Contents lists available at ScienceDirect Accident Analysis and Prevention journal homepage: www.elsevier.com/locate/aap Hazard perception skills of young drivers with Attention Deficit Hyperactivity Disorder (ADHD) can be improved with computer based driver training: An exploratory randomised controlled trial C.R. Bruce a, ⁎ , C.A. Unsworth a,b,c,d , M.P. Dillon e , R. Tay f , T. Falkmer d,g , P. Bird h , L.M. Carey a,i a Occupational Therapy, School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia b Occupational Therapy, School of Health, Medical and Applied Sciences, CQUniversity, 120 Spencer St, Melbourne, VIC 3000, Australia c Jönköping University, Gjuterigatan 5, Box 1026, 551 11, Jönköping, Sweden d School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia e Prosthetics and Orthotics, School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia f School of Business IT & Logistcs, RMIT University, Melbourne, VIC 3000 Australia g Rehabilitation Medicine Unit, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre, SE- 581 83, Linköping, Sweden h The Gosforth Clinic, PO Box 680, Maroochydore QLD 4558, Australia i The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, 245 Burgundy Street, Heidelberg, Melbourne, VIC 3084, Australia ARTICLE INFO Keywords: Attention deficit hyperactivity disorder Driving Hazard perception Traffic hazard ABSTRACT Background: Young drivers with Attention Deficit Hyperactivity Disorder (ADHD) are at higher risk of road traffic injuries than their peers. Increased risk correlates with poor hazard perception skill. Few studies have investigated hazard perception training using computer technology with this group of drivers. Objectives: *Determine the presence and magnitude of the between-group and within- subject change in hazard perception skills in young drivers with ADHD who receive Drive Smart training. *Determine whether training- facilitated change in hazard perception is maintained over time. Methods: This was a feasibility study, randomised control trial conducted in Australia. The design included a delayed treatment for the control group. Twenty-five drivers with a diagnosis of ADHD were randomised to the Immediate Intervention or Delayed Intervention group.The Immediate Intervention group received a training session using a computer application entitled Drive Smart. The Delayed Intervention group watched a doc- umentary video initially (control condition), followed by the Drive Smart computer training session. The par- ticipant’s hazard perception skill was measured using the Hazard Perception Test (HPT). Findings: After adjusting for baseline scores, there was a significant betweengroup difference in post-intervention HPT change scores in favour of the Immediate Intervention group. The magnitude of the effect was large. There was no significant within-group delayed intervention effect. A significant maintenance effect was found at 6- week follow-up for the Immediate Intervention group. Conclusions: The hazard perception skills of participants improved following training with large effect size and some maintenance of gain. A multimodal approach to training is indicated to facilitate maintenance. A full-scale trial is feasible. 1. Introduction Adolescent male drivers in the 16–19 year age group have a nine- fold increase in their crash risk (relative risk [RR], 9.8 [CI not avail- able]) (Elvik et al., 2009). During the novice driver period (i.e., usually middle adolescence until a driver licence has been held for two years), there is an increased crash risk compared to after this period (Elvik et al., 2009). Driving eventually improves and becomes an overlearned skill (Fox et al., 1998); that is, it no longer requires controlled cognitive processing (Shinar et al., 1998). One distinct group of young drivers, those with Attention Deficit Hyperactivity Disorder (ADHD), are recognised as being at additional crash risk relative to their aged matched counterparts. The RR for dri- vers diagnosed with ADHD is 1.36, 95% CI 1.18, 1.57 and the presence http://dx.doi.org/10.1016/j.aap.2017.10.002 Received 22 March 2017; Received in revised form 5 June 2017; Accepted 3 October 2017 ⁎ Corresponding Author. E-mail addresses: C.Bruce@latrobe.edu.au (C.R. Bruce), c.unsworth@cqu.edu.au (C.A. Unsworth), Michael.Dillon@latrobe.edu.au (M.P. Dillon), richard.tay@rmit.edu.au (R. Tay), T.Falkmer@curtin.edu.au (T. Falkmer), admin@gosforthclinic.com.au (P. Bird), L.Carey@latrobe.edu.au (L.M. Carey). Accident Analysis and Prevention 109 (2017) 70–77 0001-4575/ © 2017 Elsevier Ltd. All rights reserved. MARK