Simulation Software Could Improve Teenage ADHD Driver Safety

Jeffery N. Epstein, PhD

A computerized driving simulation program may help teenagers with diagnosed ADHD reduced their propensity to become distracted while driving, and is associated with a reduction in real-world driving collisions among such patients, according to new findings.

In data from a team of US investigators and behavioral scientists, a computer simulation program designed to provide driving feedback was linked to a 24% reduction in long glances and 40% reduction in collisions and near-collisions among teenaged drivers with ADHD versus control. The findings elucidate the benefit of tailored driving education and training for younger patients with ADHD, who are historically at greater risk of vehicle collisions and accidents.

Led by Jeffery N. Epstein, PhD, pediatric psychologist and director of the Center for ADHD at Cincinnati Children’s hospital, investigators assessed the benefit of an enhanced version of the Focused Concentration and Attention Learning (FOCAL) program—a single-session, desktop-based software designed to train neurotypical teen drivers reduce long glances away from the roadway—in teenagers with ADHD. The enhanced version of the program included multiple sessions and simulator training with an auditory feedback that called out instances of long glances.

Epstein and colleagues conducted a randomized, controlled trial comparing the impact of the so-called “FOCAL+” versus a modified conventional driver’s training on rates of simulation-based long driving glances and lane variation at months 1 and 6, as well as real-world driving collisions or near-collisions at 1 year.

As they noted, teen drives are at a 4-fold increased risk of collisions than adult drivers, and teenagers with ADHD are at a 2-fold increased risk of collisions than their neurotypical peers.

“Teen drivers, particularly those with ADHD, have difficulty sustaining visual attention to the roadway, especially when distracted,” investigators wrote. “When performing distracting tasks, teens take long glances (≥2 seconds) away from the roadway rather than repeated brief glances between the secondary task and the roadway, a behavior that increases the risk of motor vehicle collision.”

Investigators recruited teenagers aged 16 – 19 years old with ADHD and a valid driver’s licensce through the children’s hospital. Participants were randomized 1:1 to either FOCAL+ or control drivers training, followed by a 1-year assessment period. Each training consisted of 5 sessions, including 2 parent education courses.

Participants were evaluated at 1 month (2 simulator drives) and 6 months (2 simulator drives) to interpret rate of long glances and lane position deviation. They were then assessed at 1 year via in-vehicle recording device to interpret long glances and motor vehicle collisions or near collisions per g-force events.

The final trial included 152 participants randomized to either intervention (n = 76) or control (n = 76). The 2 groups reported similar demographic characteristics and were representative of teenagers with ADHD, aside from an underrepresentation of Black teens. The intervention group participants attended a mean 4.6 training sessions, versus 4.9 sessions among the control group.

In the simulated-driving sessions, teens in the intervention group improved their rate of mean long glances from 21.5 in 15 minutes at baseline to 16.5 at 1 month; they further improved to 15.7 at 6 months. Rates for the control group were 23.1 at baseline, 28.0 at 1 month, and 27.0 at 6 months. Investigators calculated an incidence rate ratio (IRR) of 0.64 (95% CI, 0.52 – 0.76; P <.001) at both 1 month and 6 months. They additionally reported significant improvements in lane position at 1 and 6 months.

In real-world driving outcomes at 1 year, the rate of long glances was 18.3% among intervention patients versus 23.9% in the control group, indicating a 24% relative risk (RR) reduction (RR, 0.76; 95% CI, 0.61 – 0.92). Regarding collision or near-collision per g-force events, investigators observed a 3.4% rate among the intervention arm versus 5.6% in the control arm (RR, 0.60; 95% CI, 0.41 – 0.89).

The team concluded that the tailored FOCAL+ program provided significant reductions in long glances, lane changes, and risk of collisions among teenage drivers with ADHD. They compared the benefit to that observed with standard stimulant medication for driving outcomes.

“The pharmacologic effects of these medications last approximately 10 to 12 hours. Yet, teens drive and are susceptible to motor vehicle collisions during the late afternoon after school and during the evening, when the effects of stimulant medication are typically waning,” they wrote. “Nonpharmacologic interventions for reducing ADHD-related driving risks typically target teen–parent interactions and hazard detection and have not affected adverse driving outcomes in naturalistic settings.”

The study, “Trial of Training to Reduce Driver Inattention in Teens with ADHD,” was published online in The New England Journal of Medicine.