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Simulated Driving Performance, Self-Reported Driving Behaviors, and Mental Health Symptoms in Adolescent Novice Drivers

McDonald, Catherine C.; Sommers, Marilyn S.; Fargo, Jamison D.; Seacrist, Thomas; Power, Thomas

doi: 10.1097/NNR.0000000000000270

Background Risky driving behaviors contribute to adolescent injury, disability, and death, yet little is known about how mental health factors are associated with adolescent driving behaviors.

Objectives The purpose of the research was to determine the association of risky driving behaviors and mental health symptoms in novice adolescent drivers.

Methods We recruited a convenience sample (n = 60) of adolescents to complete an assessment of driving performance errors in a high-fidelity simulator (Simulated Driving Assessment [SDA] Error Score) and a self-report measure of risky driving (Behavior of Young Novice Drivers Survey [BYNDS]). Participants also completed a mental health assessment of self-reported symptoms of depression (Center for Epidemiologic Studies-Depression Scale) and attention-deficit/hyperactivity disorder (ADHD; inattention and hyperactivity–impulsivity), conduct disorder, and oppositional defiant disorder (Conners-3 self-report and parent report). We evaluated the cross-sectional relationships between SDA Error Score, BYNDS, and mental health survey data with descriptive statistics, bivariate correlations, and linear regression.

Results In linear regression models, higher self-reported inattentive ADHD T-scores were associated with higher SDA Error Score (model adjusted R2 = .20). Higher self-reported T-scores of hyperactive–impulsive ADHD and conduct disorder were associated with higher BYNDS total scores (model adjusted R2 = .32). Parent report measures were not associated with adolescent BYNDS total score or SDA Error Score.

Discussion These data highlight the association of risky driving with adolescent symptoms of inattention, hyperactivity, and conduct disorder. The early stage of independent driving is an important time for addressing the relationship between driving performance and mental health conditions.

Catherine C. McDonald, PhD, RN, FAAN, is Assistant Professor, School of Nursing, University of Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; and Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Pennsylvania.

Marilyn S. Sommers, PhD, RN, FAAN, is Professor Emerita, School of Nursing, University of Pennsylvania, Philadelphia.

Jamison D. Fargo, PhD, is Professor, Department of Psychology, Utah State University, Logan.

Thomas Seacrist, MBE, is Director of Training, Project Manager–Biomechanics, The Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Pennsylvania.

Thomas Power, PhD, is Director of Center for Management of ADHD, Department of Pediatrics and Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children’s Hospital of Philadelphia, and Professor of School Psychology in Pediatrics and Psychiatry at Perelman School of Medicine at University of Pennsylvania, Philadelphia.

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Accepted for publication November 14, 2017.

This research was supported by the National Institute of Nursing Research of the National Institutes of Health under Award R00NR013548 (PI: McDonald). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This research was also supported by the Dorothy Mereness Endowed Research Fund at the University of Pennsylvania School of Nursing. The authors wish to thank Flaura K. Winston, MD, PhD, Nancy Kassam-Adams, PhD, Jennifer Swope, MS, and Eileen Regan, BSN, for their contributions; the CIRP Driving Simulator Core at Children’s Hospital of Philadelphia (CHOP); the Pediatric Research Consortium and the Recruitment Enhancement Core at CHOP for their assistance in recruitment; and, lastly, the participants in this study.

Clinical Trial Registration: NCT02319317

The authors have no conflicts of interest to report.

Editorial note: This manuscript was accepted under the editorship of Susan J. Henly.

Corresponding author: Catherine C. McDonald, PhD, RN, FAAN, School of Nursing, University of Pennsylvania, Claire Fagin Hall, 418 Curie Boulevard, 414, Philadelphia, PA 19104-4217 (e-mail:

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