Simulated Driver Training May Reduce Accidents Among Teens With ADHD

A simulated driving program reduced inattention and risk of crashing among teens with attention deficit-hyperactivity disorder (ADHD) compared with conventional driver’s training, according to a small study that used a program combining computer-based and driving simulator training.

During 15-minute simulated drives, teens in the training group had a mean of 16.5 long glances (>2 seconds) from the road per drive compared with 28.0 long glances per drive in those who did not undergo the training at 1 month (incidence rate ratio [IRR] 0.64, 95% CI 0.52-0.76, P<0.001), and 15.7 versus 27.0 long glances, respectively, at 6 months (IRR 0.64, 95% CI 0.52-0.76, P<0.001), reported Jeffery N. Epstein, PhD, of Cincinnati Children’s Hospital Medical Center, and co-authors.

The standard deviation of lane position was 0.98 SD at 1 and 6 months in the intervention group compared with 1.20 SD at both points for the control group (P<0.001 for both), they noted in the New England Journal of Medicine.

During real-world driving over the year after training, the rate of long glances per g-force event was 18.3% in the intervention group versus 23.9% in the control group (relative risk [RR] 0.76, 95% CI 0.61-0.92), while the rate of collision or near-collision per g-force event was 3.4% and 5.6%, respectively (RR 0.60, 95% CI 0.41-0.89).

This research provides some hope for a possible intervention that could help teens with ADHD drive more, while reducing the risk for accidents, Epstein told MedPage Today.

“I can tell you that anybody that treats teens with ADHD, when they come in for those visits, whether it be a pediatrician, whether it be a psychiatrist, or a psychologist, their parent is telling that care provider, I’m worried as all heck about my kid having a driver’s license,” he said. “And they should be, because the risk of having ADHD and driving is pretty bad.”

Epstein explained that the main goal of the study was to train teens with ADHD not to look away from the road. This was an important finding, he noted, because teens are four times more likely to be in a crash versus adult drivers, and teens with ADHD are twice as likely as their neurotypical peers to be in a crash.

“What do parents do? They usually refuse to give their kid a license, or they delay licensure, or they get their kid a license and then they’re just incredibly anxious about it,” Epstein said. “That’s really what we have today. There’s really no options out there for parents.”

Anish Dube, MD, MPH, chair of the American Psychiatric Association’s Council on Children, Adolescents, and their Families, said this intervention holds a lot of promise for young people with ADHD, who otherwise would not have any help with reducing their risks while driving.

“When you take an activity that is both pervasive and common but also high risk, like driving, it’s really important that we make sure that our young folks are safe, and that we can try to minimize the risk of any adverse outcomes happening, like accidents or injuries,” Dube told MedPage Today. “Any kind of interventions that you have that are reducing or minimizing that risk of adverse events, I think these are steps in the right direction.”

“The importance of the research is that if we know these kinds of interventions may be helpful, then you can take a public health systems approach, where you can start incorporating these kinds of interventions, especially in standard instruction like driver’s education either in school or through the DMV,” he added.

Dube said the next step would be working to make this kind of training more accessible for teens with ADHD.

Epstein noted that they are interested in developing a virtual reality-based version of the training to help make this program more accessible to teens, but these efforts are still in the early stages.

This study included a total of 152 teens with ADHD who were recruited from December 2016 to March 2020 in Kentucky, Ohio, or Indiana. At baseline, mean age was 17.4, 62% were boys, and 88% were white. Mean number of months with driving experience was 9.4, and 68% were taking stimulant medication for ADHD.

The teens were randomly assigned 1:1 to the intervention group, consisting of five sessions using both computer-based training and a console-based driving simulator, or the control group, consisting of more conventional driver’s education involving desktop-based learning modules.

The teens in the intervention group were first asked to participate in tasks designed to train them to multitask during a simulated drive while limiting long glances away from a simulated road. Next, they used the driving simulator console with a steering wheel and pedals. The participants also wore specialized glasses that tracked eye and head movements. During this simulated driving training, the teens were asked to identify random symbols on the dashboard, which required them to take their eyes off the simulated road momentarily. If they looked away for longer than 2 seconds, an alarm sounded.

Epstein and colleagues noted that they could not determine the influence of ADHD medication on accidents or near-accidents, which was a limitation to their study. They also could not determine whether the intervention would be effective if the participants had not already completed state driver training.