From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center (J.N.E., J.P., L.T., J.O.S.), and the University of Cincinnati College of Medicine (J.N.E., J.P., L.T.) - both in Cincinnati; the Department of Psychology, Saint Louis University, St. Louis (A.A.G.); the Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill (A.W.K., R.P.M.); and the Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, and Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge - both in Massachusetts (D.L.F.).
N Engl J Med. 2022 Dec 1;387(22):2056-2066. doi: 10.1056/NEJMoa2204783.
Teens with attention deficit-hyperactivity disorder (ADHD) are at increased risk for motor vehicle collisions. A computerized skills-training program to reduce long glances away from the roadway, a contributor to collision risk, may ameliorate driving risks among teens with ADHD.
We evaluated a computerized skills-training program designed to reduce long glances (lasting ≥2 seconds) away from the roadway in drivers 16 to 19 years of age with ADHD. Participants were randomly assigned in a 1:1 ratio to undergo either enhanced Focused Concentration and Attention Learning, a program that targets reduction in the number of long glances (intervention) or enhanced conventional driver's education (control). The primary outcomes were the number of long glances away from the roadway and the standard deviation of lane position, a measure of lateral movements away from the center of the lane, during two 15-minute simulated drives at baseline and at 1 month and 6 months after training. Secondary outcomes were the rates of long glances and collisions or near-collisions involving abrupt changes in vehicle momentum (g-force event), as assessed with in-vehicle recordings over the 1-year period after training.
During simulated driving after training, participants in the intervention group had a mean of 16.5 long glances per drive at 1 month and 15.7 long glances per drive at 6 months, as compared with 28.0 and 27.0 long glances, respectively, in the control group (incidence rate ratio at 1 month, 0.64; 95% confidence interval [CI], 0.52 to 0.76; P<0.001; incidence rate ratio at 6 months, 0.64; 95% CI, 0.52 to 0.76; P<0.001). The standard deviation of lane position (in feet) was 0.98 SD at 1 month and 0.98 SD at 6 months in the intervention group, as compared with 1.20 SD and 1.20 SD, respectively, in the control group (difference at 1 month, -0.21 SD; 95% CI, -0.29 to -0.13; difference at 6 months, -0.22 SD; 95% CI, -0.31 to -0.13; P<0.001 for interaction for both comparisons). 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 and 23.9% in the control group (relative risk, 0.76; 95% CI, 0.61 to 0.92); the rate of collision or near-collision per g-force event was 3.4% and 5.6%, respectively (relative risk, 0.60, 95% CI, 0.41 to 0.89).
In teens with ADHD, a specially designed computerized simulated-driving program with feedback to reduce long glances away from the roadway reduced the frequency of long glances and lessened variation in lane position as compared with a control program. During real-world driving in the year after training, the rate of collisions and near-collisions was lower in the intervention group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT02848092.).
患有注意力缺陷多动障碍（ADHD）的青少年发生机动车碰撞的风险增加。一种旨在减少导致碰撞风险的长凝视（持续时间≥2 秒）的计算机技能培训计划可能会改善 ADHD 青少年的驾驶风险。
我们评估了一项旨在减少 16 至 19 岁驾驶员注视道路时间过长（≥2 秒）的计算机技能培训计划。参与者以 1:1 的比例随机分配接受增强型专注注意力学习（干预组）或增强型常规驾驶员教育（对照组）。主要结局指标为基线、1 个月和 6 个月训练后 15 分钟模拟驾驶时的长凝视次数以及车道位置标准差（衡量偏离车道中心的侧向运动）。次要结局指标为训练后 1 年内，通过车载记录评估的长凝视次数以及涉及车辆动力（g 力事件）突然变化的碰撞或接近碰撞的发生率。
在训练后的模拟驾驶中，干预组参与者在 1 个月时有 16.5 次长凝视，在 6 个月时有 15.7 次长凝视，而对照组分别为 28.0 次和 27.0 次（1 个月时的发生率比，0.64；95%置信区间[CI]，0.52 至 0.76；P<0.001；6 个月时的发生率比，0.64；95%CI，0.52 至 0.76；P<0.001）。干预组的车道位置标准差（英尺）在 1 个月时为 0.98 SD，在 6 个月时为 0.98 SD，而对照组分别为 1.20 SD 和 1.20 SD（1 个月时的差异，-0.21 SD；95%CI，-0.29 至 -0.13；6 个月时的差异，-0.22 SD；95%CI，-0.31 至 -0.13；两者比较的交互作用 P<0.001）。在训练后 1 年内的实际驾驶中，干预组的长凝视次数发生率为 18.3%，对照组为 23.9%（相对风险，0.76；95%CI，0.61 至 0.92）；g 力事件的碰撞或接近碰撞发生率分别为 3.4%和 5.6%（相对风险，0.60；95%CI，0.41 至 0.89）。
在患有 ADHD 的青少年中，与对照组相比，专门设计的具有反馈功能以减少注视道路时间过长的计算机模拟驾驶程序可减少长凝视的频率并减少车道位置的变化。在训练后 1 年内的实际驾驶中，干预组的碰撞和接近碰撞发生率较低。（由美国国立卫生研究院资助；临床试验.gov 编号，NCT02848092。）
