July 25, 2011 -- Mom always said to look both ways before crossing the street, and this is still great safety advice, but it may not be sufficient for children with attention deficit hyperactivity disorder (ADHD).
These children are at increased risk of being struck by a car when crossing the street because they sometimes make incorrect decisions about when to cross the street and how long it will take to get to the other side, according to a new study in Pediatrics.
Up to 5% of children and adults in the U.S. have ADHD, a behavioral disorder marked by impulsiveness, hyperactivity, and inattention. Children with untreated ADHD are at risk for injury, substance abuse, poor school performance, and emotional and social problems.
"I came in thinking that kids with ADHD probably won't look left and right before they cross, but they did display appropriate curbside behavior," says Despina Stavrinos, PhD, an assistant professor in the University of Alabama at Birmingham Injury Control Research Center. "The big difference occurred in the outcome of cross."
The 78 children in the study were aged 7 to 10. Researchers tested the children's street-crossing prowess using a simulated street scene with vehicles approaching from the left and right. All the children looked left and right before crossing and waited to cross. But the 39 children with ADHD did experience more "close calls" with oncoming traffic and had less time to spare when they reached the other side of the street.
This speaks to deficits in executive functioning, or the ability to make and carry out plans, she says.
Whether or not treating ADHD with medication would affect behavior is not known, but studies of drivers with ADHD have shown that treatment can improve driving performance.
Many kids with ADHD take their medication in the morning, and it begins to wear off at the end of the day when they are more likely to be crossing the street as they walk home from school, she says. "Many parents also give kids medication holidays during the summer, which is when they are outside more."
So what can parents do to protect children with ADHD when they are crossing streets?
Practicing street crossing may help, she says.
"Parents may need to delay the age at which they allow children with ADHD to cross the street independently," she says.
The American Academy of Pediatrics stares that most children can cross streets on their own at age 10, but children with ADHD may need to wait longer.
Judy Schaechter, MD, an associate professor of pediatrics at the University of Miami School of Medicine and director of the Injury Free Coalition of Miami, suggests that concrete environmental changes such as street lights with timers and adult supervisors may help.
"Children with ADHD have difficulty weighing the more complicated thinking as how risky is this cross, and can I make it," she says.
Distraction may also be at play, she says. "These kids are at a heightened risk of being distracted and impulsive, so if there was a ball they wanted in the street, it could affect their crossing," she says.
"I was really excited to see that concrete safety behaviors were the same among kids with and without ADHD," she says. "Do look left and do look right. This matters and certainly will reduce the risks."