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FOCAL+ Simulation Reduce Crashes Caused by Anxiety Disorder

Cincinnati, USA - In a small study, teens with ADHD participated in a simulated driving program to learn how to drive in a safe and responsible manner.

Combining a driving simulator training program with computer-based training reduced the number of crashes and near collisions among teens. The research is promising because it shows that this type of training can help reduce the duration of glances away from the road and make sure they are more consistent.

Jeffery N. Epstein, Ph.D., conducted the study and is from Cincinnati Children's Hospital Medical Center. NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Center for Advancing Translational Sciences funded the project.

ADHD often affects how a person functions throughout the day and can lead to various development problems in children.Teen drivers are four times as likely to experience an accident as adult drivers, which is largely because they remain distracted for an extended period of time. The driving simulation program teaches teens how to reduce their risk by keeping their eyes on the road and checking themselves when they become distracted. Furthermore, diagnosing ADHD in adults is more difficult because there's some disagreement about whether the list of symptoms like anxiety disorder used to diagnose children and teenagers also applies to adults.

The Focused Concentration and Attention Learning (FOCAL) simulation is a computer-based program that teaches neurotypical teen drivers to limit long glances away from the roadway. Researchers found that adding a driving simulator to FOCAL enhanced the training by providing instant feedback on these long glances. As a result, they called the combined training: FOCAL+.

There were 152 teens involved in the study. Twenty-seven teens received the FOCAL+ training, which included five sessions of both computer and console-based driving simulator training. In the computer training, a screen split horizontally and participants were shown a driver’s perspective of a roadway. Half of the screen displayed a map that had street names. 

Participants were told to depress the spacebar and identify the street when an arrow points to it on the map. When they pressed the spacebar, the map filled up half of the screen and made them lose their driving perspective because they couldn't see where they are going. Pressing it one more time would restore their view of the map. Allowing it to stay on the map for three seconds would make an alarm sound. A subsequent session would only have it last for two seconds before making an alarm sound again.

To help participants prepare for on-road driving, an indoor driving simulator was created. They could get a feel for what it's like to drive on busy roads and react to traffic ahead of them. Participants wore specialized glasses that track eye and head movements. When they weren't looking straight ahead, an alarm would sound. Participants who scored poorly repeated the simulation until their scores improved.

The 76 youths who were assigned to the control group conducted driver safety instructions on a computer and then did street and symbol searches in the driving simulator with an alarm set to go off at random times.

Participants in the FOCAL+ condition had an average of 16.52 long glances (lasting more than 2 seconds) one month after entering the program. The control condition had 28.05 long glances at this time. Six months after finishing the training, the average number of long glances in the FOCAL+ group decreased to 15.7 and in the control group, it remained at 27.

FOCAL+ is an evaluation and training intervention that aims to reduce the risk of near-crashes, road departure, and driver distraction among adolescent drivers. Participants in the FOCAL+ group underwent a year-long assessment consisting of voluntary video recording of their drives and comparison with 45 control participants. The FOCAL+ group had 76% fewer long looks than the control group during driving. The rate of crashes and near crashes within the FOCAL+ group was 3.4%, compared to 5.6% for the control group, amounting to a 40% reduction in crashes and near-crashes among this at-risk population.

This study found that FOCAL+ could reduce the number of long glances and crashes caused by inattentiveness in youth with ADHD.

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