"Improving ADHD Teen Driving"

 描述(申请人提供)：操作一辆机动车需要一套复杂的技能，其中最重要的是能够持续地在视觉上照看道路。从道路上向外瞥一眼，特别是那些超过2秒的目光，会显著增加发生机动车碰撞(MVC)的风险。青少年司机比有经验的司机更容易将目光从车道上移开。此外，被诊断为注意力缺陷/多动障碍(ADHD)的青少年从道路上向远处张望的时间是典型青少年的3倍。此外，我们的初步数据表明，在患有ADHD的青少年司机中观察到的实质性驾驶缺陷是由远离道路的延长目光数量的上升所调节的。因此，显然有必要进行干预，特别是针对远离道路的长时间注视的干预，以解决患有ADHD的青少年的驾驶缺陷。这项拟议的研究将测试注意力集中和注意力学习(Focus)干预的有效性，该干预的目标是减少ADHD青少年从道路上长时间扫视的次数。基于PC的焦点训练为青少年提供了对长时间注视远离道路的危险的操作理解，并培训他们限制注视的长度。在典型青少年的测试中，Focus显著减少了从道路上长时间扫视的次数。到目前为止，Focus还没有在患有ADHD的青少年中进行测试。由于ADHD相关驾驶缺陷的严重性，以及他们难以将技能推广到自然环境中，我们加强了焦点干预(现在称为Focus+)，包括多个培训课程，并将驾驶模拟器上的练习与关于扩展扫视行为的即时反馈相结合。在拟议的随机试验中，患有ADHD的青少年将被随机分配到Focus+组或假安慰剂组。在1个月的培训课程以及4个月、8个月和12个月的培训后，青少年的驾驶技能将立即使用驾驶模拟器、路测和驾驶记录进行评估。利用这些数据，我们将检验Focus+干预在以下方面的短期和长期效果：1)减少ADHD青少年从道路上长时间扫视的比率，2)提高ADHD青少年的驾驶能力。我们还将探索干预效果的潜在调节因素。改善ADHD青少年驾驶行为对公共健康的影响怎么强调都不为过。多发性硬化症是青少年死亡的主要原因。在青少年中，ADHD对这些数字有很大贡献。通过瞄准患有多动症的青少年，多动症的风险增加了2到3倍，我们瞄准了道路上最高风险的司机群体之一。如果我们的干预措施使患有ADHD的青少年的驾驶行为正常化，那么对MVC损伤和死亡率的潜在影响将是巨大的。

 DESCRIPTION (provided by applicant): 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.