Journal of Autism and Developmental Disorders

, Volume 47, Issue 11, pp 3405–3417 | Cite as

A Pilot Study Assessing Performance and Visual Attention of Teenagers with ASD in a Novel Adaptive Driving Simulator

  • Joshua WadeEmail author
  • Amy Weitlauf
  • Neill Broderick
  • Amy Swanson
  • Lian Zhang
  • Dayi Bian
  • Medha Sarkar
  • Zachary Warren
  • Nilanjan Sarkar
Original Paper


Individuals with Autism Spectrum Disorder (ASD), compared to typically-developed peers, may demonstrate behaviors that are counter to safe driving. The current work examines the use of a novel simulator in two separate studies. Study 1 demonstrates statistically significant performance differences between individuals with (N = 7) and without ASD (N = 7) with regards to the number of turning-related driving errors (p < 0.01). Study 2 shows that both the performance-based feedback group (N = 9) and combined performance- and gaze-sensitive feedback group (N = 8) achieved statistically significant reductions in driving errors following training (p < 0.05). These studies are the first to present results of fine-grained measures of visual attention of drivers and an adaptive driving intervention for individuals with ASD.


Autism spectrum disorders Driving simulation Driving intervention Gaze-sensitive 



This work was supported in part by the National Science Foundation under Grant 967170 and by the National Institutes of Health under Grant 1R01MH091102-01A1. The authors would also express great appreciation to the participants and their families for assisting in this research. Although the manuscript text is wholly original, the work discussed here has been presented (1) at technical and autism-focused conferences, including Human Computer Interaction International and International Meeting for Autism Research, (2) in peer-reviewed engineering journals (ACM Transactions on Interactive Intelligent Systems, and IEEE Transactions on Affective Computing), and (3) in the master’s thesis of author Joshua Wade.


This study was funded by National Institutes of Health Grant Number 1R01MH091102-01A1 and National Science Foundation Grant Number 967170.

Author Contributions

JW implemented large portions of the software used in the driving simulator, oversaw all experiments, conducted all data analyses, and drafted the technical portions of the manuscript. NS and ZW conceived of the study, crafted the experimental design, and revised the manuscript. LZ and DB provided major software modules for eye tracking and physiological data acquisition, respectively, and also aided in conducting experiments. MS provided consultations regarding software engineering, 3D-modeling, and algorithm design. AW, NB, and AS provided major design considerations for the driving simulator from a clinical perspective, managed recruitment of participants, drafted portions of the manuscript, and aided in several rounds of editing and revision. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent/assent was obtained from all individual participants included in the study.


  1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Arlington, VA: American Psychiatric Publishing.CrossRefGoogle Scholar
  2. Bishop, H. J., Biasini, F. J., & Stavrinos, D. (2017). Social and non-social hazard response in drivers with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(4), 905–917.CrossRefPubMedGoogle Scholar
  3. Brooks, J., Kellett, J., Seeanner, J., Jenkins, C., Buchanan, C., Kinsman, A., Desmond, K., & Pierce, S. (2016). Training the motor aspects of pre-driving skills of young adults with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(7), 2408–2426.CrossRefPubMedGoogle Scholar
  4. Chee, D. Y., Lee, H. C., Patomella, A. H., & Falkmer, T. (2017). Driving Behavior profile of drivers with autism spectrum disorder (ASD). Journal of Autism and Developmental Disorders, 1–13, doi: 10.1007/s10803-017-3178-1.
  5. Christensen, D. L., Baio, J., Braun, K. V., Bilder, D., Charles, J., Constantino, J. N., … & Yeargin-Allsopp, M. (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2012. Morbidity And Mortality Weekly Report Surveillance Summaries, 65(3), 1–23PubMedGoogle Scholar
  6. Classen, S., & Monahan, M. (2013). Evidence-based review on interventions and determinants of driving performance in teens with attention deficit hyperactivity disorder or autism spectrum disorder. Traffic Injury Prevention, 14(2), 188–193.CrossRefPubMedGoogle Scholar
  7. Classen, S., Monahan, M., & Hernandez, S. (2013). Indicators of simulated driving skills in adolescents with autism spectrum disorder. The Open Journal of Occupational Therapy. doi: 10.15453/2168-6408.1051.Google Scholar
  8. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd edn.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  9. Constantino, J. N., & Gruber, C. P. (2012). Social responsiveness scale (2nd edn.). Los Angeles: Western Pyschological Services.Google Scholar
  10. Cox, D. J., Brown, T., Ross, V., Moncrief, M., Schmitt, R., Gaffney, G., & Reeve, R. (2017). Can youth with autism spectrum disorder use virtual reality driving simulation training to evaluate and improve driving performance? An exploratory study. Journal of Autism and Developmental Disorders, 1–12, doi: 10.1007/s10803-017-3164-7.
  11. Cox, N. B., Reeve, R. E., Cox, S. M., & Cox, D. J. (2012). Brief report: driving and young adults with ASD: Parent’s experiences. Journal of Autism and Developmental Disorders, 42(10), 2257–2262.CrossRefPubMedGoogle Scholar
  12. Cox, S. M., Cox, D. J., Kofler, M. J., Moncrief, M. A., Johnson, R. J., Lambert, A. E., … & Reeve, R. E. (2016). Driving simulator performance in novice drivers with autism spectrum disorder: The role of executive functions and basic motor skills. Journal of Autism and Developmental Disorders, 46(4), 1379–1391.CrossRefPubMedGoogle Scholar
  13. Crundall, D. E., & Underwood, G. (1998). Effects of experience and processing demands on visual information acquisition in drivers. Ergonomics, 41(4), 448–458CrossRefGoogle Scholar
  14. Curry, A. E., Yerys, B. E., Huang, P., & Metzger, K. B. (2017). Longitudinal study of driver licensing rates among adolescents and young adults with autism spectrum disorder. Autism: The International Journal of Research and Practice, 1–10. doi: 10.1177/1362361317699586.
  15. Daly, B. P., Nicholls, E. G., Patrick, K. E., Brinckman, D. D., & Schultheis, M. T. (2014). Driving behaviors in adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(12), 3119–3128.CrossRefPubMedGoogle Scholar
  16. Hale, J. B., Fiorello, C. A., Dumon, R., Willis, J. O., Rackley, C., & Elliott, C. (2008). Differential ability scales—second edition (neuro)psychological predictors of math performance for typical children and children with math disabilities. Psychology in the Schools, 45(9), 838–858.CrossRefGoogle Scholar
  17. Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45(2), 212–229.CrossRefPubMedGoogle Scholar
  18. Huang, P., Kao, T., Curry, A. E., & Durbin, D. R. (2012). Factors associated with driving in teens with autism spectrum disorders. Journal of Developmental & Behavioral Pediatrics, 33(1), 70–74.CrossRefGoogle Scholar
  19. Jerome, L., Segal, A., & Habinski, L. (2006). What we know about ADHD and driving risk: A literature review, meta-analysis and critique. Journal of the Canadian Academy of Child and Adolscent Psychiatry, 15(3), 105–125.Google Scholar
  20. Lawrence, D. H., Alleckson, D. A., & Bjorklund, P. (2010). Beyond the roadblocks: transitioning to adulthood with asperger’s disorder. Archives of Psychiatric Nursing, 24(4), 227–238.CrossRefPubMedGoogle Scholar
  21. Lord, C., & Bishop, S. L. (2010). Autism spectrum disorders: Diagnosis, prevalence, and services for children and families. Social Policy Report, 24(2), 1–26. Retrieved from
  22. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2000). Autism diagnostic observation schedule. Torrance, CA: Western Psychological Services.Google Scholar
  23. Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism diagnostic observation schedule (2nd edn.). Torrance, CA: Western Psychological Services.Google Scholar
  24. Reimer, B., Fried, R., Mehler, B., Joshi, G., Bolfek, A., Godfrey, K. M., … & Biederman, J. (2013). Brief report: Examining driving behavior in young adults with high functioning autism spectrum disorders: A pilot study using a driving simulation paradigm. Journal of Autism and Developmental Disorders, 43(9), 2211–2217.CrossRefPubMedGoogle Scholar
  25. Rutter, M., Bailey, A., & Lord, C. (2003). Social communication questionnaire (SCQ). Los Angeles: Western Psychological Services.Google Scholar
  26. Shattuck, P. T., Narendorf, S. C., Cooper, B., Sterzing, P. R., Wagner, M., & Taylor, J. L. (2012). Postsecondary education and employment among youth with an autism spectrum disorder. Pediatrics, 129(6), 1042–1049.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Sheppard, E., Ropar, D., Underwood, G., & van Loon, E. (2010). Brief report: Driving hazard perception in autism. Journal of Autism and Developmental Disorders, 40(4), 504–508.CrossRefPubMedGoogle Scholar
  28. Sheppard, E., Van Loon, E., Underwood, G., & Ropar, D. (2017). Attentional differences in a driving hazard perception task in adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 47(2), 405–414.CrossRefPubMedGoogle Scholar
  29. Tobii Technology. (2011). Accuracy and precision test method for remote eye trackers. Tobii Technology, AB 2.1.1, 1–28.Google Scholar
  30. Wade, J., Zhang, L., Bian, D., Fan, J., Swanson, A., Weitlauf, A., Sarkar, M., Warren, Z., & Sarkar, N. (2016). A gaze-contingent adaptive virtual reality driving environment for intervention in individuals with autism spectrum disorders. ACM Transactions on Interactive Intelligent Systems, 6(1), 3.CrossRefGoogle Scholar
  31. Wechsler, D. (2003). Wechsler intelligence scale for children-fourth edition (WISC-IV) administration and scoring manual. San Antonio, TX: Pearson Education, Inc.Google Scholar
  32. Wechsler, D. (2011). Wechsler abbreviated scale of intelligence (2nd edn.). San Antonio, TX: Pearson Education, Inc.Google Scholar
  33. Weitlauf, A. S., McPheeters, M. L., Peters, B., Sathe, N., Travis, R., Aiello, R., … & Warren, Z. (2014). Therapies for children with autism spectrum disorder: Behavioral interventions update. Comparative Effectiveness Review, No. 137.Google Scholar
  34. Zhang, L., Wade, J., Bian, D., Fan, J., Swanson, A., Weitlauf, A., Warren, Z., & Sarkar, N. (2017). Cognitive load measurement in a virtual reality-based driving system for autism intervention. IEEE Transactions on Affective Computing, 8(2), 176–189.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Joshua Wade
    • 1
    Email author
  • Amy Weitlauf
    • 2
  • Neill Broderick
    • 3
  • Amy Swanson
    • 2
  • Lian Zhang
    • 4
  • Dayi Bian
    • 4
  • Medha Sarkar
    • 5
  • Zachary Warren
    • 3
  • Nilanjan Sarkar
    • 1
  1. 1.Department of Mechanical EngineeringVanderbilt UniversityNashvilleUSA
  2. 2.Treatment and Research Institute for Autism Spectrum DisordersVanderbilt UniversityNashvilleUSA
  3. 3.Department of Pediatrics and PsychiatryVanderbilt UniversityNashvilleUSA
  4. 4.Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleUSA
  5. 5.Department of Computer ScienceMiddle Tennessee State UniversityMurfreesboroUSA

Personalised recommendations