Examining Patterns and Predictors of ADHD Teens’ Skill-Learning Trajectories During Enhanced FOrward Concentration and Attention Learning (FOCAL+) Training

• Published in: Human factors 2025-01, Vol.67 (1), p.49-62
• Main Authors: Epstein, Jeffery N., Garner, Annie A., Kiefer, Adam W., Peugh, James, Tamm, Leanne, Lynch, James D., MacPherson, Ryan P., Simon, John O., Fisher, Donald L.
• Format: Article
• Language: English
• Subjects: Adolescent; Attention; Attention - physiology; Attention Deficit Disorder with Hyperactivity; Attention deficit hyperactivity disorder; Automobile Driving; Error reduction; Female; Humans; Learning; Learning - physiology; Male; Real time; Risk management; Risk reduction; Training; Young Adult
• ISSN: 0018-7208; 1547-8181; 1547-8181
• DOI: 10.1177/00187208241237863

Objective Examine patterns and predictors of skill learning during multisession Enhanced FOrward Concentration and Attention Learning (FOCAL+) training. Background FOCAL+ teaches teens to reduce the duration of off-road glances using real-time error learning. In a randomized controlled trial, teens with ADHD received five sessions of FOCAL+ training and demonstrated significant reductions in extended glances (>2-s) away from the roadway (i.e., long-glances) and a 40% reduced risk of a crash/near-crash event. Teens’ improvement in limiting long-glances as assessed after each FOCAL+ training session has not been examined. Method Licensed teen (ages 16–19) drivers with ADHD (n = 152) were randomly assigned to five sessions of either FOCAL+ or modified standard driver training. Teens completed driving simulation assessments at baseline, after each training session, and 1 month and 6 months posttraining. Naturalistic driving was monitored for one year. Results FOCAL+ training produced a 53% maximal reduction in long-glances during postsession simulated driving. The number of sessions needed to achieve maximum performance varied across participants. However, after five FOCAL+ training sessions, number of long-glances was comparable irrespective of when teens achieved their maximum performance. The magnitude of reduction in long-glances predicted levels of long-glances during simulated driving at 1 month and 6 months posttraining but not naturalistic driving outcomes. FOCAL+ training provided the most benefit during training to teens who were younger and had less driving experience. Conclusion FOCAL+ training significantly reduces long-glances beginning at the 1st training session. Application Providing five FOCAL+ training sessions early on during teen driving may maximize benefit.