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Risk factors affecting Driving Behaviour during Adolescence

Risk factors affecting Driving Behaviour during Adolescence. John Brennan, Director Child & Adolescent Mental Health Service Sydney Children’s Hospital Associate Professor (UNSW Conjoint) SCH Grand Rounds June 10/2009. Fatality rates for 12-month period ending May 2009 NSW RTA Data.

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Risk factors affecting Driving Behaviour during Adolescence

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  1. Risk factors affecting Driving Behaviour during Adolescence John Brennan, Director Child & Adolescent Mental Health Service Sydney Children’s Hospital Associate Professor (UNSW Conjoint) SCH Grand Rounds June 10/2009

  2. 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 travelled³ 0.7

  3. 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

  4. Number of fatalities for 12 months ending May 2009, sex of fatality

  5. Distribution of fatalities for 12 months ending May 2009, by age and road user class

  6. Number of fatalities for 12 months ending May 2009, age of fatality

  7. Trends for fatalities and motor vehicle travel since 1978

  8. 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

  9. 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.

  10. Cases of Death USA 2005

  11. PATTERNS OF RISK FOR ADOLESCENT DRIVERS • In assessing risk, age matters • 16-19yrs if data is aggregated, lose important information about age as a risk factor • Similar issues when considering older drivers 65+, 75+, 85+ • Distance travelled allows comparison of crash risk, relative to exposure • License data – per person rates • Population data – overall risk for age group (slides refer to US date aggregated across 50 states)

  12. TEENAGE DRIVERS RISK FACTORS (AF WILLIAMS (2003) • Teenage driving risks can be considered under 3 headings. • (a) Situations where risk is elevated for all drivers • (b) Situations where risk is elevated for teenage drivers relative to older drivers • (c) situations where risk is unique to teenagers

  13. 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 older drivers have the highest rates • Younger > older crash rates • Males > females • Women > males, per mile driven • Fatal crash rates per distance travelled 16yr olds greatest • Older drivers greater fatality rate/mile – as they are more fragile Note: mileage based rates exaggerates risks for younger and older drivers. They are driving shorter distances on more congested roads/younger drivers more night time exposure.

  14. Teenage drivers: patterns of riskAllan F. Williams* Journal of Safety Research 34 (2003) 5– 15 Driver crash involvements per million miles travelled, 1995.

  15. Teenage drivers: patterns of riskAllan F. Williams* Journal of Safety Research 34 (2003) 5– 15Driver fatal crash involvements per million miles travelled, 1995.

  16. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15Crashes / licence holder • Youngest 16-19 (greatest for all crashes, greatest for fatal crashes) • Young males slightly greater crash rate Per capita rates - youngest least likely to have a licence so 16yr olds lowest/capita - fatal crashes/16yr olds, and 20-24yr have highest per capita

  17. Teenage drivers: patterns of riskAllan F. Williams* Journal of Safety Research 34 (2003) 5– 15Driver fatal crash involvements per 100,000 licensed drivers, 2000.

  18. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15Driver crash involvements per 1,000 population, 2000.

  19. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15Driver fatal crash involvements per 100,000 population, 2000.

  20. Teenage drivers: patterns of riskAllan F. Williams*Journal of Safety Research 34 (2003) 5– 15Crashes per 10,000 drivers, by months of permit or licensure, Nova Scotia. Learner period – low risk as parents are supervising Permit period – Nova Scotia data; Clear increased risk immediately following Licensing

  21. Teenage drivers: patterns of riskAllan F. Williams*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.

  22. Teenage drivers: patterns of riskAllan F. Williams*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 drivers 16-20 even greater relative increase than in daytime

  23. Teenage drivers: patterns of riskAllan F. Williams* Journal of Safety Research 34 (2003) 5– 15Sixteen- to 17-year-old drivers in all crashes, hour by hour, 1995.

  24. Teenage drivers: patterns of riskAllan F. Williams*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 killed in a vehicle with a teen driver than whilst riding a school bus. Time of day – fatal crashes two peaks; before and after school day for 16/17yr old drivers.

  25. Teenage Drivers • Alcohol Low in teenage drivers compared to older drivers When young drivers do drink however, their relative increase in risk is greater than older drivers Alcohol related fatalities have fallen substantially due to changes in law.

  26. Socio-cultural risk Factors • Driving is a rite of passage and a developmental milestone for most adolescents • Driving can be crucial for many young persons employment and education • Driving contributes to normal social development, self confidence and esteem with peers • Adolescents value driving as an opportunity for getting together with other adolescents without being supervised and scrutinized by adults • Music, distracting talk, joking around together, are considered to be important pleasurable aspects of teenage driving experience but can encourage risk taking

  27. Crash Risks Unique to Adolescence • Having passengers in the vehicle - creates a social situation affecting driving behaviour - associated with increased risk It is a very high-risk situation for teenage drivers to have multiple passengers when they are also teenagers. More than 50% of all deaths in crashes of 16-17 year old drivers occur when passengers younger than 20 years old are present and there is no adult in the vehicle.

  28. Teenage Passenger Crash fatality Rates: Many teens die as passengers in motor vehicles. - 40% of deaths in 16-19 yr olds travelling in passenger vehicles were passengers. - for 16yr olds it is 50% of fatalities - often travelling with teenage drivers

  29. Teenage drivers: patterns of riskAllan F. Williams* Journal of Safety Research 34 (2003) 5– 15Deaths of passengers in passenger vehicles per 100,000 population, United States, 2000.

  30. Crash Risks Unique to Adolescence • Crash rates by driver age and number of passenger present per 10,000 trips. • With increasing numbers of passengers the risk for older driver falls • For teenagers the rate increases exponentially with 1-3 plus passengers • The risk increases for male and female drivers with night time rates being higher • The highest risk for male and female teenager drivers is with male passengers • The risk for teenage males falls with female passengers. • The presence of one male passenger doubles the fatality rate; the presence of two male passengers doubles the fatality rate again ( for male and female teenage drivers) • Driving behaviour is affected, increased speed, increased risks • But when carrying female passengers teenagers drive more safely

  31. Teenage drivers: patterns of riskAllan F. Williams* Journal of Safety Research 34 (2003) 5– 15Crash rates by driver age and passenger presence per 10,000 trips.

  32. Only one-third of people killed in fatal crashes involving teen drivers are the drivers themselvesThe analysis of U.S. crash data from 1998 to 2007 showed that crashes involving drivers aged 15 to 17 killed 28,138 people. Of those, 10,388 (36.9 percent) were the teen drivers. The other 17,750 (63.1 percent) included, 8,829 passengers of the teen drivers, 6,858 occupants of other vehicles, and 2,063 non-motorists.. A previous analysis of data from 1995 to 2004 found that crashes 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 others. The drop in deaths between this and the most recent analysis suggests that graduated licensing and other efforts to improve teen driver safety are having an effect.

  33. National Young-Driver Survey

  34. National Young-Driver Survey 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 high for 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. • 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.

  35. Driving Performance & Traffic Accidents (Barkley et al, 2004) • Human factors are considered to be the most common cause of automobile accidents • Driving is a complex multidimensional behaviour that can be conceptualised on three hierarchical levels of competency • Strategic • Tactical • Operational Deficits in lower levels especially at the operational, can have a profound effect on higher levels of competency.

  36. Operational Competency • Comprises elementary mental functions • Attention and concentration • Reaction time • Visual scanning • Spatial perception and orientation • Visual motor integration • Speed of cognitive processing • Motor co-ordination

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

  38. TACTICAL COMPETENCY • Skills and decision making to deal with different driving conditions Eg - dense traffic - rain - intersections - traffic lights - changing speed limits - passing other vehicles - country roads - rough roads - navigating unfamiliar areas

  39. STRATEGIC COMPETENCY • Decisions about whether to drive and when eg - weather conditions - time of day and impact of fatigue - time needed to complete journey - route to take - rest stops - vehicle safety (ie. roadworthy)

  40. 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

  41. Teenage drivers with ADHD A review of driving risks and impairments associated withADHDRussell A. Barkley , Daniel CoxJournal of Safety Research 38 (2007) 113–128 • Inattention/distractibility key factors increasing risk • Young drivers with ADHD-- key findings • 2-4 times more risk of traffic accidents • 3 times more risk of injuries • 4 times more risk of being at fault • 6-8 times more risk of license suspension • Comorbid factors which add to risk • Increased aggression • Poor emotional regulation, anger • Increased risk taking / limited insight • If Conduct Disorder is also diagnosed

  42. 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).

  43. 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. PINEPsychological 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

  44. Brain regions that make up the Detection node include the fusiform face area, the superior temporal sulcus and the anterior temporal cortex. involved in carrying out basic perceptual processes on social stimuli and are highlighted in green A schematic depiction of the main regions contained within each of the three nodes of the Social Information Processingnetwork (SIPN). Developmental studies of brain processing in humans have generally found that brain systems in the detection node mature quite early in life.

  45. 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 anatomical reorganization during puberty

  46. 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. This node is involved in inhibiting motivated response tendencies and understanding the psychological perspective of other individuals as in theory of-mind tasks. Detailed morphometric studies have shown that 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).

  47. 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 the Orbito-frontal Cortex

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