A novel intervention to improve the driving performance of ADHD teens

Grant #: R01HD084430-01A1
PI: Jeff Epstein, Ph.D.
Co-I: Annie Garner, Ph.D. (Saint Louis University), Leanne Tamm, Ph.D.
Collaborators: Adam Kiefer, Ph.D., Donald Fisher, Ph.D. (Engineering/UMass)

Operating a motor vehicle requires a complex set of skills, the most important of which is the ability to continuously visually attend to the roadway. Glances away from the roadway, especially those longer than 2 seconds, significantly increase one’s risk for a motor vehicle crash (MVC). Teen drivers evidence far more extended glances away from the roadway than experienced drivers. Further, teens with a diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) emit 3-times more extended glances away from the roadway than typical teens. Moreover, our preliminary data indicate that the substantial driving deficits observed among teen drivers with ADHD are mediated by elevations in the number of extended glances away from the roadway. Hence, there is a clear need for interventions, particularly one that targets extended glances away from the roadway, to address the driving deficits of teens with ADHD. The proposed research will test the efficacy of the FOcused Concentration and Attention Learning (FOCAL) intervention, which targets reducing the number of extended glances away from the roadway, among teens with ADHD. The PC-based FOCAL training provides teens with an operational understanding of the dangers of extended glances away from the roadway and trains them on limiting the length of their glances. Tested with typical teens, FOCAL significantly attenuates the number of extended glances away from the roadway. To date, FOCAL has not been tested in teens with ADHD. Since teens with ADHD may have trouble generalizing FOCAL training to actual roadway conditions, we propose to also develop and test an enhanced FOCAL intervention (FOCAL+) that integrates practice on a driving simulator with immediate feedback regarding extended glance behavior. In the proposed randomized trial, teens with ADHD will be randomly assigned to receive either 1) FOCAL, 2) FOCAL+, or 3) a sham placebo group. Immediately after training, 1-month, 4-months, and 12-months post-training, teens driving skills will be assessed using a driving simulator. In addition, a video monitoring system installed in the teen’s car will collect information about actual driving performance over the course of one year post-training. Using this data, we will examine the short- and long-term efficacy of FOCAL and FOCAL+ interventions on 1) decreasing rates of extended glances away from the roadway among teens with ADHD, and 2) improving driving performance among teens with ADHD. We will also compare the cost-effectiveness of the FOCAL and FOCAL+ interventions and explore potential moderators of intervention efficacy. The public health impact of improving the driving behavior of teens with ADHD cannot be understated. MVCs are the leading cause of death among teens. The 2- to 3-fold increased risk of MVCs among teens with ADHD significantly contributes to these figures. By targeting teens with ADHD, we are targeting one of the highest risk groups of drivers on the road. Were our interventions to normalize driving among teens with ADHD, the potential impact on rates of MVC injuries and deaths would be substantial.