Women's Health

Simulated driving program helps teens with ADHD be safer on the road


December 29, 2022 — Nadia Tawfik was 17 when she got her first car. Two months later, Tawfik was following her mother’s car when it continued to drive straight and she quickly made the decision to take another direction and turn left. The light was green but there was no green arrow. Halfway through, Tawfik was distracted watching her mother drive away and didn’t see the car coming straight at her.

She hit him head-on.

“I didn’t pay as much attention to it as I should have,” says Tawfik four years after the accident.

Tawfik, who has ADD and is now a graduate nursing student, isn’t the only one having trouble staying alert on the road. According to the CDC, the risk of motor vehicle crashes is higher among teens ages 16 to 19 than any other age group. Road accidents are also the leading cause of death among adolescents.

For teens with Attention Deficit Hyperactivity Disorder (ADHD), the risk of an accident is even higher. According to to research Posted in JAMA Pediatricsadolescents who have been diagnosed with ADHD are 36% more likely to have a car accident than other teenage drivers. Some to research showed that ADHD is also associated with a higher likelihood of multiple collisions.

Fortunately, Tawfik was not seriously injured in the car accident, but her car needed to be replaced. But the accident left her shaken; she began to be more afraid to drive.

About 8 months later, the teenager came across an ad on social media for a study testing a computerized driver training program for teenage drivers with ADHD. She signed happily.

The purpose of the randomized controlled trial was to determine if a computer-based intervention could reduce long gazes away from the roadway and reduce driving risks for teens with ADHD, says Jeffrey Epstein, PhD, lead author of the study. to studywhich was published this month in the New England Journal of Medicine.

The study showed that for adolescents with ADHD, the intervention significantly reduced the frequency of long gazes away from the road as well as a measure of lane weaving compared to a control program. Additionally, in the year following the training, the rate of collisions and near-misses while driving in the real world was significantly lower for people in the intervention group.

These are the most surprising and significant findings for Epstein, who is also a pediatric psychologist and director of the Center for ADHD at Cincinnati Children’s Hospital, the primary site of the study.

“I had my doubts and was very happy when our results generalized to real-world driving,” Epstein said.

Epstein says he decided to focus this study on reducing long gazes (more than 2 seconds) away from the pavement because a previous ADHD research study, of which he was the author, found that teens with ADHD not only had longer gazes away from the pavement when distracted, they had more of those long gazes.

“And so we determined that was a likely reason why teens with ADHD had accidents, and we said, ‘OK, let’s try to fix this. Let’s see if we can fix this problem. “

For the study, a total of 152 adolescent drivers (ages 16-19) with ADHD were assigned to either the intervention or control group. All teens were licensed drivers and drove at least 3 hours per week. Each person received 5 weeks of training, once a week.

Members of the intervention group were trained using a program called the Focused Concentration and Attention Learning Program (FOCAL), which aims to reduce long stares away from the roadway. Those in the control group learned information typically taught in a typical driver training program like the rules of the road, but they learned nothing about long stares and focusing their attention on the road.

The FOCAL program was developed by Donald Fisher, PhD, at the University of Massachusetts, who had worked on decreasing long gazes away from the road in adolescents without ADHD. Epstein’s research team knew they needed to make the program more intensive to work with teens with ADHD, so they upgraded it to include multiple sessions. They also added a driving simulator room where teenagers had to enter the driving simulator after completing this computerized FOCAL program and they were alerted by an alarm whenever there was a glance that exceeded 2 seconds . The only way to silence the alarm was to look at the road again. Indeed, the training consisted of teaching teenagers not to look away from the road for more than 2 seconds.

The training on several occasions lasted more than 7 hours, says Epstein.

“We kind of really had them learn the skill until it became rote.”

One of the main differences between the intervention group and the control group was that the intervention group received auditory feedback when the adolescent looked away from the simulated road for more than 2 seconds, while those in the control group had not received this training in auditory feedback.

Participants in the intervention group were found to average 16.5 long gazes per reader at 1 month and 15.7 long gazes per reader at 6 months, compared to 28 and 27 long gazes respectively in the control group. A measure of pathway weaving was also significantly reduced at 1 month and 6 months in the intervention group compared to the control group.

“We got very large differences between the two groups and very, very statistically significant differences,” Epstein says.

Skill level did not change significantly between 1 and 6 months.

“They remembered those skills that we taught them,” says Epstein.

Secondary outcomes were long stare and crash/near-miss rates over a year of real-world driving.

In order to measure them, the research team placed cameras in most of the teenagers’ cars. The cameras detected and recorded the moments leading up to driving episodes triggered by high g-force on the vehicle, which occurred due to sudden changes in vehicle momentum, such as hard braking, sharp swerving or a collision.

During real-world driving over the year following training, those who participated in the intervention had a 24% reduction in the rate of long gazes per g-force event and a 40% reduction the rate of collisions or near-misses per g-force event against controls.

Tawfik, who was part of the intervention group, says the study was something that really interested him. His participation also allowed him to better understand why some of these accidents occur.

“The simulation itself has really stuck with me for all these years,” she says. “It was helpful because it reminded me to be more aware of my surroundings and not just be careful directly on the road.”

“Training works,” says John Ratey, MD, who is known for his ADHD books, such as the “Driven to Distraction” series that was written with Edward Hallowell, MD.

“It’s like any learning, it helps if you come back again and again,” Ratey says.

“I think the ADHD field is moving towards skill-based learning. As if we have to teach teenagers with ADHD skills,” says Epstein.

There was at least one limitation to the study, however. While the researchers monitored real-world driving for 1 year after the teens completed the training, they were unable to monitor the teens’ drug use during this phase of the study. In other words, it was unclear whether the teens were taking ADHD medication at the time of the crashes or the near-crashes. That said, drug rates across the intervention and controls were very similar, Epstein notes.

Real learning

Tawfik says she feels more comfortable on the road now. She learned to be self-aware and not to panic while driving. She also internalized the message not to take her eyes off the road for more than 2 seconds, a key part for her of the study she says she still applies to this day.

Sometimes her friends try to show her something on their phone while she is driving.

“I don’t watch because I know that quick glance could turn into something awful,” Tawfik says.

Parents and teens interested in learning more about the program can visit This site. Jeffrey Epstein, PhD, lead author of the study, said he hopes the intervention may one day be available using virtual reality or a smartphone app. (Everyone is welcome to complete the training – currently five weeks – on-site at Cincinnati Children’s Hospital starting in January 2023).


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