Study: Computerized skills-training can reduce inattentive driving and collisions in teens with ADHD

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Motor vehi­cle col­li­sions are a lead­ing cause of death among teens, and teens with ADHD are about twice as like­ly to be in a col­li­sion. Teens with ADHD are more like­ly to look away from the road for long peri­ods when per­form­ing dis­tract­ing tasks, e.g., view­ing their phones, check­ing a map, etc., as opposed to tak­ing repeat­ed brief glances. This increas­es the risk of col­li­sion, sug­gest­ing that train­ing teens with ADHD to reduce this behav­ior could reduce their dri­ving risk.

A recent study pub­lished in the New Eng­land Jour­nal of Med­i­cine exam­ines whether train­ing teens with ADHD to reduce their long glances away from the road would reduce their col­li­sion risk: Tri­al of train­ing to reduce dri­ver inat­ten­tion in teens with ADHD. Par­tic­i­pants where 152 16–19 year-old teens with ADHD and a valid dri­vers license and who spent at least 3 hours per week in unsu­per­vised driving.

The Study:

Teens were ran­dom­ly assigned to the com­put­er­ized train­ing con­di­tion or a con­trol con­di­tion. In the train­ing con­di­tion, which includ­ed 5 90-minute ses­sions, teens com­plet­ed ‘dri­ves’ in a dri­ving sim­u­la­tor. An eye-track­ing device on the dash­board mon­i­tored when their eyes were direct­ed towards the sim­u­lat­ed road­way and when they were look­ing else­where. Dur­ing the sim­u­lat­ed dri­ves, they were required to per­form sev­er­al dis­tract­ing tasks, includ­ing search­ing for street names on a map, and hav­ing to iden­ti­fy spe­cif­ic sym­bols on a com­put­er­ized dash­board display.

Dur­ing train­ing, the teens received audi­to­ry feed­back via when­ev­er the eye track­er detect­ed their eyes remain­ing off the road­way for a set peri­od of time, ini­tial­ly 3 sec­onds and then reduced to 2 sec­onds. The goal of this feed­back was to increase their aware­ness of long glances away from the road and to ulti­mate­ly reduce this behav­ior in the absence of feedback.

Par­tic­i­pants assigned to the con­trol con­di­tion includ­ed a typ­i­cal dri­vers edu­ca­tion cur­ricu­lum along with sim­i­lar time in the dri­ving sim­u­la­tor per­form­ing the same tasks as inter­ven­tion par­tic­i­pants. How­ev­er, unlike those in the inter­ven­tion group, teens in the con­trol con­di­tion received no audi­to­ry feed­back when their eyes were focused on the task and not the road for an extend­ed peri­od. This is an ide­al con­trol con­di­tion as these par­tic­i­pants were treat­ed sim­i­lar­ly to inter­ven­tion youth except for the feedback.

Measured Outcomes:

There were 2 pri­ma­ry out­comes in this tri­al. The first was the num­ber of long glances (last­ing over 2 sec­onds) away from the road­way dur­ing two 15-minute sim­u­lat­ed dri­ves that were con­duct­ed at base­line and at 1 month and 6 months after train­ing. Dur­ing these sim­u­lat­ed dri­ves, par­tic­i­pants were required to per­form a task that would dis­tract their eyes from the road.

The sec­ond pri­ma­ry out­come was the stan­dard devi­a­tion of lane posi­tion, as mea­sured in feet, dur­ing the sim­u­la­tor dri­ves. This out­come mea­sured the degree to which par­tic­i­pants ‘cars’ devi­at­ed from the mid-point of the lane, with high­er val­ues indi­cat­ing greater devi­a­tion. Essen­tial­ly, it reflects the extent to which par­tic­i­pants tend­ed to swerve while driving.

Sec­ondary out­comes were col­lect­ed dur­ing actu­al on-road dri­ving for 12 months after train­ing end­ed. Through accelerom­e­ters and eye-track­ing devices installed in par­tic­i­pants’ cars, researchers tracked the num­ber of sud­den accel­er­a­tion or decel­er­a­tion events, i.e., g‑force events. They could deter­mine whether a long-glance away from the road accom­pa­nied these events, and whether they involved a col­li­sion or near col­li­sion. These real-world and impor­tant dri­ving out­comes enable to test whether train­ing reduced real-world neg­a­tive dri­ving behav­ior and outcomes.

Results:

At one month after train­ing, teens in the inter­ven­tion group had over 40% few­er long glances away from the road than con­trol par­tic­i­pants, 16.5 ver­sus 28.0. Sim­i­lar results were found at 6 months, 15.7 vs. 27 long glances.

Teens receiv­ing train­ing also showed sig­nif­i­cant­ly few­er devi­a­tions from the mid­point of the lane than con­trol par­tic­i­pants at both 1 month and 6 months, thus indi­cat­ing that they more con­sis­tent­ly stayed in their lane.

The real world dri­ving out­comes also favored teens who received train­ing. Although they aver­aged more acceleration/deceleration events than con­trol par­tic­i­pants, 37.1 vs. 42.3, these events were less like­ly to occur dur­ing a long glance away from the road, 18.3% vs. 23.9%

And, most impor­tant­ly, actu­al col­li­sions or near col­li­sions occurred in only 3.4% of exces­sive acceleration/deceleration events for the inter­ven­tion group ver­sus 5.6% among teens in the con­trol group. Fur­ther­more, the actu­al num­ber of col­li­sions or near col­li­sions was 110 in the inter­ven­tion group com­pared to 159 among teens in the con­trol group, a dif­fer­ence of near­ly 25%.

Discussion:

Among teens with ADHD dis­tract­ed dur­ing sim­u­lat­ed dri­ving, train­ing them to reduce the length of glances away from the road dur­ing dis­tract­ing tasks was found to have a pos­i­tive impact.

Dur­ing sim­u­lat­ed dri­ving, teens who received train­ing took few­er long glances away from the road at both 1‑month and 6‑month fol­lowups. And, most impor­tant­ly, the num­ber of col­li­sions and near col­li­sions they expe­ri­enced in the year fol­low­ing train­ing was also reduced by approx­i­mate­ly 25%. It is like­ly that this occurred because train­ing result­ed in their tak­ing few­er long glances away from the road.

These are impor­tant find­ings giv­en the dan­gers of dis­tract­ed dri­ving in teens with ADHD. And, although med­ica­tion treat­ment also has been shown to improve dri­ving behav­ior in teens with ADHD, even those who take med­ica­tion are often dri­ving at times when it would not be active in their system.

Let’s hope that this approach to reduc­ing dri­ving risk in teens with ADHD is some­thing that can be made acces­si­ble to teens and their fam­i­lies. The study is avail­able here and includes inter­est­ing videos demon­strat­ing some of the meth­ods that were used.

– Dr. David Rabin­er is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­o­gy and Neu­ro­science at Duke Uni­ver­si­ty. He pub­lish­es the Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

The Study in Context:

• Sur­vey of 2500 fam­i­lies finds what ADHD treat­ments seem to work/ not work as applied in the real world
• What are cog­ni­tive abil­i­ties and how to boost them?