By Kathleen Berger, Executive Producer for Science and Technology

Clinical psychologist Annie Garner, PhD, has spent years working with children who have attention-deficit/hyperactivity disorder (ADHD).

“Children with ADHD become adolescents with ADHD who become drivers with ADHD,” said Garner. “Inattention, hyperactivity, impulsivity affect drivers. Teens with ADHD are twice as likely as teens without ADHD to be involved in a motor vehicle crash.”

This prompted Garner to become co-investigator of this new study to help teenage drivers with ADHD.

“We recruited 152 teens with ADHD who were between the ages of 16 and 19. In our previous work, we had found that one of the primary mechanisms or causes of driving issues in teens with ADHD was how frequently they looked away from the road,” said Garner.

Garner is an associate professor at Saint Louis University in the Department of Psychology.

“What we call an extended eye glance in the driving literature is looking away for more than two seconds,” she explained. “Anything more than two seconds increases your crash risk significantly. We wanted to develop an intervention that would teach teens with ADHD to be more aware of those. We call them extended eye glances and then train them to reduce the frequency of those extended eye glances.”

To accomplish reducing extended eye glances, Garner helped develop technology called Enhanced Focuses Concentration and Attention Learning (FOCAL+). The FOCAL+ program is devised to reduce glance duration to distracting tasks by training teens to use repeated but brief glances between the secondary task of looking at a road map and the roadway during a desktop computer simulation.

In driving simulator training following the desktop training, study participants wore special glasses which tracked eye and head movements while they maneuvered a steering wheel and pedals.

“We put them in a driving simulator where they also drove and engaged in a secondary task, using a center console that we created and they would look down at it,” said Garner. “When they would look away, we had them wearing eyeglasses that help tell us how long they had been looking away from the road. And then those eye glances would send them a beep. It would be a loud beep, annoying beep, that would say you’re looking away from the road too long and then it would go away once they looked back at the forward road.”

Following the initial five-times a week training on Focal+, an in-vehicle camera monitored the driving habits of the study participants for a year.

“We were really interested in how it changed their driving on the actual road. So, we installed cameras into the teens cars and we followed their driving behaviors for a year and we were able to, from those videos, look at extended eye glances in their driving, during the driving, as well as crashes and near crashes over the course of the year,” Garner said.

The research is published in the New England Journal of Medicine. The study  shows how a computerized program enhanced by driving simulation training with feedback lowers the risk of car crashes for teenagers with attention-deficit/hyperactivity disorder (ADHD).

“At one month and six months, we saw statistically significantly fewer extended eye glances in the driving simulator, and we also saw that they had better control of their driving-simulator car. In the real world, we also found fewer extended eye glances, 23% fewer extended eye glances, and they had a 40% reduced risk of crashes and near crashes in the real world compared to teens who had been in our control intervention group.”

The control intervention group used only the more basic form of computer- based, desktop education focused on learning the rules of the road.

Now that Focal+ has proven success, the goal is to find ways to make the technology and training available to more teen drivers with ADHD.

“We’re looking for the next phase of research,” said Garner. “We’re looking for ways to make it more accessible to folks. One area that we’re looking at is VR, using virtual reality as a way to give teens this experience without all of the other equipment that goes into Focal+ right now, because that would definitely be more cost-effective, most likely. But we’re looking into that and we’re exploring other options.”