Childhood accidents and their relationship with problem behaviour

1.1 Background It is widely assumed that child pedestrian accidents result from inadequate road user knowledge and skills. This is the basis for educational and skills training packages designed to reduce accident rates. However, in-depth studies of these accidents and studies on individual differences in accident risk suggest that motivational factors may be more important. There is evidence that children who exhibit problem behaviours (e.g. fighting and stealing) are at increased risk of pedestrian accident involvement. Previous research has typically not controlled for risk exposure (e.g. time spent in the traffic environment) or broad social factors (e.g. social class) and so there is a need for more definitive evidence on the link between problem behaviour and accident risk. If such a link exists, there are several theories that could explain it. One common factor may be lower adherence to what may be regarded as responsible social values (values that society as a whole accepts as pro-social and desirable such as being kind, respecting authority, trying hard and not harming others). 1.2 Aims The aims of the study were: 1. to confirm the previously discovered relationship between traffic accident rates and problem behaviour 2. to examine whether this relationship still holds when factors socio-economic and environmental factors have been controlled for 3. to examine how far behavioural characteristics of children are associated with traffic accident rates controlling for socio-economic and environmental factors 4. to examine how far aspects of parenting style are associated with traffic accident rates controlling for socio-economic and environmental factors 5. to construct a parsimonious model explaining the link between problem behaviour and pedestrian accident rates 6. to examine whether traffic accident rates are associated with rates of other types of accident 7. to examine whether similar factors underlie non-traffic accident rates as underlie traffic accident rates. 1.3 Methods A total of 1027 children aged between 7 and 15 years were interviewed and completed a set of computerised and paper and pencil tests. The study was based in south London. The sample was drawn from the list of a health centre supplemented by children who had been treated at accident and emergency departments in three hospitals as a result of a traffic accident. The children's carers also completed a questionnaire and were interviewed. In addition, the children's teachers were asked to complete a questionnaire about them. Information was collected on: Sensation seeking Danger seeking Responsiveness to rewards Impulsiveness Hyperactivity Ability to sustain attention Propensity to anger Response to punishment Anxiety Adherence to responsible social values Parenting style Problem behaviour Pedestrian/cycling accidents Other accidents Social class Family circumstances Housing circumstances Neighbourhood characteristics Exposure to traffic The procedure was repeated in 116 children a year after the first session to assess the re-test reliability of the measures. 1.4 Results The main findings were as follows:- The key measures used in the study were found to have moderate to good re-test reliability. There were clear relationships between problem behaviour measured in a variety of ways and both traffic and non-traffic accident rates controlling for age and sex. These relationships remained when factors external to the child were controlled for. Sensation seeking, impulsiveness, hyperactivity and low adherence to responsible social values were associated with traffic accident risk. The link between traffic accident rates and problem behaviour could be accounted for by a single common variable: low adherence to responsible social values. Low adherence to responsible social values was associated with impulsiveness, anger, reduced sensitivity to punishment and danger seeking. Traffic accident rates were significantly associated with rates of other types of accident after controlling for external factors. The psychological variables underlying other types of accident only partially overlapped with those underlying traffic accidents. Examination of age trends in adherence to social values, problem behaviour, risky road user behaviour and traffic accident frequency reveals that a reduction in sense of social responsibility is synchronous with an increase in problem behaviour and risky road user behaviour and just predates the manifest increase in traffic accident risk. This is consistent with the view that these variables play a causal role in traffic accident liability. 1.5 Conclusions It appears that motivational factors, and particularly adherence to responsible social values are important in placing certain children at greater risk of traffic accident than others. This may be because such children are more careless or reckless in the traffic environment or because they are less able or willing to learn road user skills. The former explanation is more parsimonious and receives indirect support from the fact that accident rates increase in the early teenage years when road crossing skills would have already been used by the child for many years but when there is a sharp decrease in adherence to responsible social values and an increase in problem behaviour. The findings imply that behavioural measures to reduce traffic accident rates should place greater emphasis on raising standards of responsibility and changing attitudes and habits rather than focusing exclusively on knowledge and skills. The ability to identify high risk children suggests that targeting risk reduction measures may be cost-effective