Driver training software program associated with fewer distractions in ADHD youth

A driver training software program reduced the frequency of long glances from the roadway among adolescents with ADHD compared with a control training program, a randomized controlled trial found.

Teenagers with ADHD are two times more likely than neurotypical teens to be in a collision, Jeffrey N. Epstein, PhD, a professor in the department of pediatrics at the University of Cincinnati, and colleagues wrote in The New England Journal of Medicine.

Previous research has shown that this risk is especially heightened early on. A 2019 Pediatrics study found that crash rates were particularly higher in adolescents with ADHD during the first month of licensure, regardless of licensing age. They also had higher rates of moving violations.

Epstein and colleagues noted that teenagers, especially those with ADHD, struggle to sustain visual attention while driving.

“When performing distracting tasks, teens take long glances away (2 seconds) 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. Teens with ADHD have higher rates of long glances than neurotypical teens,” they wrote.

To address attention difficulties, the researchers evaluated the effectiveness of an enhanced version of the Focused Concentration and Attention Learning (FOCAL) program, a desktop-based software program aimed to reduce long glances of 2 seconds or longer in neurotypical adolescent drivers. The enhanced version, termed FOCAL+, included multiple sessions and simulator training “with immediate auditory feedback when long glances occurred,” Epstein and colleagues wrote.

The researchers randomly assigned 152 adolescents aged 16 to 19 years with ADHD to either the FOCAL+ intervention (n = 76) or a modified conventional driver’s training program, which served as the control group (n = 76).

There were two primary outcomes. The first was the number of long glances from the roadway during two 15-minute simulated drives at baseline, with follow-ups at 1 month and 6 months. The second was the standard deviation of lane position during simulation drives.

“Specifically, every 17 msec during the map search tasks for these drives, the software located the center of the car in relation to the center of the lane,” Epstein and colleagues wrote. “A standard deviation around each participant’s mean lane position was computed with the use of these values. A standard deviation of 0 indicated no deviation in lane position.”

The researchers also assessed long glances and collisions or near-collisions during changes in vehicle momentum, or “g-force event,” in the real world.

At baseline, the FOCAL+ group had a mean number of 21.5 long glances per drive, while the control group had a mean number of 23.1. During follow up, Epstein and colleagues found that the FOCAL+ group had a mean number of:

• 16.5 long glances per drive at 1 month; and
• 15.7 long glances per drive at 6 months.

These were significantly lower than the mean number of long glances in the control group, which registered means of 28 and 27 at 1 month and 6 months, respectively (incidence RR = 0.64; 95% CI, 0.52-0.76).

Epstein and colleagues reported that FOCAL+ participants had a standard deviation of lane position of 0.98 at both 1 month and 6 months, while the control group’s standard deviation was 1.2 at both follow-up periods.

A year after training, the rate of long glances during a g-force event in a real-world setting was 18.3% for FOCAL+ participants and 23.9% for control participants (RR = 0.76; 95% CI, 0.61-0.92), while collision rates for the intervention group and control group during g-force events was 3.4% and 5.6%, respectively (RR = 0.6; 95% CI, 0.41-0.89).

The researchers noted that the number of participants taking ADHD medication was similar throughout the trial and post-trial; however, they were unable to determine the influence of ADHD medication on collisions or near-collisions.

Additionally, since all the participants had completed state-required driver training, Epstein and colleagues said it is unknown whether the FOCAL+ program would have been effective in the event of no prior training.

While the FOCAL+ intervention used “artificial secondary tasks in a laboratory setting” that greatly differ from the “driver-motivated, impulse-susceptible secondary tasks” in real-world settings, Epstein and colleagues wrote that “the effects of training were observed during real-world driving, which suggests that the teens with ADHD in our trial were able to carry over trained skills to real-life settings.”

References:

• Curry A, et al. Pediatrics. 2019;doi:10.1542/peds.2018-2305.
• Epstein JN, et al. N Engl J Med. 2022;doi:10.1056/NEJMoa2204783.