Mediating factors associated with pedestrian injury in children with attention-deficit/hyperactivity disorder.

OBJECTIVE: Unintentional injury is the leading cause of pediatric mortality. One leading cause of unintentional injury is pedestrian injury. Children with developmental disabilities, particularly those with attention-deficit/hyperactivity disorder-combined type (ADHD-C) seem to have increased pedestrian injury risk. This study examined (1) the differences in pedestrian behavior between children with ADHD-C and normally developing comparison children and (2) the mediating factors that might link ADHD-C with pedestrian injury risk. PATIENTS AND METHODS: A total of 78 children aged 7 to 10 years (39 children with ADHD-C diagnoses and 39 age- and gender-matched typically developing children) participated. The main outcome measure was pedestrian behavior, as measured in a semi-immersive, interactive, virtual pedestrian environment. Key pedestrian variables related to different aspects of the crossing process were identified: (1) before the cross (ie, evaluating aspects of the crossing environment); (2) making the cross (ie, deciding to cross and initiating movement); and (3) safety of the cross (ie, safety within the pedestrian environment after the decision to cross was made). RESULTS: Children with ADHD-C chose riskier pedestrian environments to cross within (F(1,72) = 4.83; P < .05). No significant differences emerged in other aspects of the crossing process. Executive function played a mediating role in the relationship between ADHD-C and the safety of the cross. CONCLUSIONS: Children with ADHD-C seem to display appropriate curbside pedestrian behavior but fail to process perceived information adequately to permit crossing safely.

How mothers parent their children with behavior disorders: implications for unintentional injury risk.

INTRODUCTION: This study was designed to test the role of parental supervision in explaining why children with behavior disorders have increased risk of unintentional injury. METHOD: Children referred to a pediatric behavior disorders clinic and their mothers were unknowingly observed in a "hazard room" environment that housed several items that appeared dangerous but actually were altered to be safe. RESULTS: Mother and child behavior in the hazard room was correlated to parent-, teacher-, and observational-reports of children's externalizing behavior patterns, children's injury history, and mother's parenting styles. Maternal ignoring of children's dangerous behavior in the hazard room was the strongest correlate to children's injury history. CONCLUSIONS: Poor parental supervision might serve as a mechanism to explain why children with behavior disorders, and those with oppositional behavior patterns in particular, have increased risk of unintentional injury.

Effects of long-term psychostimulant medication on growth of children with ADHD.

The objective was to assess the effects of long-term psychostimulant medication on growth parameters in children with attention deficit hyperactivity disorder (ADHD). Eighty-nine children diagnosed with ADHD treated by prescribed psychostimulant medications were followed with repeated growth measures over a 3 years duration. Anthropometric measurements were recorded at baseline, 3, 6, 12, 24, and 36 months. Medical records were reviewed for demographic information, medication side effects and appetite suppression. Body mass index (BMI) and z-scores were determined at each follow up visit. Descriptive and analytical analyses by repeated measures analysis of varianc were performed. Significant weight loss was documented mostly during the first few months of treatment with stimulants. Although z-scores for weight showed significant changes over the 2 years of treatment, further analysis of the changes did not reach clinical significance. BMI growth was within normal limits throughout the duration of treatment. Baseline weight predicted weight loss for heavier children only. Pre-pubertal children were more subject to weight loss than children during puberty, as well as children for which appetite suppression was reported. No long-term impact on height was noted. Different stimulant medication did not differ in their effects on growth. Generally, parents and providers can be reassured that growth changes with long-term stimulant therapy are not clinically significant for a diverse group of children with ADHD.