Influence of Stimulant Medication on Pedestrian Safety for Children with Excessive Daytime Sleepiness

Abstract

Background and Objective Pedestrian crashes represent a leading cause of pediatric injury. Children have particular risk due to underdeveloped cognitive and executive function skills. Given children with excessive daytime sleepiness (EDS) face deficiencies in executive function and cognitive skill that impact cognitive functions necessary for safe pedestrian engagement, this study examined whether treatment with the stimulant medication modafinil might improve both cognitive functioning and pedestrian safety among children with EDS. Methods Twelve children aged 8-16 years diagnosed with EDS participated in a within-subjects experiment. Children completed two laboratory visits, one while treated with modafinil and one untreated. During each visit, children completed two self-report sleepiness inventories, two cognitive tests [psychomotor vigilance test (PVT) and Conners' continuous performance task (CPT; version 3.0, Multi-Health Systems, Inc.)], and 20 virtual pedestrian environment street-crossings. Parents completed a sleepiness survey about children. ResultsaaRelated samples t-tests found consistent patterns of reduced sleepiness, improved cognitive functioning, and safer pedestrian behavior while children were medicated with modafinil compared to unmedicated. Statistically significant differences emerged for parent-reported child sleepiness (p < 0.01); PVT false starts, indicating improved attention, vigilance and alertness (p < 0.10); CPT omissions, signifying failure to respond to stimuli (p < 0.05); and shortest time-to-con-tact with oncoming virtual traffic (p < 0.05). Chi-square demonstrated children had fewer collisions with oncoming virtual traffic while medicated than unmedicated (p < 0.05). ConclusionsaaMedication with the stimulant modafinil improved multiple aspects of cognitive functioning and pedestrian safety among children with EDS. The greatest benefits emerged on measures of alertness, attention, and response latency. Results suggest modafinil may improve real- world functioning in tasks like crossing streets.