highest risk for male and female teenager drivers is

with male passengerswith male passengers The risk for teenage males falls with female passengers.The risk for teenage males falls with female passengers. The presence of one male passenger doubles the fatality The presence of one male passenger doubles the fatality

rate; the presence of two male passengers doubles the rate; the presence of two male passengers doubles the fatality rate again ( for male and female teenage drivers)fatality rate again ( for male and female teenage drivers)

Driving behaviour is affected, increased speed, increased Driving behaviour is affected, increased speed, increased risksrisks

But when carrying female passengers teenagers drive But when carrying female passengers teenagers drive more safelymore safely


Crash rates by driver age and passenger presence per 10,000 trips.

Only one-third of people killed in fatal crashes involving Only one-third of people killed in fatal crashes involving teen drivers are the drivers themselvesteen drivers are the drivers themselves

The analysis of U.S. crash data from 1998 to The analysis of U.S. crash data from 1998 to 2007 showed that crashes involving drivers aged 2007 showed that crashes involving drivers aged 15 to 17 killed 28,138 people. Of those, 10,388 15 to 17 killed 28,138 people. Of those, 10,388 (36.9 percent) were the teen drivers. The other (36.9 percent) were the teen drivers. The other 17,750 (63.1 percent) included, 8,829 17,750 (63.1 percent) included, 8,829 passengers of the teen drivers, 6,858 occupants passengers of the teen drivers, 6,858 occupants of other vehicles, and 2,063 non-motoristsof other vehicles, and 2,063 non-motorists..

. .

A previous analysis of data from 1995 to 2004 found that crashes A previous analysis of data from 1995 to 2004 found that crashes involving drivers aged 15 to 17 killed 30,917 people. Of those involving drivers aged 15 to 17 killed 30,917 people. Of those deaths, 36.2 percent were the teen drivers and 63.6 percent were deaths, 36.2 percent were the teen drivers and 63.6 percent were others. The drop in deaths between this and others. The drop in deaths between this and the most recent the most recent analysis suggests that graduated licensing and other efforts to analysis suggests that graduated licensing and other efforts to improve teen driver safety are having an effect. improve teen driver safety are having an effect.

National Young-Driver Survey

Our data reveal a striking lack of awareness of how inexperience among adolescent drivers affects safety.

Although 60% believed that

inexperience heavily influences

safety, only 15% reported exposure to inexperienced drivers in a sample that

solely included passengers and

young drivers, nearly all of whom would be considered inexperienced by experts.

Inexperience is heavily mitigated during the learner period when a parent is present. A teen’s risk is at its lifetime highest level on the first day of independent driving. This risk continues to be disproportionately highfor the first 6 months of independent driving and doe not reach adult levels until the age of 25 years. The steep decline that begins after the first month of driving demonstrates that inexperience contributes most heavily to crashes. Developmental factors, including cognitive immaturity, emotional liability, and risk taking, also affect crash rates. if these developmental factors were the primary forces contributing to crashes, a much slower decline in crash rates would be expected.

National Young-Driver Survey

Driving Performance & Traffic Driving Performance & Traffic Accidents Accidents

(Barkley et al, 2004)(Barkley et al, 2004)

Human factors are considered to be the Human factors are considered to be the most common cause of automobile most common cause of automobile accidentsaccidents

Driving is a complex multidimensional Driving is a complex multidimensional behaviour that can be conceptualised on behaviour that can be conceptualised on three hierarchical levels of competencythree hierarchical levels of competency

1.1. StrategicStrategic2.2. TacticalTactical3.3. OperationalOperational

Deficits in lower levels especially at the Deficits in lower levels especially at the operational, can have a profound effect on operational, can have a profound effect on higher levels of competency.higher levels of competency.

Operational CompetencyOperational Competency

Comprises elementary mental Comprises elementary mental functionsfunctions

Attention and concentrationAttention and concentration Reaction timeReaction time Visual scanningVisual scanning Spatial perception and orientationSpatial perception and orientation Visual motor integrationVisual motor integration Speed of cognitive processing Speed of cognitive processing Motor co-ordinationMotor co-ordination

Driving Performance & Traffic Driving Performance & Traffic AccidentsAccidents

Inattention and distraction from Inattention and distraction from within the vehicle (eg mobile phone, within the vehicle (eg mobile phone, playing with radio/CD, iPod, talking playing with radio/CD, iPod, talking to other passengers) is among the to other passengers) is among the most common contributors to traffic most common contributors to traffic accidents.accidents.

TACTICAL COMPETENCYTACTICAL COMPETENCY Skills and decision making to deal with Skills and decision making to deal with

different driving conditions different driving conditions

EgEg - dense traffic- dense traffic- rain- rain- intersections- intersections- traffic lights- traffic lights- changing speed limits- changing speed limits- passing other vehicles- passing other vehicles- country roads- country roads- rough roads - rough roads - navigating unfamiliar areas- navigating unfamiliar areas

STRATEGIC COMPETENCYSTRATEGIC COMPETENCY

Decisions about whether to drive and Decisions about whether to drive and whenwhen

egeg - weather conditions- weather conditions

- time of day and impact of - time of day and impact of fatiguefatigue

- time needed to complete- time needed to complete journey journey

- route to take- route to take

- rest stops- rest stops

- vehicle safety (ie. roadworthy)- vehicle safety (ie. roadworthy)

Association of driving with the 3 hierarchical levels of competency — operational, tactical, and strategic.

Russell A. Barkley , Daniel CoxJournal of Safety Research 38 (2007) 113–128

Teenage drivers with ADHD Teenage drivers with ADHD

A review of driving risks and impairments associated withADHD


Inattention/distractibility key factors Inattention/distractibility key factors increasing riskincreasing risk Young drivers with ADHD-- key findingsYoung drivers with ADHD-- key findings 2-4 times more risk of traffic accidents2-4 times more risk of traffic accidents 3 times more risk of injuries3 times more risk of injuries 4 times more risk of being at fault4 times more risk of being at fault 6-8 times more risk of license suspension6-8 times more risk of license suspension

Comorbid factors which add to riskComorbid factors which add to risk Increased aggressionIncreased aggression Poor emotional regulation, angerPoor emotional regulation, anger Increased risk taking / limited insightIncreased risk taking / limited insight If Conduct Disorder is also diagnosedIf Conduct Disorder is also diagnosed

Anger, aggression, risky behavior, and crash-related outcomes in three groups

of drivers. Deffenbacher, J. L., Lynch, R. S., Filetti, L. B., Dahlen, E. R., &

Oetting, E. R.(2003). Behavioral Research and Therapy, 41(3),

333−349. Driving anger has been shown to be positively correlated

with loss of concentration while driving, loss of vehicular

control, near-collisions, and generally aggressive driving

practices (Deffenbacher et al., 2000). High-anger drivers report, more aggressive and less

constructive forms of expressing anger while driving,

more aggressive and risky behaviour on the road, more frequent displays of anger and aggression

when provoked during driving, and a greater number of crashes than do low-anger

drivers (Deffenbacher et al., 2003).

The social re-orientation of adolescence: a neuroscience perspective on the process and

its relation to psychopathologyERIC E. NELSON*, ELLEN LEIBENLUFT, ERIN B. MCCLURE AND DANIEL S. PINE

Psychological Medicine, 2005, 35, 163–174. Observed alterations in adolescent social

behaviour reflect genetically programmed developmental changes in the Cerebral Cortical Social Information Processing Network, (SIPN)

This Network can be divided into 3 Subsystems

1. The Detection Node 2. The Affect Node 3. The Cognitive Regulation Node

A schematic depiction of the main regions contained within each of the three nodes of the Social Information Processingnetwork (SIPN).

Brain regions that make up the Detection node include the fusiform face area, the superior temporal sulcus and theanterior temporal cortex.

involved in carrying out basic perceptual processes on social stimuli and are highlightedin green

Developmental studies of brain processing inhumans have generally found that brain systemsin the detection node mature quite early in life.

Brain regions that make up the Affective node include the amygdala, hypothalamus, nucleus

accumbens, and bed nucleus of the stria terminalis and are highlighted in red.

The regions that make up the affective node are densely innervated by gonadal steroid receptors and undergo both functional and anatomicalreorganization during puberty

Brain regions that make up the Cognitive-Regulation Node include the dorsomedial prefrontal cortex and the

ventral prefrontal and Orbito-frontal cortex are depicted in blue.

Detailed morphometric studies have shownthat portions of the prefrontal cortex, including Orbito-frontal, ventrolateral, and medial prefrontal regions, do not reach maturity until early adulthood, typically in the late teens or early twenties (Sowell et al. 1999; Casey et al. 2000; Gogtay et al. 2004).

This node is involved in inhibiting motivated response tendencies and understanding the psychological perspective of other individuals as in theory of-mind tasks.

Neurodevelopmental Trajectories of the Human CerebralCortex, Philip Shaw,1 Noor J.

Kabani,3 Jason P. Lerch,4 Kristen Eckstrand,1 Rhoshel et al, The Journal of Neuroscience, April 2, 2008 • 28(14):3586 –3594

Developmental Trajectories of theOrbito-frontal Cortex

The social re-orientation of adolescence: a neuroscience

perspectiveERIC E. NELSON*, ELLEN LEIBENLUFT, ERIN B. MCCLURE AND DANIEL

S. PINEPsychological Medicine, 2005, 35, 163–174. f 2004 While rapid and dramatic changes occur in the affective

node of the SIPN at the onset of puberty, resulting in powerful emotional urges for sexual behaviour independence and the formation of new social bonds (Steinberg & Morris, 2001), the maturation of the cognitive node lags behind by several years (Beauregard et al. 2001; Casey et al. 2000; Ochsner et al. 2002; Schafer et al. 2002).

Thus, in individuals who have powerful emotional responses to social stimuli the ability to regulate, contextualize, plan, or inhibit newly emergent and highly motivated behaviour in a context-appropriate manner is far from mature. This mismatch may lead to behavioural

difficulties for some individuals.

The American Academy of Pediatrics advises The American Academy of Pediatrics advises pediatricians to:pediatricians to:

* Ask 16-year-olds if they are applying for a driver's * Ask 16-year-olds if they are applying for a driver's permit soon. permit soon.

* Discuss driving risks and ask probing questions about * Discuss driving risks and ask probing questions about driving behaviour. driving behaviour.

* Ask specific questions about medication use, use of * Ask specific questions about medication use, use of alcohol, night-time driving, seatbelt use, and use of a alcohol, night-time driving, seatbelt use, and use of a cell phone while driving. cell phone while driving.

* Encourage parents to place driving restrictions on * Encourage parents to place driving restrictions on their teenagers, such as making sure the novice driver is their teenagers, such as making sure the novice driver is accompanied by an adult. accompanied by an adult.

* Ask parents to consider a written contract with their * Ask parents to consider a written contract with their children, establishing the rules of engagement and children, establishing the rules of engagement and penalties for failure to follow them. penalties for failure to follow them.

* Remind teens and parents that many state laws restrict * Remind teens and parents that many state laws restrict cell phone use and night-time driving for novice drivers. cell phone use and night-time driving for novice drivers.

ADHD especially if associated with ODD and poor anger ADHD especially if associated with ODD and poor anger management places adolescents at particularly high management places adolescents at particularly high risk.risk.

P1 drivers must:P1 drivers must: Have P plates (red P on white background) displayed conspicuously at the front Have P plates (red P on white background) displayed conspicuously at the front

and rear exterior of the car when driving. The letter P on the plate must not be and rear exterior of the car when driving. The letter P on the plate must not be hidden. If towing a trailer, a P plate must be on the back of the trailer. hidden. If towing a trailer, a P plate must be on the back of the trailer.

Not exceed zero blood alcohol concentration (this means you cannot drink Not exceed zero blood alcohol concentration (this means you cannot drink before driving). It is also illegal to drive under the influence of drugs.before driving). It is also illegal to drive under the influence of drugs.

Observe a maximum speed limit of 90 km/h.Observe a maximum speed limit of 90 km/h. Observe towing restrictions (you are only allowed to tow light trailers of up to Observe towing restrictions (you are only allowed to tow light trailers of up to

250 kilograms unloaded weight). 250 kilograms unloaded weight). Not accumulate more than three demerit points. Not accumulate more than three demerit points. Be restricted to driving an automatic or clutchless manual transmission vehicle, Be restricted to driving an automatic or clutchless manual transmission vehicle,

if the test was not passed in a manual vehicle. if the test was not passed in a manual vehicle. Not supervise a learner driver.Not supervise a learner driver. Not upgrade the licence to a higher class.Not upgrade the licence to a higher class. If aged under 25, you may only carry one passenger under the age of 21 If aged under 25, you may only carry one passenger under the age of 21

between 11pm and 5am.between 11pm and 5am. Only carry the number of passengers that can be properly seated in seats and Only carry the number of passengers that can be properly seated in seats and

restrained by approved seat belts or child restraints.restrained by approved seat belts or child restraints. Only drive vehicles that have a seat belt fitted to the driver's position and you Only drive vehicles that have a seat belt fitted to the driver's position and you

must wear the seat belt.must wear the seat belt. Not use any functions of a mobile phone including hands-free devices.Not use any functions of a mobile phone including hands-free devices. Not drive certain prohibited vehicles.Not drive certain prohibited vehicles. Failure to comply with any of the above requirements is an offence and carries Failure to comply with any of the above requirements is an offence and carries

heavy penalties, including loss of licence. P1 licence holders will also have their heavy penalties, including loss of licence. P1 licence holders will also have their licence suspended for at least three months for any speeding offence.licence suspended for at least three months for any speeding offence.

Gogtay, N., Giedd, J. N., Lusk, L., Hayashi, K. M., Greenstein, D.,

Vaituzis, A. C., Nugent, T. F., Herman, D. H., Clasen, L. S., Toga,

A. W., Rapopport, J. L. & Thompson, P. M. (2004). Dynamic

mapping of human cortical development during childhood

through early adulthood. Proceedings of the National Academy of

Sciences USA 101, 8174–8179.

Dzirasa also urges pediatricians to learn about their state's driving Dzirasa also urges pediatricians to learn about their state's driving laws and discuss them with both teens and parents. Maryland has a laws and discuss them with both teens and parents. Maryland has a graduated driver's licensing law that eases novice drivers into graduated driver's licensing law that eases novice drivers into driving in three stages: learner's permit, provisional license and driving in three stages: learner's permit, provisional license and driver's license. Research shows that graduated licensing reduces driver's license. Research shows that graduated licensing reduces both the number of accidents and the number of severe injuries, both the number of accidents and the number of severe injuries, Dzirasa says. For example, one study showed that graduated Dzirasa says. For example, one study showed that graduated licensing led to 35 percent fewer crashes that require licensing led to 35 percent fewer crashes that require hospitalizations among 16-year-olds. Other studies have shown that hospitalizations among 16-year-olds. Other studies have shown that the crash rate among 16- year-olds dropped by 26 percent to 41 the crash rate among 16- year-olds dropped by 26 percent to 41 percent in the first year after the adoption of a graduated licensing percent in the first year after the adoption of a graduated licensing law. law.

High-risk behaviors or conditions among teen drivers include lack of High-risk behaviors or conditions among teen drivers include lack of experience; nonuse of seatbelts; alcohol and other drug use; common experience; nonuse of seatbelts; alcohol and other drug use; common pediatric conditions, such as ADHD, that increase accident risk; use pediatric conditions, such as ADHD, that increase accident risk; use of cell phones and audio equipment that distract drivers; nighttime of cell phones and audio equipment that distract drivers; nighttime driving; and the "it can't happen to me" thinking that's typical of driving; and the "it can't happen to me" thinking that's typical of teenagers and youth. teenagers and youth.

In 2001 alone, 3,600 teens died in car accidents and 337,000 were In 2001 alone, 3,600 teens died in car accidents and 337,000 were injured, according to the National Highway Traffic Safety injured, according to the National Highway Traffic Safety Administration. Administration.

A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance Russell A. Barkley Daniel Cox. Journal of Safety Research 38 (2007) 113–128

Committee on Injury, Violence, and Poison Prevention and Committee on Adolescence

Pediatrics 2006;118;2570-2581

Young driver safety

Crashes and passengers Young drivers have a greater risk of

involvement in a fatal crash if they have two or more passengers.

Of the 89 young drivers involved in fatal crashes from

2001 to 2003, 36 per cent were driving with two or more passengers.

This contrasts with 15 per cent for drivers aged 26 and over.

Young driver safety

Time of crash The involvement of young drivers in late night and

early morning fatal crashes is significantly higher than that of older drivers as outlined in figure 3.

Of the 96 P plate drivers aged under 26 who were involved in fatal crashes from 2001 to 2003, 33% crashed between 10pm and 5am.This compared with 14% of drivers aged 26 years and over.

Young drivers with a P licence are six times more likelyto be involved in a fatal crash between 10pm and 5amthan other drivers.**The over-involvement of young drivers is highest onFriday and Saturday nights. However, young drivers arealso over-represented on other nights of the week.

National Young-Driver Survey: Teen Perspective and Experience With Factors

That Affect Driving Safety Pediatrics 2008;121;e1391-e1403

Kenneth R. Ginsburg, Flaura K. Winston, Teresa M. Senserrick, Felipe García-España, Sara Kinsman, D. Alex Quistberg, James G. Ross and Michael R Elliott.

Factors related to seat belt use among Factors related to seat belt use among fatally injured teenage drivers fatally injured teenage drivers Anne T. Anne T. McCarttMcCartt , ,

and Veronika Shabanova and Veronika Shabanova NorthrupNorthrup

Seat belt use was examined for teenage (16–19 years) drivers Seat belt use was examined for teenage (16–19 years) drivers who were who were fatally injuredfatally injured in traffic crashes occurring in the in traffic crashes occurring in the United States during the years 1995–2000.United States during the years 1995–2000.

Results:Results: During 1995–2000, During 1995–2000, mean belt use was 36% among mean belt use was 36% among fatally injuredfatally injured teenage drivers teenage drivers

and 23% among fatally injured teenage passengersand 23% among fatally injured teenage passengers.. Lower belt use among fatally injured teenage drivers was Lower belt use among fatally injured teenage drivers was

associated with associated with increasing ageincreasing age;; Male drivers; Male drivers; Drivers of SUVs, vans, or pickup trucks rather than cars; older Drivers of SUVs, vans, or pickup trucks rather than cars; older

vehicles; vehicles; crashes occurring crashes occurring late at nightlate at night; ; crashes occurring on crashes occurring on rural roadwaysrural roadways; single vehicle crashes; ; single vehicle crashes; and drivers with BACs of 0.10 or higher. and drivers with BACs of 0.10 or higher. Teenage driver belt use declined as the number of teenage Teenage driver belt use declined as the number of teenage

passengers increasedpassengers increased, , but increased in the presence of at least one passenger 30 years but increased in the presence of at least one passenger 30 years

or older. or older.

Passenger effects on teenage driving and Passenger effects on teenage driving and opportunities for reducing the risks of such opportunities for reducing the risks of such

traveltravel llan F. llan F. WilliamsWilliamsaa, , , , , Susan A. , Susan A. FergusonFergusonbb and Anne T. and Anne T. McCarttMcCarttcc

bFerguson International LLC, 1328 Lancia Drive, McLean, VA 22102, USA bFerguson International LLC, 1328 Lancia Drive, McLean, VA 22102, USA 20072007 Despite passenger restrictions in the Despite passenger restrictions in the

majority of US states, majority of US states, 42% of 16- and 17-year-old drivers in 42% of 16- and 17-year-old drivers in

fatal crashes in 2005 were transporting fatal crashes in 2005 were transporting teenagers with no adults in the vehicle;teenagers with no adults in the vehicle;

61% of teenage passenger deaths 61% of teenage passenger deaths (1,222 in 2005) occurred in vehicles (1,222 in 2005) occurred in vehicles driven by other teenagers.driven by other teenagers.

Wider application of passenger Wider application of passenger restrictions is indicatedrestrictions is indicated..

Ways to make passenger restrictions more Ways to make passenger restrictions more effective are needed, and other techniques effective are needed, and other techniques for reducing this major problem need for reducing this major problem need development and testing.development and testing.

Association of driving with the 3 hierarchical levels of competency — operational, tactical, and strategic.


The effect of teenage passengers on the fatal crash risk The effect of teenage passengers on the fatal crash risk of teenage driversof teenage drivers

Preusser, DF | Ferguson, SA | Williams, AFPreusser, DF | Ferguson, SA | Williams, AFAccident Analysis & Prevention Accident Analysis & Prevention

[Accid. Anal. Prev.]. Vol. 30, no. 2, pp. 217-222. Mar 1998.[Accid. Anal. Prev.]. Vol. 30, no. 2, pp. 217-222. Mar 1998.

Fatal crash-involved drivers of passenger vehicles were identified Fatal crash-involved drivers of passenger vehicles were identified in the Fatality Analysis Reporting System for the period 1990 in the Fatality Analysis Reporting System for the period 1990 through 1995. Each driver was categorized as being alone in the through 1995. Each driver was categorized as being alone in the vehicle at the time of the crash or with one or more passengers. vehicle at the time of the crash or with one or more passengers. Drivers at fault or responsible for crash occurrence were Drivers at fault or responsible for crash occurrence were defined as all drivers involved in a single-vehicle crash, or defined as all drivers involved in a single-vehicle crash, or drivers in multiple-vehicle crashes who were coded in the drivers in multiple-vehicle crashes who were coded in the Fatality Analysis Reporting System as committing one or Fatality Analysis Reporting System as committing one or more driver errorsmore driver errors. . The results indicated that passenger The results indicated that passenger presence was associated with proportionately more at-fault presence was associated with proportionately more at-fault fatal crashes for drivers aged 24 and youngerfatal crashes for drivers aged 24 and younger,, were a neutral were a neutral factor for drivers aged 25-29, and were associated with fewer at-factor for drivers aged 25-29, and were associated with fewer at-fault involvements for drivers aged 30 and older. fault involvements for drivers aged 30 and older. Relative risk of Relative risk of fatal crash involvement was particularly high for teenage fatal crash involvement was particularly high for teenage drivers traveling, day or night, with two or more teenage drivers traveling, day or night, with two or more teenage passengerspassengers..

Additional research is needed to determine how the added Additional research is needed to determine how the added risk associated with teenage passengers riding with teenage risk associated with teenage passengers riding with teenage drivers can be reduced or eliminated. drivers can be reduced or eliminated.

Passenger effects on teenage driving and Passenger effects on teenage driving and opportunities for reducing the risks of such opportunities for reducing the risks of such

traveltravel llan F. llan F. WilliamsWilliamsaa, , , , , Susan A. , Susan A. FergusonFergusonbb and Anne T. and Anne T. McCarttMcCarttcc

bFerguson International LLC, 1328 Lancia Drive, McLean, VA 22102, USA bFerguson International LLC, 1328 Lancia Drive, McLean, VA 22102, USA 20072007 Passenger presence increases crash risk for teenage drivers, especially when the Passenger presence increases crash risk for teenage drivers, especially when the

passengers are other teenagers and especially when they are male. passengers are other teenagers and especially when they are male. Teenagers are more susceptible to peer influences than adults.Teenagers are more susceptible to peer influences than adults. The combination of passenger-induced distraction and driving inexperience can disrupt The combination of passenger-induced distraction and driving inexperience can disrupt

driving behavior,driving behavior, teenage driver risk taking increases in vehicles with multiple teenagers. teenage driver risk taking increases in vehicles with multiple teenagers. Possible ways to reduce the resulting crash problem include altering the in-vehicle behavior Possible ways to reduce the resulting crash problem include altering the in-vehicle behavior

of teenagers or influencing their selection of travel partners. of teenagers or influencing their selection of travel partners. Legal restrictions on passengers with teenage drivers have been found effective in reducing Legal restrictions on passengers with teenage drivers have been found effective in reducing

the crash problem. Parental monitoring of teenage driving behavior, the crash problem. Parental monitoring of teenage driving behavior, programs aimed at teenagers themselves, could be other optionsprograms aimed at teenagers themselves, could be other options but their efficacy is unproven.but their efficacy is unproven. It currently is unknown why female passengers have a different effect than males or if that It currently is unknown why female passengers have a different effect than males or if that

might offer clues about future interventions.might offer clues about future interventions. ConclusionsConclusions Despite passenger restrictions in the majority of states, Despite passenger restrictions in the majority of states, 42% of 16- and 17-year-old drivers in fatal crashes in 42% of 16- and 17-year-old drivers in fatal crashes in

2005 were transporting teenagers with no adults in the 2005 were transporting teenagers with no adults in the vehicle;vehicle;

61% of teenage passenger deaths (1,222 in 2005) 61% of teenage passenger deaths (1,222 in 2005) occurred in vehicles driven by other teenagers.occurred in vehicles driven by other teenagers.

Wider application of passenger restrictions is indicatedWider application of passenger restrictions is indicated.. Ways to make passenger restrictions more effective are needed, Ways to make passenger restrictions more effective are needed,

and other techniques for reducing this major problem need and other techniques for reducing this major problem need development and testing.development and testing.

Hyperactive children as young adults: Driving behavior, safe driving abilities, and adverse

driving outcomes. Fischer, M., Barkley, R. A., Smallish, L., & Fletcher, K. (2007). Accident Analysis

and Prevention, 39,94−105.

A multimethod, multilevel, multisource battery of driving measures was collected during young adulthood (mean age, 20 years) on a large sample of clinically referred hyperactive children (n=147) and community control children (n=71) who were followed for more than 13 yearsA greater percentage of children in the hyperactive group than

in the control groupreported receiving a ticket for reckless driving, driving without a license, having hit-and-run crashes, or having their licenses suspended or revokeda greater proportion of the hyperactive group compared with the control group had received traffic citations, and the mean number of citations per individual was greater in young adults with a history of hyperactivity/ADHD

behind-the-wheel road tests revealed a significantly greater number of errors in driving resulting from impulsiveness in the hyperactive group than in the control group.

Hyperactive children as young adults: Driving behavior, safe driving abilities, and adverse

driving outcomes. Fischer, M., Barkley, R. A., Smallish, L., & Fletcher, K. (2007). Accident Analysis

and Prevention, 39,94−105.

performance on simulated driving tests demonstrated slower and more variable reaction times,

more frequent errors of impulsiveness (e.g., false alarms, poor rule following),

greater steering variability, and a greater number of scrapes and crashes of the simulated vehicle against road boundaries in the hyperactive group than in the control group.

The road test and simulator results began to reveal a possible basis for elevated driving risks in formerly hyperactive/ADHD children —

Impairment in Level I Operational (elementary cognitive) abilities that are necessary for the safe operation of the vehicle.

Noteworthy in this study was that it did not find a greater frequency of crashes or a greater proportion having such crashes in the hyperactive than in the control group.

The hyperactive/ADHD participants dramatically underreported their current symptoms relative to the reports given by their parents for those same symptoms (Barkley, 2002a). This problem of underreporting may also have affected the validity of their self-reported driving behavior or their history of adverse driving outcomes.

Driving outcomes of young people with attentional difficulties in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 39(5),

627−634. (Woodward, Fergusson, & Horwood, 2000).

Attention deficits were assessed in a large sample of 13-year-old children from New Zealand (the Christchurch longitudinal project; N=1265),

driving outcomes were evaluated during a follow-up study, when the

children were 21 years of age Data collection included reports of teacher and parent-rated

measures of attentional difficulties; incidents of risky driving behavior, including drinking and driving, traffic violations, and involvement in automobile accidents;

and measures of potentially confounding factors, including individual, socio-familial, and driving-related factors.

Thirteen-year-old children with high levels of attention deficit were at greater risk as adolescents for traffic offenses and vehicular crashes.

After various confounding factors were controlled, the associations between attention deficits and increased risk of injury during an accident, driving without a license, and traffic violations were still present.

Inattentive and hyperactive behaviors and driving

offenses in adolescence. Nada-Raja, S., Langley, J. D., McGee, R., Williams, S. M., Begg, D. J., & Reeder, A. I. (1997).

Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 515−522.

In a comparable study that was also conducted in New Zealand (the Dunedin Multidisciplinary Health and

Development Study), Symptoms of ADHD and other comorbid disorders were

assessed at age 15, and their influence on driving offenses was evaluated when the adolescents were between 15 and 18 years of age

Attention deficits were associated with increased risks for crashes involving injury, driving without a license, and traffic violations. Associations persisted after conduct problems, driving experience, and sex of subjects were controlled.

Notably, Conduct Disorders were associated with driving risks beyond those associated with the symptoms of ADHD.

In addition, ADHD in female subjects was significantly associated with driving offenses and more traffic crashes compared with females with other disorders (CD and anxiety/depressive disorder) or no disorder (P=0.05).

Documents

Risk factors affecting Driving Behaviour during Adolescence John Brennan, Director Child & Adolescent Mental Health Service Sydney Children’s Hospital