Research Studies |
Article | Type of Study | Objective | Participants | Key Findings | Limitations | MQI |
Almberg et al. 2015 | Observational Interview; cross-sectional | To explore driving education experienced by individuals with ASD or ADHD | Individuals with ASD (N = 19, Mage = 20.7) Individuals with ADHD (N = 14, Mage = 20.6) Driving instructors (N = 9)
| | | 0.68 |
Anstey et al. 2012 | Observational; cross-sectional | To evaluate the importance of cognitive function for the Capacity to Drive Safely | | | | 0.59 |
Ball et al. 2010 | Randomized, controlled trial (RCT) | To test the effects of cognitive training on motor vehicle collision involvement in older drivers | | | | 0.78 |
Barkley et al. 2002 | Observational; cross-sectional | To examine the impact of ADHD on multiple levels of driving ability | | Adults with ADHD reported more traffic citations than controls ADHD adults made more errors than controls on a visual reaction task Controls used safer driving habits than ADHD adults
| | 0.69 |
Biederman et al. 2007 | Naturalistic; cross-sectional | To examine the association between ADHD and driving | | | | 0.73 |
Bishop et al. 2017 | Naturalistic; cross-sectional | To evaluate driving performance around hazards among adolescents with ASD | Young adult drivers with ASD (N = 16) Typically-developing controls (N = 16, Mage for groups combined = 23.17)
| | | 0.69 |
Borowsky et al. 2010 | Observational; cross-sectional | To observe the effects of age and experience on identifying hazards | Inexperienced drivers (N = 21, age range = 17–18) Experienced drivers (N = 19, age range = 22–30) Elderly-experienced drivers (N = 16, age range = 65–72)
| Young drivers responded less sensitively to unplanned hazards More experienced drivers gazed more to the right at T-intersections, while young drivers gazed straight ahead
| Small sample size Unclear study aims
| 0.51 |
Brooks et al. 2016 | Naturalistic; cross-sectional | To investigate the motor aspects of pre-driving skills in young adults with ASD | Young adults with ASD (N = 10, Mage = 15.9) Neuro-typical controls (N = 31, Mage = 16.7)
| | | 0.66 |
Chee et al. 2015 | Observational interview; cross-sectional | To understand the viewpoints of drivers with ASD | Young adults with ASD (N = 50, Mage = 21.8) Typically developed adults (N = 57, Mage = 23.6)
| | | 0.68 |
Corbett et al. 2009 | Observational; cross-sectional | To compare and contrast executive functioning in children with ASD, ADHD, and typical development. | Children with ASD (N = 18, Mage = 9.44) Children with ADHD (N = 18, Mage = 9.40) TD children (N = 18, Mage = 9.56)
| Children with ADHD showed deficits in vigilance, inhibition, and working memory Children with ASD showed deficits in vigilance, response inhibition, cognitive flexibility/switching, and working memory
| | 0.67 |
Cox et al. 2012 | Observational interview | To gain a better understanding of driving and ASD | | | | 0.48 |
Cox et al. 2017 | RCT | To investigate whether virtual reality driving simulation training improves ASD driving performance | | | Small sample size A control group of neuro-typical drivers could have differentiated the effects of ASK from that of being a novice driver Greater emphasis of on-road training during the training interval could have been encouraged
| 0.66 |
Crundall et al. 2010 | RCT | To assess the effects of commentary training on learner drivers’ performance in a simulator | | | | 0.56 |
Curry et al. 2017 | Retrospective cohort | To examine the association between ADHD, and licensing and crash involvement | | | Diagnosis relied on primary care clinicians and not testing of DSM-V standards Driving exposure was not examined Results may not be as generalizable due to New Jersey’s licensing age, the urbanized area, and the higher prevalence of ADHD in the studied cohort relative to US-based estimates
| 0.64 |
Curry et al. 2018 | Retrospective cohort | To compare the proportion of adolescents with and without ASD who acquire a learner’s permit and driver’s license | | 1/3 ASD individuals obtained a license compared to 83.5% of other adolescents ASD individuals obtain their license on a median of 9.2 months later than other adolescents 89.7% of individuals with ASD who acquired a permit and were eligible to do so obtained a license within 2 years
| | 0.73 |
Daly et al. 2014 | Observational; cross-sectional | To compare driving history, preferences, and behaviors of adult drivers with ASD with controls | Adults with ASD (N = 78, Mage = 32.9) Adults without ASD (N = 94, Mage = 35.3)
| Drivers with ASD reported lower ratings of their ability to drive and higher numbers of traffic accidents and citations Drivers with ASD reported higher numbers of intentional violations, mistakes, and slips/lapses
| | 0.7 |
Fabiano et al. 2011 | Pilot intervention | To address adolescents with ADHD that have a strong desire to drive | | After the intervention, participants decreased hard braking during simulator drives Parent-teen and family relationships, and driving improved after the intervention
| Small sample size of experienced, licensed drivers The baseline data for some participants may have been too brief Potential confound with the driving behaviors measured (e.g., hard braking) and the season of data collection (winter)
| 0.64 |
Fabiano et al. 2016 | RCT | To determine whether the Supporting the Effective Entry to the Roadway program improved family functioning and driving behavior | | | There was no control group that received no intervention Results may not generalize to families with less parental involvement Timing of assessments was not aligned with the first month of independent driving Medication was not directly manipulated STEER participants received more attention and interaction with study clinicians
| 0.76 |
Fischer et al. 2007 | Longitudinal, observational; cohort | To evaluate the impact of ADHD on driving ability | Children diagnosed as hyperactive (N = 147, Mage = 21.1 at follow-up) Typically-developing control group (N = 71, Mage = 20.5 at follow-up)
| Hyperactive drivers were more often ticketed for reckless driving, driving without a license, hit and run crashes, and more had license suspensions/revocations Cost of initial crash was greater for the hyperactive group The hyperactive group employed less safe driving practices
| The examiner was not blind to group membership Reliance on self-report data No correction was used in analysis for experiment wise error
| 0.56 |
Garner et al. 2012 | Observational; cross-sectional | To understand the relationship between symptoms of ADHD and adverse driving outcomes | | | | 0.69 |
Groom et al. 2015 | Naturalistic; cross-sectional | To compare driving performance of adults with and without ADHD | Adults with ADHD (N = 22, Mage = 31.4) Adult controls (N = 21, Mage = 34.0)
| Participants with ADHD reported more violations, lapses, and accidents than controls Participants with ADHD displayed higher average speed and speeding, and showed poorer vehicle control, greater levels of frustration with other road users, and a trend for less safe driving when changing lanes in the driving simulator
| | 0.67 |
Huang et al. 2012 | Observational; cross-sectional | To compare the characteristics of driving and non-driving teens with higher functioning ASD | | 63% of adolescents currently drive or plan to drive and 29% of teens that are age-eligible to drive currently drive More driving teens were in full-time education, planned to attend college, and held a paid job Individualized education plans with driving goals, indicators of functional status, and parent experience with teaching teens to drive predicted driving status in the adolescent
| | 0.68 |
Kenworthy et al. 2014 | RCT | To evaluate the effectiveness of Unstuck and On Target | | Individuals in the Unstuck and On Target group showed greater improvements in: problem-solving, flexibility, planning/organizing, and the ability to follow rules, make transitions, and be flexible Both groups made equal improvements in social skills
| Small sample size not followed longitudinally Did not evaluate specific characteristics of the interventionists A task used to measure executive functioning had not been validated
| 0.62 |
Kingery et al. 2015 | Naturalistic; cross-sectional | To determine whether ADHD- and texting-related driving impairments are mediated by extended visual glances away from the roadway | | Adolescents with ADHD displayed more visual inattention to the roadway during driving simulation Increased lane variability in the ADHD group was mediated by an increased number of extended glances from the roadway
| The driving simulator may not represent actual driving The conversation conditions may not have represented actual conversations Cognitive distraction was not captured
| 0.64 |
Klauer et al. 2006 | Naturalistic | To evaluate driver inattention using the driving data collected in the 100-Car Naturalistic Driving Study | | Driving while drowsy increased near-crash/crash risk by 4 to 6 times, engaging in complex secondary tasks increased it by 3 times, and engaging in moderate secondary tasks increases it by 2 times Driving-related inattention to the forward roadway was safer than baseline driving Younger and less experienced drivers had high involvement in inattention-related crashes
| Conducted in only one metropolitan area Secondary tasks were not controlled during analysis and duration of secondary tasks was not analyzed No continuous audio feed was present
| 0.74 |
Lanzi 2005 | Pilot intervention | To develop and implement a learner’s license program for adolescents with mild mental retardation or other cognitive limitations | | | | 0.49 |
Matthews et al. 1991 | Observational; cross-sectional | To map associations between individual differences in driver stress and personality variables | Study 1: Adult drivers (N = 159) Study 2: Adult drivers (N = 44) Study 3: Adult drivers (N = 49) Study 4: Adult drivers (N = 50)
| General driver stress was positively correlated with neuroticism, minor crash involvement, and higher frequency of daily hassles and aggressiveness Higher driver stress was associated with poorer self-rated attention Driver stress was associated with stressed mood states
| | 0.57 |
Mayhew et al. 2003 | Retrospective cohort | To examine changes in collisions among new drivers | | Length of time since licensure is associated with decreasing crash rates, with declines most pronounced in the first 6 months The involvement of certain crash types decline more rapidly than other crash types
| The results do not control for different levels of exposure for young and older novice drivers to the risk of a collision Reasons for differential changes in crash patterns for young and older novice drivers are unknown
| 0.55 |
Merkel et al. 2016 | Naturalistic; cross-sectional | To assess on-road driving behavior in a sample of young adult drivers with ADHD | Young adults with ADHD (N = 17, Mage = 20.71) Young adults without ADHD (N = 19, Mage = 21.16)
| Drivers with ADHD were more likely to have more crashes, minor events, and g-force events G-force events for drivers with ADHD were more risky and illegal, hyperactive/impulsive, and had more distracted behaviors
| The video recording device was only active, therefore behaviors were only analyzed, during g-force events Only young adults with ADHD that had a minimum record of driving difficulty were recruited for the study
| 0.77 |
Moudon et al. 2011 | Retrospective cohort | To estimate the odds of a pedestrian dying or being disabled as a result of a collision with a motor vehicle | | | The data only estimates injury severity and does not estimate collision frequency Data on pedestrians’ age and gender, and on vehicle descriptive (e.g., vehicle type, vehicular speeds) were not complete
| 0.64 |
Narad et al. 2013 | Naturalistic; cross-sectional | To investigate the risks of adolescence, ADHD, and distracted driving on driving performance | Adolescents with ADHD (N = 28, Mage = 16.86) Adolescents without ADHD (N = 33, Mage = 17.14)
| Adolescents with ADHD reported less driving experience and a higher proportion of driving violations Adolescents with ADHD drove with more variability in speed and lane position during simulated drives All drivers drove with increased variability in speed and lane position during the texting condition
| Simulator performance may not represent real-world driving behaviors Driving settings were limited to suburban and urban roadways The ADHD sample may not have been representative of the ADHD population
| 0.77 |
Patrick et al. 2018 | Naturalistic; cross-sectional | To examine differences in driving behavior between young adults with and without ASD | Young adults with ASD (N = 50, Mage = 19.79) Typically-developing young adults (N = 50, Mage = 19.73)
| | Controls reported more previous driving experience than the participants with ASD The sample did not include many licensed drivers The order of the secondary tasks were not counterbalanced
| 0.71 |
Poulsen et al. 2010 | RCT | To develop a hazard perception training intervention for drivers with ADHD symptoms | | | Small sample of self-referred drivers Effects of the intervention on specific subtypes of ADHD were not studied Participants were not clinically assessed for ADHD
| 0.71 |
Reimer et al. 2010 | Naturalistic; cross-sectional | To explore the impact of cognitive distractions on young drivers with and without ADHD | Young adults with ADHD (N = 25, Mage = 20.56) Young adults without ADHD (N = 35, Mage = 20.65)
| Drivers with ADHD had more difficulty driving with a hands-free device in a simulator, but did not show decreased performance Drivers with ADHD exhibited a larger decline in performance when driving with a secondary task in a low demand setting
| | 0.77 |
Reimer et al. 2013 | Naturalistic; cross-sectional | To explore driving behavior and visual attention in young adult drivers with high functioning ASD | Young adults with HF-ASD (N = 20, Mage = 20.20) Community controls (N = 20, Mage = 20.70)
| Individuals with HF-ASD exhibited a higher and unvaried heart rate Individuals with HF-ASD showed a gaze pattern suggestive of a diversion of visual attention away from high stimulus areas of the roadway
| | 0.66 |
Sheppard et al. 2010 | Observational; cross-sectional | To investigate hazard perception in young adults with and without ASD | Young adults with ASD (N = 23, Mage = 18.55) Comparison controls (N = 21, Mage = 18.83)
| | | 0.62 |
Sheppard et al. 2016 | Observational; cross-sectional | To explore attentional patterns in individuals with and without ASD | | | | 0.62 |
Sobanski et al. 2008 | Nonrandomized control trial | To assess history of driving and determine whether pharmacotherapy improves driving related cognitive functions in adults with ADHD | Adults with ADHD (N = 27, Mage = 34.3) Control adults (N = 27, Mage = 34.3)
| Adults with ADHD drove more per year, were registered and fined by traffic authorities more, were involved in more accidents, and self-reported driving more insecure and hectic Methylphenidate treatment improved information processing, visual orientation, and sustained visual attention
| Small sample size and controls recruited from the authors’ circle of friends Investigators were not blind to medication or control status Some data was collected from self-reports
| 0.65 |
Wade et al. 2015 | RCT | To test a gaze-contingent driving intervention | | | | 0.54 |
Review Papers |
Article | Review Type | Objective | Outcomes | Limitations |
Barkley and Cox 2007 | Literature Review | Review driving risks associated with ADHD | Risks for driving offenses and crashes were increased among children with more severe ADHD symptoms Adults with ADHD are at increased risk for adverse driving outcomes Drivers with high aggression have been found to have a higher prevalence of psychiatric disorders, such as ADHD MPH medications improve driving performance in adolescents with ADHD
| More research is needed on how medication, other that MPH, impacts driving performance Other treatments need to be evaluated on their efficacy of improving driving outcomes
|
Elander et al. 1993 | Literature Review | To review methodological issues on the study of differential crash involvement | Hazard perception latency plays a role in how driving skill contributes to crash risk Driving styles of driving faster and willingness to commit driving violations increase crash risk and may be explained in terms of personality and antisocial motivation
| |
Lindsay 2016 | Systematic Literature Review | To review the literature on factors affecting driving for people with ASD | Many people with ASD encounter challenges in obtaining a driver’s license, driving confidence, and driving performance Direct communication, encouraging coping mechanisms, breaking down tasks, and providing regular and consistent driving lessons are all useful strategies when teaching people with ASD to drive
| More rigorous research is needed Confounds not often accounted for Perspectives of individuals with ASD on challenges and their experience is inadequate
|
Wilson et al. 2018 | Literature Review | To review driving behaviors of individuals with ASD | Individuals with ASD drive differently than neuro-typical individuals Individuals with ASD have shortcomings on skills related to driving, but how this affects their safety and the safety of other on the road is unclear Training programs can improve skills related to driving
| There are few ASD-specific learner training programs available Many studies use data from observations in driving simulator and/or virtual reality settings, or use self-report driving data
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