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. Because of the magnitude of ADHD-related driving deficits and their difficulty with generalization of skills to natural environments, we have enhanced the FOCAL intervention (now termed FOCAL+) to include multiple training sessions and to integrate 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 FOCAL+ or a sham placebo group. Immediately after 1 month of training sessions and 4-, 8- and 12-months post-training, teens' driving skills will be assessed using a driving simulator, a road test, and driving records. Using this data, we will examine the short- and long-term efficacy of the FOCAL+ intervention 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 explore potential moderators of intervention efficacy. The public health impact of improving the driving behavior of teens with ADHD cannot be overstated. MVCs are the leading cause of death among teens. among teens with ADHD significantly contributes to these figures. By targeting teens with ADHD, The 2- to 3-fold increased risk of MVCs 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.

Public Health Relevance

Teens with Attention-Deficit/Hyperactivity Disorder (ADHD) have high rates of negative driving outcomes, including motor vehicle crashes, which may be caused by visual inattention (i.e., looking away from the roadway to perform secondary tasks). A driving intervention that trains teens to reduce instances of looking away from the roadway will be tested in teens with ADHD. Developing effective and disseminable treatments for teens with ADHD could reduce public health costs related to motor vehicle crashes.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Child Psychopathology and Developmental Disabilities Study Section (CPDD)
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Lee, Karen
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Cincinnati Children's Hospital Medical Center
United States
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