The efficacy of hazard perception training and education: A systematic review and meta-analysis.

BACKGROUND: Hazard perception (HP) has been argued to improve with experience, with numerous training programs having been developed in an attempt to fast track the development of this critical safety skill. To date, there has been little synthesis of these methods. OBJECTIVE: The present study sought to synthesise the literature for all road users to capture the breadth of methodologies and intervention types, and quantify their efficacy. DATA SOURCES: A systematic review of both peer reviewed and non-peer-reviewed literature was completed. A total of 57 papers were found to have met inclusion criteria. RESULTS: Research into hazard perception has focused primarily on drivers (with 42 studies), with a limited number of studies focusing on vulnerable road users, including motorcyclists (3 studies), cyclists (7 studies) and pedestrians (5 studies). Training was found to have a large significant effect on improving hazard perception skills for drivers (g = 0.78) and cyclists (g = 0.97), a moderate effect for pedestrians (g = 0.64) and small effect for motorcyclists (g = 0.42). There was considerable heterogeneity in the findings, with the efficacy of training varying as a function of the hazard perception skill being measured, the type of training enacted (active, passive or combined) and the number of sessions of training (single or multiple). Active training and single sessions were found to yield more consistent significant improvements in hazard perception. CONCLUSIONS: This study found that HP training improved HP skill across all road user groups with generally moderate to large effects identified. HP training should employ a training method that actively engages the participants in the training task. Preliminary results suggest that a single session of training may be sufficient to improve HP skill however more research is needed into the delivery of these single sessions and long-term retention. Further research is also required to determine whether improvements in early-stage skills translate to improvements in responses on the road, and the long-term retention of the skills developed through training.

Outcome evaluation of the p drivers Program: Randomised controlled trial of a program to improve safe driving among novice drivers.

BACKGROUND: Globally, road traffic crashes are the leading cause of death for young adults. The P Drivers Project was a trial of a behavioural change program developed for, and targeted at, young Australian drivers in their initial months of solo driving when crash risk is at its highest. METHODS: In a parallel group randomised controlled trial, drivers (N = 35,109) were recruited within 100 days of obtaining their probationary licence (allowing them to drive unaccompanied) and randomised to an intervention or control group. The intervention was a 3 to 6-week multi-stage driving behaviour change program (P Drivers Program). Surveys were administered at three time points (pre-Program, approximately one month post-Program and at 12 months after). The outcome evaluation employed an on-treatment analysis comprising the 2,419 intervention and 2,810 control participants who completed all required activities, comparing self-reported crashes and police-reported casualty crashes (primary outcome), infringements, self-reported attitudes and behaviours (secondary outcomes) between groups. RESULTS: The P Drivers Program improved awareness of crash risk factors and intentions to drive more safely, relative to the controls; effects were maintained after 12-months. However, the Program did not reduce self-reported crashes or police-reported casualty crashes. In addition, self-reported violations, errors and risky driving behaviours increased in the intervention group compared to the control group as did recorded traffic infringements. This suggests that despite the Program increasing awareness of risky behaviour in novice drivers, behaviour did not improve. This reinforces the need to collect objective measures to accompany self-reported behaviour and intentions. CONCLUSIONS: The P Drivers Program was successful in improving attitudes toward driving safety but the negative impact on behaviour, lack of effect on crashes, and the large loss to follow-up fail to support the use of a post-licensing behaviour change program to improve novice driver behaviour and reduce crashes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: 363,293 (ANZCTR, 2012).

Driving Difficulties and Preferences of Advanced Driver Assistance Systems by Older Drivers With Central Vision Loss.

Purpose: The purpose of this study was to investigate driving difficulties and Advanced Driver Assistance Systems (ADAS) use and preferences of drivers with and without central vision loss (CVL). Methods: Fifty-eight drivers with CVL (71 ± 13 years) and 68 without (72 ± 8 years) completed a telephone questionnaire. They rated their perceived driving difficulty and usefulness of technology support in 15 driving situations under good (daytime) and reduced visibility conditions, and reported their use experience and preferences for 12 available ADAS technologies. Results: Drivers with CVL reported more difficulty (P = 0.002) and greater usefulness of technology support (P = 0.003) than non-CVL drivers, especially in reduced visibility conditions. Increased driving difficulty was associated with higher perceived technology usefulness (r = 0.34, P < 0.001). Dealing with blind spot road users, glare, unexpected pedestrians, and unfamiliar areas were perceived as the most difficult tasks that would benefit from technology support. Drivers with CVL used more advanced ADAS features than non-CVL drivers (P = 0.02), preferred to own the blind spot warning, pedestrian warning, and forward collision avoidance systems, and favored ADAS support that provided both information and active intervention. The perceived benefits of and willingness to own ADAS technologies were high for both groups. Conclusions: Drivers with CVL used more advanced ADAS and perceived greater usefulness of driver assistance technology in supporting difficult driving situations, with a strong preference for collision prevention support. Translational Relevance: This study highlights the specific technology needs and preferences of older drivers with CVL, which can inform future ADAS development, evaluation, and training tailored to this group.

Perceptions of novice driver education needs; Development of a scale based on the Goals for driver education using young driver and parent samples.

Professional driver education and training has traditionally been used to improve the driving skills of young people with the expectation that they will drive more safely and therefore be less likely to crash. Despite this, much research has failed to find such an effect. The Goals for Driver Education (GDE) is a theoretical framework developed to improve the effectiveness of driver education. The GDE seeks to draw attention to a broader array of factors that may influence the driving of young people and hence increase the scope of what is included in driver education and training. Within the GDE, factors affecting driving and driver education are grouped into combinations of four hierarchical levels that represent influences on driving at increasing levels of abstraction (GDE level 1: Vehicle manoeuvring; GDE level 2: Mastery of traffic situations; GDE level 3: Goals and contexts of driving; GDE level 4: Goals for life and skills for living) and three types of individual competencies (Knowledge and skills; Risk-increasing factors; Self-evaluation skills). However, to date there have been few, if any, attempts to operationalise the GDE in a quantitative way. In response, the Perceptions of Driver Education Scale (PDES) was developed to gain an understanding of what two important stakeholder groups in the driver education and training ecosystem perceived to be important to be taught to novice drivers. Understanding these perceptions may lead to greater acceptance of the driver education and training that is designed and make it more effective. Following rigorous scale development procedures, thirty-five items were developed a priori using expert opinion and deployed, via an online survey, to a sample of parents of novice drivers (N = 518) and a separate sample of novice drivers (N = 247), both from Queensland, Australia. Exploratory Factor Analysis was performed on the parent responses and Confirmatory Factor Analysis was performed using the novice driver responses. A 29-item 9 factor solution was judged to be the best fit with the overall scale and each of the factors displaying strong levels of internal consistency. The 9 factors cover most hierarchical level and competency combinations, although removal of items meant that there is no representation concerning perceptions of Self-evaluation skills related to Level 3: Goals and contexts of driving within the PDES. Overall, the PDES is a valid and reliable instrument for investigating the aspects of driver education and training that are perceived as important by novice drivers and parents. The scale may also be applicable for use with other stakeholder groups and could also be used to evaluate pre-existing driver education and training programs.

Financial status and travel time to driving schools as barriers to obtaining a young driver license in a state with comprehensive young driver licensing policy.

The highest lifetime risk for a motor vehicle crash is immediately after the point of licensure, with teen drivers most at risk. Comprehensive teen driver licensing policies that require completion of driver education and behind-the-wheel training along with Graduated Driver Licensing (GDL) are associated with lower young driver crash rates early in licensure. We hypothesize that lack of financial resources and travel time to driving schools reduce the likelihood for teens to complete driver training and gain a young driver's license before age 18. We utilize licensing data from the Ohio Bureau of Motor Vehicles on over 35,000 applicants between 15.5 and 25 years old collected between 2017 and 2019. This dataset of driving schools is maintained by the Ohio Department of Public Safety and is linked with Census tract-level socioeconomic data from the U.S. Census. Using logit models, we estimate the completion of driver training and license obtainment among young drivers in the Columbus, Ohio metro area. We find that young drivers in lower-income Census tracts have a lower likelihood to complete driver training and get licensed before age 18. As travel time to driving schools increases, teens in wealthier Census tracts are more likely to forgo driver training and licensure than teens in lower-income Census tracts. For jurisdictions aspiring to improve safe driving for young drivers, our findings help shape recommendations on policies to enhance access to driver training and licensure especially among teens living in lower-income Census tracts.

Hazard perception training effectiveness on experienced drivers: decay of improvement in the follow-up.

A variety of road hazard perception training programmes have been proposed recently, based on the assumption that these skills contribute to lower crash rates across different countries. However, the long-term effectiveness of suggested programmes has been under-investigated. The main objective of this study is to explore the long-term effectiveness of online hazard perception training for experienced drivers and examine the moderating role of driving self-efficacy. Fifty-six experienced drivers (21 males and 35 females) were assigned to the experimental (n = 31) or the control (n = 25) group. The experimental group received two 45 min session interventions; the control group received no intervention. The effectiveness of the programme was tested by the change in scores of Lithuanian hazard prediction test (HPT) LHP12 that was conducted before training (pre-test), immediately after training (post-test) and six months after training (follow-up). The twelve-item Adelaide Driving Self-Efficacy Scale (ADSES; George et al., 2007) was used to measure self-reported driving self-efficacy at the pre-test. The results revealed a significant increase in hazard prediction scores immediately after training, but the short-term effect of training decayed at follow-up. Experienced drivers with higher self-efficacy developed better hazard prediction skills during training. The results confirmed short-term effectiveness of the programme.

Trial of Training to Reduce Driver Inattention in Teens with ADHD.

BACKGROUND: Teens with attention deficit-hyperactivity disorder (ADHD) are at increased risk for motor vehicle collisions. A computerized skills-training program to reduce long glances away from the roadway, a contributor to collision risk, may ameliorate driving risks among teens with ADHD. METHODS: We evaluated a computerized skills-training program designed to reduce long glances (lasting ≥2 seconds) away from the roadway in drivers 16 to 19 years of age with ADHD. Participants were randomly assigned in a 1:1 ratio to undergo either enhanced Focused Concentration and Attention Learning, a program that targets reduction in the number of long glances (intervention) or enhanced conventional driver's education (control). The primary outcomes were the number of long glances away from the roadway and the standard deviation of lane position, a measure of lateral movements away from the center of the lane, during two 15-minute simulated drives at baseline and at 1 month and 6 months after training. Secondary outcomes were the rates of long glances and collisions or near-collisions involving abrupt changes in vehicle momentum (g-force event), as assessed with in-vehicle recordings over the 1-year period after training. RESULTS: During simulated driving after training, participants in the intervention group had a mean of 16.5 long glances per drive at 1 month and 15.7 long glances per drive at 6 months, as compared with 28.0 and 27.0 long glances, respectively, in the control group (incidence rate ratio at 1 month, 0.64; 95% confidence interval [CI], 0.52 to 0.76; P<0.001; incidence rate ratio at 6 months, 0.64; 95% CI, 0.52 to 0.76; P<0.001). The standard deviation of lane position (in feet) was 0.98 SD at 1 month and 0.98 SD at 6 months in the intervention group, as compared with 1.20 SD and 1.20 SD, respectively, in the control group (difference at 1 month, -0.21 SD; 95% CI, -0.29 to -0.13; difference at 6 months, -0.22 SD; 95% CI, -0.31 to -0.13; P<0.001 for interaction for both comparisons). During real-world driving over the year after training, the rate of long glances per g-force event was 18.3% in the intervention group and 23.9% in the control group (relative risk, 0.76; 95% CI, 0.61 to 0.92); the rate of collision or near-collision per g-force event was 3.4% and 5.6%, respectively (relative risk, 0.60, 95% CI, 0.41 to 0.89). CONCLUSIONS: In teens with ADHD, a specially designed computerized simulated-driving program with feedback to reduce long glances away from the roadway reduced the frequency of long glances and lessened variation in lane position as compared with a control program. During real-world driving in the year after training, the rate of collisions and near-collisions was lower in the intervention group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT02848092.).

Building a Campaign to Increase Older Driver Safety.

With aging, physical and cognitive changes can affect driving safety. Emergency nurses can provide education for seniors that can create awareness of these changes and ways to mitigate the changes, allowing the older driver to remain independent and a safer driver.

Identifying community-level disparities in access to driver education and training: Toward a definition of driver training deserts.

OBJECTIVE: Obtaining a license may be challenging for teens due to access to driving instruction; in some states, behind-the-wheel (BTW) instruction is required to secure a license before age 18. We investigate spatial accessibility to BTW centers, and how this geographic distribution intersects with metrics of social disparity at the metropolitan level, toward identifying Driver Training Deserts (DTDs): geographic areas of disconnection to driver training. METHODS: For the Columbus OH region, we collect socioeconomic variables at the Census tract unit of analysis and geocoded locations of public and private BTW training centers and estimate travel time to the nearest BTW training center. We define travel time as either the mean or the maximum travel time to BTW centers across all 1 km × 1 km grid cells within a Census tract. We employ spatial statistical approaches, including homogeneous/inhomogeneous K functions, to determine whether BTW training centers are clustered. Next, we define DTDs as Census tracts with a poverty rate and travel time to BTW centers larger than the 75th percentile values across the region. RESULTS: BTW training centers are spatially clustered across the region; the magnitude of this clustering is so great that BTW centers exhibit statistically significant patterns of clustering, even when considering the underlying spatial distribution of socio-economic characteristics. We find that 11-27 Census tracts are identified as DTDs depending on the definition of travel time. DTDs contain a disproportionate percent of the high poverty population (8.7-23.5%) and, depending on the definition of travel time, a disproportionately large African American population. CONCLUSIONS: Methodologically, defining DTDs necessitates a fine-grained spatial approach as suburban and rural Census tracts tend to be large and thus can be poorly represented by travel times averaged over the Census tract. Defining DTDs as a measure of individual-specific variables - income and impedance - allows DTDs to be addressed with policy interventions. The findings motivate future research correlating DTDs with licensure rates, enrollment in driver training, and safe driving outcomes to understand if DTDs can help explain health equity outcomes related to young driver safety.

Identifying best practices in a process evaluation of a novice driver education program.

Best practice for learning to drive programs should be evidence-based and incorporate the range of lower and higher-order skills outlined in the internationally recognized Goals for Driver Education (GDE) matrix. A set of practices derived from the matrix, together with pertinent adult learning approaches and driving instruction research formed the basis of an evaluation checklist developed to review the Keys2drive program (a national single-session interactive education program for learner drivers in Australia). The checklist criteria consisted of 18 practices, including: having a sound theoretical base; reflecting various GDE components; facilitating parental involvement; provision of feedback; building resilience; use of coaching approaches; commentary driving; self-assessment; understanding of risk factors; and supporting safe vehicle choices and graduated licensing schemes. The program review sought to determine the extent to which Keys2drive is aligned with best practice according to the checklist criteria. Evaluations of driver education programs should recognize that novice drivers, in discussions with their instructors/supervisors, may have differing interpretations and values concerning various GDE goals, such as their awareness of critical risk factors. As a best practice, instructors should be prepared to ask the novice 'How?' and 'Why?' questions relevant to their GDE goal interpretations and values.

ADRIS: The new open-source accessible driving simulator for training and evaluation of driving abilities.

BACKGROUND AND OBJECTIVE: Independent living and transportation are crucial aspects for people living with a disability. After an injury, it is important to assess driving ability, in terms of physical and psychological conditions, and to test the effects of prescribed drugs. Within this framework, driving simulators are suitable tools for training driving skills; however, available tools are expensive or lack appropriate sets of behavioral measures to fully characterize the drivers' ability. METHODS: This work presents the first step toward the development of ADRIS, a new open-source, accessible, realistic virtual reality simulator for training and testing driving skills of people with sensory-motor disability. This includes a prototype based on an open-source simulator for autonomous driving research (CARLA), with the addition of customized features such as adaptable driving controllers, a virtual reality headset, and the possibility to collect behavioral and physiological data. Also, the new system allows to set different environmental conditions, to include and control the timing of potentially dangerous situations, and to set scenarios with various difficulty levels. RESULTS: Tests on 17 healthy participants demonstrated that the simulator is well tolerated in terms of discomfort, physical fatigue, and mental effort. Also, the system is easy to use and is capable of providing a realistic driving experience, allowing the extraction of reliable behavioral parameters. CONCLUSIONS: ADRIS combines a high-fidelity virtual world, with customizable features specifically designed for the training and testing of people living with a disability, thus making it usable in many contexts such as home training, rehabilitation, education, and research.

Skilled maneuvering: Evaluation of a young driver advanced training program.

BACKGROUND: Young drivers (YDs) are disproportionately injured and killed in motor vehicle crashes throughout the United States. Nationally, YDs aged 16 to 20 years constituted nearly 9% of all traffic-related fatalities in 2018. A Nevada Advanced Driver Training (ADT) program for YDs aims to reduce YD traffic injuries and fatalities through four modules taught by professional drivers. The program modules include classroom-based didactic lessons and hands-on driving exercises intended to improve safe driving knowledge and behaviors. The overarching purpose of this study was to determine if the Nevada ADT program achieved its objectives for improving safe driving knowledge and behaviors based on program-provided data. A secondary purpose of this study was to provide recommendations to improve program efficiency, delivery, and evaluation. The findings of this study would serve as a basis to develop and evaluate future ADT interventions. METHODS: The exploratory mixed methods outcome evaluation used secondary data collected during three weekend events in December 2018 and March 2019. The study population consisted of high school students with a driver's license or learner's permit. Pretests/posttests and preevent questionnaires on student driving history were matched and linked via personal identifiers. The pretests/posttests measured changes in knowledge of safe driving behaviors. This study used descriptive statistics, dependent samples t test, Pearson's r correlation coefficient, and χ2 (McNemar's test) with significance set at p = 0.05, 95% confidence interval. Statistical analysis was conducted using IBM SPSS version 24 (Armonk, NY). Qualitative data analysis consisted of content and thematic analysis. RESULTS: Responses from YD participants (N = 649) were provided for analysis. Aggregate YD participant knowledge of safe driving behaviors increased from a mean of 43.9% (pretest) to 74.9% (posttest). CONCLUSION: The program achieved its intended outcomes of improving safe driving knowledge and behaviors among its target population. LEVEL OF EVIDENCE: Prognostic/Epidemiologic, Level V.

Gymkhana and pylon slalom driving training effects on the cerebellum structure.

To develop a suitable automobile design as per each driver's characteristics and state, it is important to understand the brain function in acquiring driving skills. Reportedly, the brain structures of professionals, such as athletes and musicians, and those who have received training in special skills, undergo changes with training. However, the development process of the brain in terms of acquiring driving skills has not yet been clarified. In this study, we evaluated the effects of driving training on the brain and observed an increase in the volume of the right cerebellum after short-term training (3 days). The right cerebellum is responsible for controlling the right hand and right foot, which are important for driving. Drivers train to control a vehicle smoothly at high speeds at gymkhana and pylon slalom courses, which are often used in motor sports. The brain structure was analyzed before and after training using magnetic resonance imaging. Voxel-based morphometry was used to assess possible structural changes. First, the lap times after training were clearly shortened and vehicle dynamics were more stable, indicating that the drivers' skill level clearly improved. Second, brain structural analysis revealed a volumetric increase in the right cerebellum. The cerebellum is involved in the process of learning sensory motor skills, such as smooth steering and pedal operations, driving course shape, and vehicle size perception. These results suggest a new inner model for driving operation and support the hypothesis that motor learning affects the cerebellum during vehicle driving training.

Modeling learner-controlled mental model learning processes by a second-order adaptive network model.

Learning knowledge or skills usually is considered to be based on the formation of an adequate internal mental model as a specific type of mental network. The learning process for such a mental model conceptualised as a mental network, is a form of (first-order) mental network adaptation. Such learning often integrates learning by observation and learning by instruction. For an effective learning process, an appropriate timing of these different elements is crucial. By controlling the timing of them, the mental network adaptation process becomes adaptive itself, which is called second-order mental network adaptation. In this paper, a second-order adaptive mental network model is proposed addressing this. The first-order adaptation process models the learning process of mental models and the second-order adaptation process controls the timing of the elements of this learning process. It is illustrated by a case study for the learner-controlled mental model learning in the context of driving a car. Here the learner is in control of the integration of learning by observation and learning by instruction.

The effect of hazard awareness training on teen drivers of varying socioeconomic status.

OBJECTIVE: To compare the effectiveness of the Risk Awareness and Perception Training (RAPT) program among teens of various socioeconomic status (SES). METHODS: A secondary analysis was undertaken of data collected from 5036 teen participants for a study in 2011. They were randomly assigned to either receive RAPT or a placebo training. The total number of crashes (property damage only and injury) within the first 12 months after licensure was recorded. A Poisson regression model was employed to investigate the effectiveness of RAPT in terms of crash frequency among teens in different levels of SES, as measured by SES level (high or low) or poverty rate. RESULTS: Poverty rate was significantly associated with participants' crash frequency within the first 12 months after licensure such that when poverty rate increased, the crash frequency increased. The interacting effect of poverty rate and training was also significant. When compared to participants who did not receive RAPT, participants who received RAPT had fewer crashes when poverty rate increased. CONCLUSION: The RAPT program attenuated the negative effect of teen drivers' SES on crashes. No significant effect of sex or age was found, indicating that in terms of crashes, regardless of age or sex, RAPT is equally effective at reducing crashes for lower SES teens.

Drive aware training: A computerized training program for older drivers' detection of road hazards.

OBJECTIVE: Cognitive training for reducing crash rate can be delivered to older drivers via in-person on-road sessions, a driving simulator, or using computer-based cognitive methods. Despite established effectiveness, in-person on-road assessment and rehabilitation are expensive, and limited professional service may not be readily accessible; simulator-based training may not fit every driver due to simulator sickness. In comparison, computerized training is easier to implement and could be delivered with little cost to older drivers with computer access. Based on the Drive Aware Task, a validated measure of attentional processes in hazard detection, we developed a computerized cognitive training method with a focus on hazard detection. In this study, we examined the effectiveness of this newly-developed interactive training program in improving older drivers' detection of road hazards. METHODS: Using a matched-pair design, nine triads of three older drivers (aged 65 or above) with matched pretest performance and gender were formed. For each triad, each participant was randomly allocated to one of the three groups: 1) active training group to receive the two training sessions (1.5-2.5h per session); 2) passive training group to receive two video-watching sessions (i.e., watch the video of training session performance from the corresponding paired participant); 3) no-contact control group. Older drivers' performances on hazard detection and simulated driving were measured before and after training. RESULTS: The active training group showed significant training effects on the computerized hazard detection task and simulated driving performance, while there were only marginal effects in the passive training group and no effects in the no-contact control group. A post-training survey suggested older drivers were receptive to the Drive Aware training program. CONCLUSIONS: The computerized Drive Aware training program has the potential to be used as a prevention and intervention tool to improve older drivers' hazard detection performance. Future studies should examine the effectiveness of this tool in more diverse samples and in long-term outcomes.

Is a flick-through enough? A content analysis of Advanced Driver Assistance Systems (ADAS) user manuals.

Advanced Driver Assistance Systems (ADAS) are being developed and installed in increasing numbers. Some of the most popular ADAS include blind spot monitoring and cruise control which are fitted in the majority of new vehicles sold in high-income countries. With more drivers having access to these technologies, it is imperative to develop policy and strategies to guarantee the safe uptake of ADAS. One key issue is that ADAS education has been primarily centred on the user manual which are not widely utilised. Moreover, it is unclear if user manuals are an adequate source of education in terms of content and readability. To address this research gap, a content analysis was used to assess the differences in ADAS-related content and readability among the manuals of the highest selling vehicles in Australia. The qualitative findings showed that there are seven themes in the user manuals: differences between driving with and without ADAS, familiarisation requirements, operational limits of the ADAS, potential ADAS errors, behaviour adaptation warnings, confusion warnings, and malfunction warnings. The quantitative analysis found that some of the manuals require several years of education above the recommended for a universal audience (>8 years) to be understood. Additionally, there is a notable number of text diversions and infographics which could make comprehension of the user manual difficult. This investigation shows that there is a lack of standardisation of ADAS user manuals (in both content and delivery of information) which requires regulatory oversight. Driver ADAS education needs to be prioritised by policymakers and practitioners as smart technology continues to increase across the transport system. It seems that current strategies based on user manuals are insufficient to achieve successful adoption and safe use of these technologies.

Human error in motorcycle crashes: A methodology based on in-depth data to identify the skills needed and support training interventions for safe riding.

OBJECTIVE: Human error by either rider or other vehicle driver is the primary contributing factor in crashes involving powered-two-wheelers. A human-factor-based crash analysis methodology is key to enhancing the road safety effectiveness of rider training interventions. Our aim is to define a methodology that uses in-depth data to identify the skills needed by riders in the highest risk crash configurations to reduce casualty rates. METHODS: The methodology is illustrated through a case study using in-depth data of 803 powered-two-wheeler crashes. Seven types of high-risk crash configuration based on pre-crash trajectories of the road-users involved were considered to investigate the human errors as crash contributors. Primary crash contributing factor, evasive maneuvers performed, horizontal roadway alignment and speed-related factors were identified, along with the most frequent crash configurations and those with the greatest risk of severe injury. RESULTS: Straight Crossing Path/Lateral Direction was the most frequent crash configuration and Turn Across Path/Opposing Direction was identified as that with the highest risk of serious injury. Multi-vehicle crashes cannot be considered as a homogenous category of crashes to which the same human failure is attributed, as different interactions between motorcyclists and other road users are associated with both different types of human error and different rider reactions. Human error in multiple-vehicle crashes differed between those configurations related to crossroads and those related to rear-end and head-end crashes. Both single-vehicle crashes and multi-vehicle head-on crashes frequently occur along curves. The involved collision avoidance maneuvers of the riders differed significantly among the highest risk crash configurations. The most relevant lack of skills are identified and linked to their most representative context. In most cases a combination of different skills was required simultaneously to avoid the crash. CONCLUSIONS: The results contribute to understand the motorcyclists' responses in high-risk crash scenarios. The findings underline the need to group accident cases, beyond the usual single-vehicle versus multi-vehicle collision approach. The different interactions with other road users should be considered to identify the competencies of the motorcyclists needed to reduce crash risks. Our methodology can be applied to increase the motorcyclists' safety by supporting preventive actions based on riders' training and eventually ADAS design.

Ready for a Learner's Permit? Clinical Neuropsychological Off-road Tests and Driving Behaviors in a Simulator among Adolescents with ADHD and ASD.

A simulator driving test (SDT) and two neuropsychological tests, the Useful Field of View (UFOV) test and the Test of Variables of Attention (TOVA) were evaluated with regard to validity for fitness to drive on 51 young clients diagnosed with attention deficit hyperactivity disorder (ADHD), 33 of whom also had autism spectrum disorder (ASD), and 38 adolescents without a neurodevelopmental diagnosis. The results show generally much greater variability and significantly poorer performance in the SDT and the TOVA for clients with ADHD/ASD compared with the control group. The SDT results were strongly intratest correlated, but had no interest correlation with either the UFOV test or the TOVA. The greater variability among clients with ADHD/ASD suggests greater effort and susceptibility to motivational issues and decline in sustained attention over several tests. In conclusion, the SDT is sensitive and has good face validity, and the TOVA is sensitive to neuropsychological aspects of safe driving. The SDT and the TOVA thus complement each other, and discrepancy between test scores calls for special consideration.

Long-Term Effects of Driving Skill Training on Safe Driving in Older Adults with Mild Cognitive Impairment.

BACKGROUND/OBJECTIVE: A driving skill program had positive effects on safe driving performance in older adults, even those with cognitive impairment. However, the long-term effects of the program remain unclear. The purpose of this study was to examine whether such effects were maintained at 1 year after the intervention in older adults with cognitive impairment who had low driving skills. DESIGN: A secondary analysis of single-blind randomized controlled trial. SETTING: Community setting in Japan. PARTICIPANTS: Community-living adults, aged 65 years or older (n = 159), with mild cognitive impairment (MCI). INTERVENTION: The intervention group completed 10 classroom sessions of 1 hour and 10 on-road sessions of 50 minutes, focusing on common problem areas of older drivers. The control group received one education class about safety driving. MEASUREMENTS: On-road driving performance was assessed by certified driving school instructors in a driving school at preintervention and postintervention, and 1-year follow-up. RESULTS: A total of 159 community-living older drivers participated in this study and were randomized to either an intervention group (n = 71) or a control group (n = 88). One year after the intervention, 104 of 159 community-living older drivers completed the follow-up assessment (intervention group, n = 58). Regarding the safe driving skill score, there was a significant group × time interaction (P < .01), indicating benefits of the intervention over time. Although the intervention group showed a significant decline in the safe driving skill score from postintervention (score = 38.9 ± 46.1) to 1-year follow-up (score = -0.3 ± 55.2), there was a significant difference between the groups at 1-year follow-up (control group score = -148.5 ± 46.4) (P < .05), and between preintervention (score = -132.0 ± 54.6) and 1-year follow-up in the intervention group (P < .05). CONCLUSION: The driving skill program maintained safe driving performance that had been improved by the intervention in older adults with MCI.