儿童期和成年期持续性注意缺陷多动障碍对机动车事故风险的影响：来自注意力缺陷多动障碍儿童多模式治疗研究的结果。
Effects of Childhood and Adult Persistent Attention-Deficit/Hyperactivity Disorder on Risk of Motor Vehicle Crashes: Results From the Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder.
机构信息
The Royal's Institute of Mental Health Research, University of Ottawa, Ontario, Canada.
Saint Louis University, St. Louis, Missouri.
出版信息
J Am Acad Child Adolesc Psychiatry. 2020 Aug;59(8):952-963. doi: 10.1016/j.jaac.2019.08.007. Epub 2019 Aug 22.
OBJECTIVE
To determine motor vehicle crash (MVC) risk in adults with a history of childhood attention-deficit/hyperactivity disorder (ADHD) and persistent ADHD symptoms.
METHOD
Participants with (n = 441) and without (n = 239; local normative comparison group) childhood ADHD from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) Study were included. Participants provided self-reports on total number of MVCs they had been involved in and the time of licensure. Driving experience was estimated as the number of months since licensure. Total number of MVCs by adulthood was regressed on baseline ADHD status adjusting for sex, age at follow-up, driving experience, baseline oppositional defiant disorder/conduct disorder comorbidity, baseline household income level, adult oppositional defiant disorder/conduct disorder symptoms, adolescent and adult substance use, and adult antisocial personality disorder symptoms. We repeated the analysis using adult ADHD status (persistent versus desistant versus local normative comparison group) and symptom level as the predictor variables. Results are presented as incidence rate ratio (IRR) and CI.
RESULTS
Childhood ADHD was associated with a higher number of MVCs (IRR = 1.45, CI = 1.15-1.82), and adult ADHD symptom persistence was associated with more MVCs than desistance (IRR = 1.46, CI = 1.14-1.86). ADHD desistance was not associated with a significantly increased risk for MVCs compared with the local normative comparison group (IRR = 1.24, CI = 0.96-1.61). Concurrent symptoms of inattention and hyperactivity/impulsivity predicted MVC risk.
CONCLUSION
Persistence of ADHD into adulthood is a stronger predictor of MVC risk than childhood-limited ADHD.
CLINICAL TRIAL REGISTRATION INFORMATION
Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study; https://clinicaltrials.gov; NCT00000388.
目的
确定有儿童期注意缺陷/多动障碍（ADHD）病史和持续性 ADHD 症状的成年人发生机动车碰撞（MVC）的风险。
方法
纳入了来自注意力缺陷多动障碍多模式治疗研究（MTA）的参与者，他们患有（n=441）或未患有（n=239；当地正常比较组）儿童期 ADHD。参与者报告了他们所涉及的 MVC 总数以及获得驾照的时间。驾驶经验估计为获得驾照后的月数。使用 ADHD 基线状态调整性别、随访时年龄、驾驶经验、基线对立违抗性障碍/品行障碍共病、基线家庭收入水平、成人对立违抗性障碍/品行障碍症状、青少年和成年期物质使用以及成年反社会人格障碍症状后，对成年时的 MVC 总数进行回归分析。我们使用成年 ADHD 状态（持续性、缓解性和当地正常比较组）和症状水平作为预测变量重复了分析。结果以发病率比（IRR）和置信区间（CI）表示。
结果
儿童期 ADHD 与 MVC 数量较多相关（IRR=1.45，CI=1.15-1.82），成年 ADHD 症状持续性与 MVC 数量较多相关，而缓解性与 MVC 数量较少相关（IRR=1.46，CI=1.14-1.86）。与当地正常比较组相比，ADHD 缓解组发生 MVC 的风险无显著增加（IRR=1.24，CI=0.96-1.61）。注意力不集中和多动/冲动的并发症状预测了 MVC 风险。
结论
成年期 ADHD 的持续性是 MVC 风险的更强预测因子，而非儿童期 ADHD 局限于儿童期。
临床试验注册信息
注意力缺陷多动障碍多模式治疗研究（MTA）；https://clinicaltrials.gov；NCT00000388。
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