# Improving ADHD Teen Driving

> **NIH NIH R01** · CINCINNATI CHILDRENS HOSP MED CTR · 2024 · $690,144

## Abstract

Project Summary
Motor vehicle crashes (MVC) are the leading causes of death among teens with eight teens dying per day in
an MVC. Teens with Attention-Deficit Hyperactivity Disorder (ADHD) are at twice the risk of MVC compared to
teen drivers without ADHD. A programmatic line of research by this investigative team has identified long (>2
secs) glances away from the roadway, particularly during engagement with secondary tasks, as being a key
mechanism in ADHD teen driving risk. In the original research grant, the investigative team developed and
tested a driver training program, enhanced FOcused Concentration and Attention Learning (FOCAL+), to
specifically target reducing rates of extended glances away from the roadway in teens with ADHD. In a
randomized controlled trial (RCT), teens with ADHD randomly assigned to FOCAL+ demonstrated 41% fewer
long-glances and less variability in lane position during simulated driving assessments conducted immediately
after the final training session, and 1- and 6-months post-training compared to teens assigned to modified
driver's training. Moreover, during naturalistic driving over the course of a year of driving, FOCAL+ teens had
40% less risk of a crash/near-crash event than control teens. However, there are considerable barriers to
disseminating FOCAL+ in its current format. FOCAL+, as implemented in the RCT, requires costly (~$90K)
hardware and software that are quite complex to use. Though there has been much interest in offering this
training since publication of our RCT results, key stakeholders have reported that the expense and complexity
of the hardware and software requirements are barriers to adoption. In the proposed study, with input from
relevant stakeholders, FOCAL+ training will be converted to an immersive virtual reality (iVR) platform. iVR-
FOCAL+ will provide an affordable ($5K), single hardware, single software, easily-executable solution that
implementation sites (i.e., driving schools, outpatient occupational therapy) will be able to afford, adopt, and
offer to teens with ADHD. Using a Type 2 hybrid effectiveness-implementation design, teens with ADHD will
be randomly assigned to receive either iVR-FOCAL+, the original FOCAL+ or a sham control group. The iVR-
FOCAL+ training will be implemented in real-world, non-research settings (i.e., driving schools, outpatient
occupational therapy). At baseline and 1- and 6-months post-training, teens' driving skills will be assessed
during driving simulation. Naturalistic driving will be assessed during the year after training using video event
recorders installed in the teen's car. Training costs and implementation outcomes (e.g., barriers to
implementation) for each training will be collected. Using these data, we will examine the relative effectiveness
and cost-effectiveness of iVR-FOCAL+ intervention compared to FOCAL+ training. Finally, implementation of
iVR-FOCAL+ will be tested and described. The proposed research has the potential to facili...

## Key facts

- **NIH application ID:** 10976004
- **Project number:** 2R01HD084430-06A1
- **Recipient organization:** CINCINNATI CHILDRENS HOSP MED CTR
- **Principal Investigator:** JEFF N. EPSTEIN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $690,144
- **Award type:** 2
- **Project period:** 2016-09-16 → 2029-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10976004

## Citation

> US National Institutes of Health, RePORTER application 10976004, Improving ADHD Teen Driving (2R01HD084430-06A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10976004. Licensed CC0.

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