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Kids with ADHD More Likely to Be Injured Crossing the Street

Looking Left and Right Is Not Enough


Updated August 17, 2011

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Kids with ADHD More Likely to Be Injured Crossing the Street

Parents of children with ADHD may want to delay the time when their children are allowed to cross a street by themselves. New research finds that kids with ADHD are at increased risk of being hit by a vehicle when crossing a street.

Photo © Nick White

A study has found that crossing the street can be especially dangerous for kids with attention deficit hyperactivity disorder (ADHD). Researchers at the University of Alabama at Birmingham studied 39 children, aged 7 to 10, who have ADHD, as well as 39 children with typical development. They found that the kids with ADHD had more difficulty judging the time it would take to cross safely, chose smaller gaps in traffic to cross within and had considerably less time to reach the end of the crosswalk before the next car approached. All these factors lead to a greater likelihood that they could be hit by a car while trying to cross the street.

Though the children with ADHD seemed to assess street crossing safety -- waiting before crossing and checking traffic by looking left and right -- in the same manner as their peers without ADHD, at some point in their decision-making, the kids with ADHD appeared to have difficulty processing information in a way that would allow them to cross safely.

Looking Left and Right Is Not Enough

Despina Stavrinos, Ph.D., assistant professor at the University of Alabama at Birmingham Department of Medicine and director of the Translational Research for Injury Prevention Laboratory, is lead author of the study.

"The most surprising finding of the study was that kids with ADHD were displaying appropriate curbside behavior, and we didn’t go in really expecting to see that," said Dr. Stavrinos. "We thought that perhaps kids with ADHD -- having difficulties with attention and impulsivity -- might not look left and right before crossing, but in fact they did. They looked left and right just as typically developing peers."

Dr. Stavrinos noted the importance of this key finding. "We have ingrained in our kids ‘look left and right before crossing’ and that might not just be enough when it comes to kids with ADHD," she said. "And it makes it difficult for parents to look for the signs of when their child might be ready to cross the street independently. Making the motions – looking left and right – is an easy sign to look for and parents may be looking for just that single sign. Okay, my kid looked left and right so they can probably cross on their own, but looking left and right is not enough.”

How Executive Function Comes into Play

Impairments in executive function seem to be the strongest underlying factor creating challenges for kids with ADHD while crossing the street. What is executive function? It is basically the control center or management system of the brain -- the system that organizes the plan for executing a certain behavior. Though as adults it may seem like a simple task, the decision-making process around crossing the street can be quite complex. In order to cross safely one must:

  • estimate the speed of oncoming vehicles into the crosswalk
  • judge the distance of those vehicles from the crosswalk
  • take into account one’s own distance and how long it would take to get across to the other side

All of these things going on at one time make crossing the street a really complex task. "For adults these decisions may seem automatic, but for a child, especially a child with ADHD, who may display some difficulty with executive functioning, it can be quite a daunting task," said Dr. Stavrinos.

What Can Parents Do?

The American Academy of Pediatrics suggests that kids typically have developed the cognitive skills to safely cross the street independently by 10 years of age. It is important for parents to realize, however, that this is not a "one size fits all" rule. It is okay -- and often safer -- to delay expectations. Your child may not yet be ready to cross the street on his or her own, especially if he or she has ADHD.

In the meantime, you can spend time talking with your child, teaching and practicing skills. Some of these issues, like timing ability are difficult teach, explained Dr. Stavrinos.

"But you can help by talking about the key issues involved in crossing the street. ‘Okay I am looking left and right, but as I am looking these are the things that I am looking at. I am looking at how fast the oncoming car is moving. Do I have enough time to get across to the other side safely, etc?’ So teaching more safety skills than just looking left and right," said Dr. Stavrinos.


Despina Stavrinos, Ph.D. Phone Interview/Email Correspondence. August 2, 2011.

Despina Stavrinos, Fred J. Biasini, Philip R. Fine, J. Bart Hodgens, Snehal Khatri, Sylvie Mrug, and David C. Schwebel. “Mediating Factors Associated With Pedestrian Injury in Children With Attention-Deficit/Hyperactivity Disorder” Pediatrics 2011; 128:2 296-302

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