THE INFLUENCE OF VISUAL SUPPORTS ON DRIVING PERFORMANCE IN NOVICE DRIVERS WITH AUTISM SPECTRUM DISORDER

Rationale: Driving is a valued instrumental activity of daily living (IADL) that signifies a transition to increased independence. However individuals with Autism Spectrum Disorder (ASD) obtain their license at a lower rate than typically developing peers due to differences in motor skills, visual processing, cognition and confidence. Visual supports are objects that provide visual and/or tangible information to improve an individual’s understanding of any given activity or context. As an intervention tool to improve functioning, visual supports are included in the ASD guidelines for facilitating attention, improving quality of movement, and increasing predictability to reduce anxiety. However, while there are multiple visual supports in the driving environment, the strategy of using visual supports for driving intervention with autistic individuals has not been addressed in the literature. Purpose: To examine the effectiveness of using a visual support strategy, an interactive app called Drive Focus® was used as an occupational therapy intervention to improve driving performance in autistic individuals. Specifically, the research questions were: Does the use of a visual support intervention improve overall driving performance of ASD individuals as measured by (1) a standardized occupational therapy assessment of driving performance and (2) improved speed and accuracy of hazard recognition (critical and non-critical) by utilizing eye tracking technology. Design: A pre- and post-test design. Participants: Participants were 14 individuals with ASD between the ages of 14 and 30 (M = 19, SD = 4.33) with various driving experience. Methods: Each participant wore the Tobii Pro eye tracking glasses that track and record pupil glances at specific hazards on an interactive driving simulator. Outcomes include average fixation duration (how long they look at a hazard), number of fixations (how many times they see a hazard), and time to first fixation (how long it takes to see a hazard) for critical and non-critical items during four simulated driving scenarios. Each participant drove two scenarios for the pre-test and two different, but matched scenarios for the post-test. All scenarios were randomly assigned and counterbalanced in terms of critical hazards and high inter-rater reliability was achieved (a = .953). Between the pre- and post-tests, all participants completed six 45-minute intervention sessions utilizing the visual support Drive Focus®. Analysis: Driving performance was measured by a standardized occupational therapy driving performance checklist and eye tracking technology. Eye tracking outcomes were recorded and imported into the Tobii Pro Analysis software before being analyzed using repeated measures ANOVAs along with the Performance Analysis of Driving Ability (P-Drive) results. Results: Participants significantly increased their maneuvers driving performance scores in the urban scenario and orientate scores in the rural scenario. Moreover, the average duration of fixation toward signs increased in the rural scenario and toward pedestrians in the urban scenario. However, overall driving performance did not show statistically significant change. Discussion: Findings from this study suggest visual supports may be an effective occupational therapy intervention tool for specific aspects of driving performance. These results align with previous literature suggesting visual supports can improve attention allocation and movement deficits in this population. The positive influence varied based on driving condition (i.e., urban and rural) with rural improvements being related to critical cues in the environment (i.e., signs) and urban improvements directed toward critical hazards (i.e., pedestrians). However, regardless of condition, the intervention may have given participants the ability to allot more visual attention to critical items as it pertained to the driving environment. With more attention directed toward processing hazards, driving performance was improved. Still, due to the small sample size further research needs to be completed to help determine the efficacy of using visual supports to improve driving performance in this population. Nevertheless, practitioners may use visual support interventions to address deficits in IADL performance for individuals with ASD, although different visual supports may provide different benefits to clients