Utility of a Novel Simulator Paradigm in the Assessment of Driving Ability in Individuals with and Without Attention‑Defcit Hyperactivity Disorder
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ADHD Attention Defcit and Hyperactivity Disorders (2019) 11:403–411 https://doi.org/10.1007/s12402-019-00303-w ORIGINAL ARTICLE Utility of a novel simulator paradigm in the assessment of driving ability in individuals with and without attention‑defcit hyperactivity disorder John Bernstein1 · Scott Roye1 · Matthew Calamia1 · Alyssa De Vito1 Received: 10 October 2018 / Accepted: 6 April 2019 / Published online: 12 April 2019 © Springer-Verlag GmbH Austria, part of Springer Nature 2019 Abstract This study aimed to evaluate the utility of a novel, more cost-efective driving simulator, Assetto Corsa (AC), in detecting diferences in driving performance between individuals with and without ADHD. Driving simulators are a useful means of assessing driving performance in those with attention-defcit hyperactivity disorder (ADHD); however, they are frequently expensive and thus unavailable to many researchers. A total of 87 participants (16 with ADHD, 71 without) completed an AC driving simulator task. They also completed computerized measures of attention and executive functioning and a question- naire assessing self-reported driving behaviors and anger, ADHD and related symptoms, and mind wandering. Relative to those without ADHD, participants with ADHD reached higher average ground speeds and more greatly utilized the throttle. They also applied higher maximum pressure to the throttle and brake pedals. Within the full sample, greater mind wander- ing was associated with average and maximum throttle pressure and maximum ground speed. Findings confrm prior works indicative of a deleterious efect of ADHD diagnosis on simulator performance and may be attributed to a combination of impulsivity and mind wandering. Keywords Simulation and virtual reality · Mental disabilities · Distraction · Driver behavior · Attentional processes Introduction 2006). A majority of this literature has been derived from self-report and on-road evaluation data (Jerome et al. 2006; Driving is the most popular method of transportation in Merkel et al. 2016; Randell et al. 2016). In comparison with the USA; the average American puts in over 13,000 miles their non-ADHD peers, those with ADHD are two to four behind the wheel each year (US Department of Transporta- times more likely to be involved in an accident (Bron et al. tion). However, driving is also potentially dangerous both 2018; Sadek 2014). They also perform more poorly when to the driver and to the others on the road. In 2017, over completing on-road evaluations (Merkel et al. 2016; Randell 37,000 motor vehicle-related deaths occurred in the USA et al. 2016), are more likely to sufer bodily injury due to alone (National Highway Traffic Safety Administration being involved in an accident, receive speeding tickets, be 2018). Although other variables such as vehicle malfunction found at fault, and have their license suspended (Barkley and environmental conditions are associated with collisions, and Cox 2007; Barkley et al. 1996; Curry et al. 2017). These human factors are considered to be the strongest contributor negative outcomes may be attributed to a variety of symp- to motor vehicle collisions (Castro 2008). toms characteristic of ADHD, including heightened impul- Symptoms of attention-deficit hyperactivity disorder sivity (Jerome et al. 2006) and hyperactivity (Fischer et al. (ADHD) have been shown to be one such human factor 2007). Clinical trials further show that inadequate concen- that has a negative efect on driving ability (Jerome et al. tration contributes to ADHD individuals’ higher crash risk, but this may be improved with stimulant medication (Cox et al. 2004; Verster et al. 2008). Among those with ADHD, * John Bernstein concentration difculties may manifest themselves through [email protected] unintentional mind wandering, or a tendency to be distracted 1 Department of Psychology, Louisiana State University, 217 from one’s task due to insufcient monitoring capabilities Audubon Hall, Baton Rouge, LA 70803, USA (McVay and Kane 2010). Like inattention, mind wandering Vol.:(0123456789)1 3 404 J. Bernstein et al. may be associated with crash risk (Galéra et al. 2012; Seli (Barkley et al. 1996), others have not found such diferences et al. 2015). However, its association with driving perfor- (Barkley et al. 2002; Groom et al. 2015). Additionally, while mance among those with ADHD has not received extensive individuals with ADHD typically demonstrate poorer execu- attention in the literature. tive functioning (EF) capacities, disagreement persists as to In addition to self-report and on-road methods, simula- whether these measures are useful for screening for impaired tor technologies represent an additional tool for assessing driving in those with ADHD, as EF measures may only be driving safety in clinical populations, including those with modestly associated with driving performance (Barkley et al. ADHD (Reimer et al. 2010; Weafer et al. 2008). In compari- 2002). son with questionnaires, driving simulators are considered The current study aimed to evaluate the sensitivity of a to have higher ecological validity and are not limited by pit- novel, less costly driving simulator to the detrimental efects falls common across much of the feld of psychology when of ADHD and related symptoms. In doing so, this study served using retrospective self-report measures (e.g., poor partici- as a pilot efort in exploring the simulator’s potential utility for pant insight or memory, bias toward conveying oneself in an future use in both clinical and research contexts. overly positive manner) (Schultheis and Rizzo 2001). Meas- ures sensitive to the cognitive efects of ADHD have also Methods shown some promise in predicting driving safety; however, these measures again lack ecological validity and may only Participants and procedure be weakly correlated with actual driving performance (Bar- kley et al. 2002). Although on-the-road evaluations remain This research complied with the American Psychological the “gold standard” when assessing driving safety, simula- Association Code of Ethics and was approved by the Loui- tors represent a less dangerous means of obtaining a glimpse siana State University Institutional Review Board. Informed into an individual’s driving, are less time-consuming, and do consent was obtained from each participant. Participants not require as much training to administer (Schultheis and were recruited from two sources: (1) the undergraduate psy- Rizzo 2001). However, although simulators have been in use chology student pool and (2) a separate study examining the for several decades, the high costs associated with acquir- efects of white noise on cognitive performance in individuals ing and running participants on full-body simulators have with or without ADHD. Individuals recruited from the white limited the number of research groups and institutions with noise study for the present one both self-reported history of access to simulator data. Top-end simulators, such as the ADHD and met criteria for the disorder based on a structured National Advanced Driving Simulator-1 at the University of interview (i.e., the Diagnostic Interview for ADHD in Adults Iowa (www.nads-sc.uiowa .edu), cost in the millions of US (DIVA)) administered as part of the white noise study (Kooij dollars to develop and implement, and charge signifcant fees and Francken 2010; Roye 2017). Participants recruited via the on a per-participant basis. These simulators ofer a superior undergraduate student pool were ofered extra credit in their driving experience in terms of fdelity, control responsive- psychology courses in return for their participation. Partici- ness, and complexity of motion platforms; however, they are pants recruited via the white noise study were not psychology also cost-prohibitive to most researchers. Even simulators students and were ofered $15 as compensation. Inclusionary described as being “low cost,” such as one recently intro- criteria included that participants be native English speakers duced at the University of Oulu in Finland, has a purchasing and over the age of 18. Participants were also required to be fee of approximately $28,000 (Koskela et al. 2011). With licensed drivers and presently drive on a weekly basis at least recent improvements in personal computer (PC) technol- fve miles per week. ogy, PC-based simulators have been increasingly used for Data collection was completed in one 2-h session for research purposes (Hassan and Gausemeier 2013). However, each participant. Study investigators or trained undergradu- striking a balance between simulator fdelity and monetary ate research assistants conducted all study procedures. All cost has remained challenging. study sessions began with informed consent, followed by Prior studies examining diferences in driving simulator completion of the measures described below in the order that performance between ADHD individuals and their non-ADHD they appear. All participants from both groups completed the peers have yielded a variety of fndings, mostly suggestive of a same study measures. deleterious efect of ADHD status on driving. In comparison with those without ADHD, individuals with ADHD typically Measures display increased speeding (Barkley et al. 1996; Fischer et al. 2007; Groom et al. 2015). Other aspects of driving demon- Driving simulator strate more mixed fndings; for example, whereas some have identifed diferences in lane deviation (i.e., standard deviation The present study utilized a custom-built, personal of lateral position) (Fischer