Driving Program Steers Teens With ADHD in the Right Direction

Deborah Brauser

February 08, 2011

February 8, 2011 — Because of the success of a therapeutic program using a driving simulator to help teenagers with attention-deficit/hyperactivity disorder (ADHD) become better drivers, the University of Buffalo has been rewarded a $2.8 million grant from the National Institute of Health's (NIH's) National Institute of Child Health and Human Development.

The grant will allow the program, which lets teens "experience" the dangers of texting and not paying proper attention while driving in dramatic demonstrations, to continue and will fund new research.

"We felt strongly that a good driving intervention would be one that focuses not only on the driver but also on the parents who are going to be in charge of monitoring these teens," Gregory A. Fabiano, PhD, associate professor of counseling, school, and educational psychology at the University at Buffalo, State University of New York, told Medscape Medical News.

Dr. Gregory A. Fabiano

"The research we're doing here will help make the roads safer for everyone," said Dr. Fabiano.

He noted that this particular group is considered to be the most risky of all drivers.

"Teen drivers are the worst on the road. And some recent research has shown that compared to that worst group of drivers, teen drivers with ADHD were significantly more at risk for everything," Dr. Fabiano explained in a release.

"We've worked with children with ADHD for a long time at the university. And as we watched those kids grow up, we kept hearing a lot of concerns from parents about the transition to independent driving, about their kids entering the roadway," said Dr. Fabiano.

Alternatives to Medication

He noted that although several researchers have begun investigating interventions for teenagers with ADHD, many of them have focused on medication.

"We started to think we should also be focusing on some viable alternatives for families that have concerns that their teen might refuse or forget to take their medicine or if they're driving at times when their stimulant medications may not be therapeutically active, such as later in the evening or first thing in the morning, or even on weekends if they don't take it on nonschool days."

So Dr. Fabiano and his team developed an intervention called the STEER program, which stands for Supporting Teens' Effective Entry into the Roadway.

In STEER, teens with ADHD practice driving skills on a state-of-the art simulator while an onboard monitor tracks their behaviors. This lets them and their parents review the driving performance and interactions together afterward.

"We can sit and talk to a teen or to a family about the right things to do in a car but that only takes you so far. Once you have knowledge, the next step is to perform. By putting an individual in the simulator, we can have the teen actually practice driving skills in a life-like environment. The success stories have been really gratifying," said Dr. Fabiano.

The investigators recently completed a small feasibility study that looked at their recruitment strategy and how successful it was at getting teens with ADHD to enroll in STEER and whether or not it was a promising intervention.

Findings 'Promising'

"We not only wanted to see how the teens would respond, we wanted to also see how the parents would respond to our coaching of their parenting skills," said Dr. Fabiano.

The findings are "promising" and showed that neither teens nor their parents found it "too demanding" or too boring.

The NIH grant will fund a larger study that randomly assigns teenagers with ADHD and driver learner's permits to undergo either the STEER program along with a community-provided driver's education program or the driver's education program alone.

In addition, both groups will put in time in the simulator so that their driving skills can be tracked, as well as to show them how texting and driving while intoxicated can affect their outcomes.

"Teens often do not realize their ability to drive while texting is severely compromised — until they lose control of their simulated vehicle. In our research, we have yet to have somebody be a successful texter while driving, and that includes our internal staff and me," said Dr. Fabiano.

Although the driving simulators are currently used just as a part of STEER to teach drivers and to record behaviors, there are plans for eventual studies on the feasibility, cost-effectiveness, and benefits of other centers incorporating these types of simulators into their own programs.

"There is no question that the simulator is an expensive piece of equipment. However, if one considers the cost of accidents, the injuries that accidents cause, and even the deaths of teen drivers, if this works, it would certainly justify the costs of a simulator or other technology. If the research eventually shows that it can prevent these terrible outcomes, it may be something to consider," said Dr. Fabiano.

Additional information, including a video of the simulator in action, is available at the University at Buffalo Website.

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