Journal of Autism and Developmental Disorders

https://doi.org/10.1007/s10803-019-04341-1

ORIGINAL PAPER

A Pilot Study Comparing Newly Licensed Drivers With and Without

Autism and Experienced Drivers in Simulated and On‑Road Driving
Daniel J. Cox1   · Justin M. Owens3 · Laura Barnes2 · Matt Moncrief1 · Mehdi Boukhechba2 · Simone Buckman1 ·
Tom Banton1 · Brian Wotring3

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
This study compared newly licensed drivers with and without autism spectrum disorder (ASD) and experienced drivers.
Twenty new drivers (8 with ASD) and 16 experienced drivers completed the Driving Attitude Scale (DAS) and drove a
simulator and an instrumented vehicle. Heart rate (HR), galvanic skin response (GSR), wrist movement, eye-gaze and driving
performance were monitored. ASD drivers had more negative attitudes toward driving and greater change in HR, GSR and
wrist movement. In a driving simulator, drivers with ASD scored lower than NT drivers and were rated less safe. There were
fewer differences during on-road driving. Poorer driving and greater anxiousness in the new drivers with ASD indicates the
need for a large-scale study of driving performance and apprehension to formulate remediation.

Keywords  Autism · Driving · Anxiety · Simulator · On-road driving

Licensure to drive a motor vehicle is a privilege that confers
the opportunity to easily access social, occupational, and
medical resources, especially in areas without reliable public
transportation. However, it also presents a risk to drivers,
passengers and pedestrians. In 2015, the U.S. had 35,092
driving-related fatalities and an estimated 2.44 million non-
fatal injuries that cost the U.S. economy more than 99 billion
dollars (NHTSA 2016).
Surveys of parents (Cox et al. 2012) and studies of nov-
ice drivers who have earned a learner’s permit but not an
independent license (Cox et al. 2016) indicate that learn-
ing to drive safely is more difficult for youths with ASD.
Electronic supplementary material  The online version of this
article (https​://doi.org/10.1007/s1080​3-019-04341​-1) contains
supplementary material, which is available to authorized users.
* Daniel J. Cox
djc4f@virginia.edu
1
Department of Psychiatry and Neurobehavioral Sciences,
University of Virginia Health System, P.O. Box 800‑223,
Charlottesville, VA 22908, USA
2
Department of Systems and Information Engineering,
University of Virginia, P.O. Box 400‑747, Charlottesville,
VA 22904, USA
3
Virginia Tech Transportation Institute, 3500 Transportation
Research Plaza, Blacksburg, VA 24060, USA
This may be, in part, due to the following symptoms of
ASD: (1) Difficulty with motor planning and coordination,
which can interfere with complex tasks such as steering,
accelerating, braking, and judging time and distance, espe-
cially when two or more of these tasks occur simultane-
ously, (2) Hyper-focus and shifting attention, which limit
attention and may compromise abilities such as maintaining
lane position, maintaining appropriate following distances,
and attending to upcoming traffic signals, and (3) A desire
for a structured environment of routines and rules, which
presents a substantial problem when driving routines are
disrupted by events like detours, new destinations/routes or
atypical traffic. Despite these difficulties, one longitudinal
study followed individuals with ASD to age 25 and found
that approximately one third secured an independent driver’s
license with conventional driver training (Curry et al. 2018).
However, there are few studies of the driving performance of
individuals with ASD who have a driver’s license. Table 1
presents the relevant available literature.
Findings from these previous studies, whether from sur-
veys, simulator testing or on-road testing, converge to show
that licensed drivers with ASD perform more poorly, and
may experience more collisions and citations, than neuro-
typical (NT) drivers. However, there has not been an inves-
tigation of drivers with ASD that addresses concordance and

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Table 1  Available literature concerning licensed ASD drivers

First author (year) N (ASD) Years of licensure Study type Significant findings

Reimer et al. (2013) 10
Daly et al. (2014) 78
Bishop et al. (2017) 16
Chee et al. (2017a) 17
Chee et al. (2017b) 16
Not Reported Simulator (1) High functioning ASD participants trended toward higher, less varied
heart rates than controls (2) As cognitive demand increased, ASD partici-
pants appeared to look away from high stimulus areas of the road
Not Reported Survey Relative to the non-ASD control group, drivers with ASD: (1) gave lower
ratings of their ability to drive, (2) reported more traffic accidents and
citations, (3) reported more difficulty on subscales measuring intentional
violations, mistakes, and slips or lapses
Not Reported Simulator Non-ASD drivers responded more quickly to pedestrians than vehicles,
(8 years. since learn- while response times of drivers with ASD were the same for vehicles and
ers permit) pedestrians
< 2 years (5) Simulator Relative to the non-ASD control group, drivers with ASD: (1) were slower
≥ 2 years (12) in visual scanning and motor speed, (2) reported more on-road driv-
ing lapses, (3) made more simulated driving mistakes and reacted more
slowly in challenging situations, and (4) exhibited less tailgating
< 2 years (6) On-road Relative to the non-ASD control group, drivers with ASD: (1) maneuvered
≥ 2 years (10) their vehicles more poorly at turns and pedestrian crossings, and (2) were
better than the control group in their use of turn signals at roundabouts
and checking for cross-traffic at intersections

divergence in the results of these studies using a comprehen-
sive, multi-modal methodology.
Methods
Participants
New drivers who earned an independent driver’s license in
the past 2 years were recruited from ASD websites, parent
support groups, high school newspapers and driving educa-
tors. Experienced drivers were recruited from new driver
parents and websites. All participants were required to be
between the ages of 16 and 65, have a driver’s license, and
not use adaptive equipment to drive. In addition, the expe-
rienced drivers needed 10 or more years of driving experi-
ence and could not have been diagnosed with or received
resources for ASD. New drivers were required to have
less than 2 years of driving experience. ASD drivers were
required to have a report of their diagnostic evaluation from
a licensed professional, evidence of receiving special educa-
tion for ASD, and a t score of 65 or higher on the Autism
Spectrum Rating Scale (ASRS) (Goldstein and Naglieri
2010). Neuro-typical new drivers could not have been diag-
nosed with ASD nor received special education for ASD and
had to have a t score of less than 60 on the ASRS.
Recruitment of new ASD drivers proved challenging,
likely due to several factors: (1) there are fewer drivers
with ASD than there are NT drivers, (2) it can be a per-
ceived threat to have driving skills re-evaluated after a
license is secured, (3) there may be aversions to driving
an unfamiliar car, (4) there may be anticipated discomfort
from having a research assistant seated nearby rating their
driving performance, and (5) it may be stressful to drive
on unfamiliar roads. As a consequence of low enrollment
of drivers with ASD after 16 months of recruitment, par-
ticipation was capped at 20 new drivers (8 with ASD, 12
NT) and 16 experienced adult drivers (two of whom were
parents of ASD driver participants). These groups had
1.7 (± 1.4), 1.1 (± 0.9) and 32.1 (± 12.1) years of driving
experience, respectively. Their respective mean ages were
20.2 (± 1.6), 18.7 (± 2.3) and 50.3 (± 11.2) years. Novice
NT drivers and new drivers with ASD did not differ in
driving experience (p = .65) or age (p = .09).
Procedures
Participants signed an IRB-approved consent form prior
to participation. To provide background information, each
participant completed either the self-report or parent-
report version of the Driving Attitude Scale (DAS) and
reported previous driving mishaps. Parents completed
the ASRS and the Behavioral Rating Inventory of Execu-
tive Function (BRIEF; Roth et al. 2014) at the screening
visit. Participants were given a wearable fitness tracker
(Microsoft Band II) to wear during simulated and on-road
driving; this provided the physiological metrics described
below. Each participant then drove a route on a driving
simulator for 30 min, followed by driving an instrumented
2012 Toyota Camry on a prescribed public road route that
lasted approximately 30 min. Routes were designed to be
as comparable as possible between the simulator and the
on-road environment. One week after the assessment, par-
ents and drivers repeated the DAS to quantify test-retest
reliability.

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Journal of Autism and Developmental Disorders
Driving Attitude Scale
This scale measures one’s attitudes about driving by using 9
positive items (e.g. “Smiles and gets physically excited when
talking about possibly driving”) and 9 negative items (e.g.
“Gets agitated or tense when talking about driving”) that
are rated on a 4-point scale (0 = Not at all, 3 = A lot). There
are 2 versions of this scale: the parent report (DAS-PR, see
Ross et al. 2018) where parents assess their child’s attitudes
toward driving, and the self-report (DAS-SR), where drivers
report on their own driving attitudes.
The DAS-PR has good internal consistency (α = .85).
It has been used to compare novice (learner’s permit only)
ASD to neuro-typical drivers, demonstrating that drivers
with ASD had fewer positive and more negative attitudes
toward driving, and they significantly increased their posi-
tive attitudes and decreased their negative attitudes toward
driving following 12 sessions of virtual reality driver train-
ing (Ross et al. 2018). The DAS-SR was the same as the
DAS-PR, except all the questions were phrased in the first
person.
Driving Mishaps
At the end of the DAS, each new driver reported the number
of times the following things occurred in their last 12 months
of driving:
• Lost control of their vehicle
• Had a collision, regardless of damage
• Were stopped by the police
If they had been driving for less than 12 months, they
reported all instances of these events. The counts were then
adjusted to reflect the number of events per 12 months of
driving.
Microsoft Band II Activity Tracker
The Microsoft Band II was used in conjunction with Android
smartphones provided by the research team to collect physi-
ological signals during the course of the experiment. Each
Fig. 1  Virtual reality driving
simulator displaying an emerg-
ing motorcycle hazard
participant was asked to wear the Band on the dominant
hand and to keep the smartphone near their body (e.g. in a
pocket). The Sensus smartphone application (Xiong et al.
2016) was used to collect passive data from the band, includ-
ing heart rate (HR), galvanic skin response (GSR) and micro
wrist movement based on acceleration in three axes. These
particular measures were chosen because previous literature
has shown elevated HR and GSR correlate with elevated
stress (Sioni and Chittaro 2015). Moreover, signals captured
from wrist micro-movement (e.g. shaky hands) were also
found to be indicative of stressful episodes (Min et al. 2015).
Data collected from the Band were continuously transmitted
to the smartphone via Bluetooth, then downloaded at the end
of the experiment to a desktop computer for analysis.
Driving Simulator
Participants drove a Driver Guidance System simulator
developed by General Simulation. The simulator has been
previously described in detail (Cox et al. 2016). Briefly, the
driver’s console has most of the features found in a real car
(e.g. dashboard, turn signals, side and rear-view mirrors).
The driving environment was simulated by projecting syn-
chronized images from three digital projectors onto a curved
screen in front of the driver’s seat. Projector resolution was
1280 × 720 pixels at 120 frames per second. The resulting
virtual environment spanned 210° of the subject’s field of
view (Fig. 1). Participants were asked to drive the simulator
as they would drive their own car and to follow the traffic
laws at all times.
The tactical driving test was a simulated 15 mile drive
through rural, highway, and urban roads in which partici-
pants responded to traffic signals, traffic and road conditions,
and driving hazards. An automated voice instructed partici-
pants where to turn. The simulator tracked and recorded the
driving responses made by participants. This generated 15
different outcome variables related to braking, speed, steer-
ing, and judgment (see Table 5). To enable performance
comparisons between variables and also the construction
of a composite performance score, each participant’s data
for each variable was converted to a z-score based on the
13

entire sample’s mean and standard deviation. The resulting
composites served as indices of overall performance (Cutter
et al. 1999; Cox et al. 2000).
Throughout the driving test, the driver’s gaze position
was recorded using a Gazepoint GP3 eye tracker. The Gaz-
epoint GP3 samples at 60 Hz with 0.5°–1° of visual angle
accuracy. Video playback of the drive showed the gaze posi-
tion superimposed on the virtual environment. Gaze could
be displayed either from the driver’s viewpoint as a dot mov-
ing across the virtual environment, or from a bird’s eye view
as a narrow cone originating at the car (Fig. 2). The latter
had the advantage that participants’ gaze could be assessed
in relation to the car’s position. Gaze was assessed during
eight challenging segments of the simulated drive (4 turns
and 4 other maneuvers). The scenarios in these segments
included; merging onto a highway and passing a slow lead
car, turning left from a highway ramp, avoiding a motorcycle
making a left turn in front of the driver, cresting a hill and
avoiding an on-coming car, and yielding to a bicyclist at a
right turn. In each segment, we identified critical visual tar-
gets that the driver should observe to successfully negotiate
the situation, such as speed limit signs, the motorcyclist,
cross-traffic from the left, side mirror use, and looking into
a turn. A trained rater then reviewed roughly 45 s of video
surrounding each event, tallying whether or not the driver
looked at the designated targets. The rater also indicated
how comfortable she would have been as a passenger dur-
ing each driving segment. A 1 to 4 rating scale was used,
where 1 = ‘Comfortable’, 2 = ’Slightly Uncomfortable’, 3 =
Fig. 2  Illustration of bird’s-eye view eye-tracking of driver looking
into turn
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Journal of Autism and Developmental Disorders
‘Very Uncomfortable’, and 4 = ‘Need to get out of the car’.
To prevent bias, the rater was blind to the driver’s group
assignment (ASD, NT, Experienced).
On‑Road Driving
To provide in-depth detail about real-world driving perfor-
mance and to enable comparison with simulated driving,
participants were then asked to drive an instrumented vehi-
cle on a public-road route near the University of Virginia in
Charlottesville, VA. This 9-mile course incorporated urban,
highway and suburban driving, and was designed to match
critical features of the simulated driving course as closely
as possible.
The test vehicle was a 2012 Toyota Camry instrumented
with a Data Acquisition System developed by the Virginia
Tech Transportation Institute (VTTI DAS). The VTTI DAS
design has been used in a wide variety of naturalistic driv-
ing studies and is similar to that used in the Second Strate-
gic Highway Research Program Naturalistic Driving Study
(SHRP 2 NDS) (Antin et al. 2017; Klauer et al. 2017; Sven-
son et al. 2017). The system provides a broad array of infor-
mation about driver behavior and performance on a con-
tinuous basis. Continuous data include video views of the
driver and forward roadway collected at 15 Hz, kinematic
data including vehicle speed and acceleration in three axes,
vehicle speed, and lane tracking (including self-confidence
values). The vehicle was equipped with a passenger-side
emergency brake to ensure safety.
In-house analysis software was employed to view the data
and to step through on-road data frame-by-frame. Video of
drivers’ faces was coded frame-by-frame at 15 Hz by trained
data coders who categorized eye glances by location (e.g.
forward roadway, interior, left mirror, etc.). This provided
researchers an exceptionally detailed snapshot of where the
driver was looking and in what context, what was occurring
in front of the study vehicle, and how the vehicle was being
controlled at all times. An example layout of this data is
shown in Fig. 3.
To enable efficient analyses of the large amount of data
obtained during on-road drives, data were analyzed at two
levels of granularity: over the course of the full-trip and at
6 targeted locations that comprised three intersections and
three “driving segments”. The three intersections included
one unprotected left-turn across traffic, one T-intersection
with a crosswalk, and a light-controlled, sharp right turn
in a downtown area. The three driving segments included a
winding road in a residential area, a country road through
forest, and an urban road through a college campus business
district with substantial pedestrian activity.
Intersection segments were defined as beginning 5 s
before the participant entered the intersection and ending
Journal of Autism and Developmental Disorders

Fig. 3  Software utilized for time synchronized viewing of the driver’s face, the forward video and frame-by-frame kinematic data (distance to
center line, speed, acceleration in x-axis, etc.)

Table 2  Analyses completed for each on-road participant Hypotheses

Metric Portion of trip analyzed
It was hypothesized that newly licensed drivers with ASD
Full trip Intersections Driving
seg-
would find driving more stressful, as reflected by the DAS
ments and physiological measures, and would perform more
poorly on simulator and on-road driving, as reflected both
Speed variability x x
by driving performance metrics and examiner’s subjective
Lane position variability x x
ratings.
Hard-brake events x x x
Glance distribution x x
Results
when s/he completed the maneuver into the final goal
lane. Targeted driving segments were defined as beginning Stress and Driving
when the front of the vehicle passed a specified landmark
(e.g. a speed-limit sign) and ending 20 s later in order to Driving Attitude Scale
standardize duration. Table 2 summarizes the types of data
analyzed at each level. The parent-report indicated that new drivers with ASD,
compared to new NT drivers, had more negative attitudes
toward driving (p < .01) but a similar number of positive

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 Journal of Autism and Developmental Disorders

attitudes (p = .92). This was confirmed by the self-report, set to generate HR data at 1 Hz, GSR data at 5 Hz, and
which indicated that negative attitudes toward driving were accelerometer data √ at 8 Hz. We extracted the magnitude of
greater for new drivers with ASD than for both new NT (p acceleration a = x2 + y2 + z2 of all accelerometer readings
= .014) and experienced (p < .001) drivers (Table 3). The to make them orientation free. To account for physiological
negative attitudes reported by new ASD drivers and parents baseline differences, HR, GSR and wrist acceleration data
were correlated (r = .68, p = .021). Further, report of nega- were group-mean centered around each participant. Thus,
tive attitudes was reliable on test-retest (r = .69, p < .001). the raw physical data were parsed by z-scores as follows:
zi = (xi − x̄ )∕𝜎 where x̄ is the sample mean and 𝜎 is the sam-
Physiological Measures ple standard deviation.
Because of the small sample sizes and lack of differences
Because of technical issues (i.e. the MS Band II was not found between new NT and experienced drivers for physi-
properly connected to the phone) some participants’ physi- ological metrics, they were combined into one group (non-
ological data were lost. Band data was available for 6 new ASD drivers) and compared against new drivers with ASD.
ASD, 6 new NT and 6 experienced drivers. The Band was Figure 4 presents box plots comparing the physiological
responses of these two groups during the target events iden-
tified in simulated and on-road driving sessions. For both
Table 3  Mean DAS scores for parent-report (DAS-PR) and self- simulated and on-road driving, new drivers with ASD had
report (DAS-SR) of negative and positive attitudes toward driving consistently higher activation in HR, GSR, and wrist accel-
Scale Attitude Mean DAS scores eration than non-ASD drivers in challenging road segments.
This indicates that during challenging events, new drivers
ASD drivers NT drivers Expe-
rienced with ASD experienced higher arousal in their physiological
drivers measures than non-ASD drivers.
To test the statistical significance of these findings, and
DAS-PR Positive 21.25 21.0 N/A
since data consisted of multiple physiological observations
Negative 12.25 9.43
nested within individual participants, a multilevel random
DAS-SR Positive 17.13 19.17 18.33
coefficient modelling approach with a random intercept for
Negative 11.88 10.17 9.2
each participant was used. In total, six models were built to

Fig. 4  Box plots describing individual differences between new ASD and non-ASD drivers in heart rate, galvanic skin response (GSR) and
micro-movements. The data are from challenging driving events only. Red points indicate average physical measures per participant

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Journal of Autism and Developmental Disorders

model the three physiological parameters for simulated and
on-road driving. Each model contained a state-dependent
variable having one of the physical outcomes (HR, GSR
and acceleration). The “lme4” package in R was used to fit
mixed-effects models with full information maximum like-
lihood estimation (R Core Team 2018; Bates et al. 2015).
Table 4 shows the physiological changes new drivers with
ASD (as compared to non-ASD drivers) experienced during
challenging simulated and on-road events. For those with
ASD, driving had a significant effect on HR (simulation: b
= 0.075, p = 0.000, on-road: b = 0.270, p = 0.045), GSR
(simulation: b = 0.086, p = 0.000, on-road: b = 0.171, p =
0.012), and wrist acceleration (simulation: b = 0.006, p =
0.035, on-road: b = 0.036, p = 0.000). This indicates that
new drivers with ASD had statistically-significantly higher
levels of arousal in HR, GSR and wrist micro-movements
than non-ASD drivers during target events. Note that there
were no significant differences between the new drivers with
ASD and the non-ASD drivers when physiological measures
were compared across the entire duration of the simulation
and on-road drives (see supplement). This suggests that new
drivers with ASD were not under significantly more stress
than non-ASD drivers during the entire drive—just during
the challenging segments.
Driving Simulator
Tactical Performance
Due to the fact that some participants withdrew from the
simulator drive due to experiencing Simulator Adaptation
Syndrome, 7 new drivers with ASD, 10 new NT drivers
and 9 experienced drivers completed the simulator drive.
In order to make comparisons across measures and to sum
metrics for an overall Driving Composite score, all scores
were first converted to z-scores based on the group’s overall
mean and standard deviation. This meant that a score of 0
was average performance, a score of 1 was positive perfor-
mance one standard deviation above the mean, and nega-
tive scores reflected negative performance. Table 5 shows
z-scores for each simulator variable and the overall Driving
Composite for new drivers with ASD, new NT drivers, and
experienced drivers.
Using SPSS v.25, the individual variables and composite
scores were compared across groups using 1 × 3 ANOVAs,
with contrasts. The Tactical Driving Composite score was
significantly lower for the new ASD drivers (p < .01). On
individual skills, new drivers with ASD performed signifi-
cantly lower in measures of reckless driving, driving off the
road, driving in the oncoming lane of traffic, and in high
and low speed collisions. While not significant, new drivers
with ASD trended toward lower performance than the other
groups on all variables except tailgating, and they tended
to swerve and make more lane changes than new NT driv-
ers. There were no significant differences between the new
NT and experienced drivers. Table 6 presents significant
exploratory correlations between the Driving Quotient and
subscales on the BRIEF and the ASRS.
Eye Tracking
The new ASD, new NT and Experienced drivers did not
differ in the number of critical driving targets they viewed
during simulated driving. Similarly, there was no difference
in the number of times these groups appeared to check the
speedometer. However, a rater blind to group assignment,

Table 4  Results of Linear Condition Sensor n b SE DF t p

mixed effect models comparing
new drivers with ASD to Simulated driving Heart rate 12,493 Intercept 0.202 0.079 12474 2.536 0.011
non-ASD drivers (baseline =
Fixed effect 0.075 0.006 12474 11.108 0.000
non-ASD drivers) on heart rate,
acceleration and GSR (galvanic Acceleration 67,548 Intercept 0.012 0.012 67531 6.986 0.000
skin response) during the Fixed effect 0.006 0.003 67531 2.098 0.035
challenging events of simulated GSR 2945 Intercept 0.823 0.123 2928 6.687 0.000
and on-road driving
Fixed effect 0.086 0.016 2928 5.185 0.000
On-road driving Heart rate 4716 Intercept 0.042 0.118 4696 0.357 0.721
Fixed effect 0.270 0.135 4696 1.997 0.045
Acceleration 40,923 Intercept − 0.132 0.020 40923 6.508 0.000
Fixed effect 0.036 0.007 40923 4.787 0.000
GSR 841 Intercept 1.000 0.245 823 4.071 0.000
Fixed effect 0.171 0.068 823 2.508 0.012

The number of observations (n), the fixed effects estimate (b), the standard error (SE), the denominator
degrees of freedom (DF), the ratios between the estimates and the standard errors (t), and the associated p
value from a t distribution (p) are reported for each dependent variable (Heart rate, Acceleration and GSR).
Rows in bold represent fixed effects when being a new driver with ASD had a significant effect on the
physical measures

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Table 5  Mean z-scores for each performance variable and participant type based on driving the entire simulated course
Simulated driving variables Driver type F(2,23) p Contrast:
ASD vs.
New ASD New NT Experienced NT

Speed control
Tailgating 0.29 − 0.22 0.02 0.52 0.6
Speeding (> 5 mph over posted limit) − 0.28 0.47 − 0.30 1.89 0.17
Reckless driving (> 20 mph posted limit) − 0.66 0.33 0.14 2.43 0.11 0.04
Difficulty maintaining posted speed limit − 0.52 0.17 0.26 1.44 0.26
Steering control
Roadway departures − 0.72 0.28 0.28 2.91 0.08 0.04
Driving in on-coming lane − 0.67 0.47 0.03 3.09 0.07 0.02
Swerving − 0.67 0.33 0.00 1.67 0.21 0.09
Wheels off road − 0.56 0.22 0.21 1.56, 0.23
Braking control
Rolling stops − 0.04 0.14 − 0.12 0.17 0.85
Sluggish deceleration 0.17 0.20 − 0.35 0.85 0.44
High speed collisions − 0.87 0.33 0.32 4.81 0.02* 0.01
Low speed collisions − 0.77 0.24 0.33 3.43 0.05* 0.03
Judgment
Missed turns − 0.08 0.73 0.62 1.06 0.36
Number of lane changes − 0.71 0.19 0.34 2.8 0.08 0.07
Driving too slow (< 20 mph speeding) − 0.14 − 0.05 0.16 0.2 0.82
Composite
Tactical driving composite score − 6.48 3.34 1.61 4.36 0.03* 0.01

Negative scores indicate worse than average performance. Significant and marginal contrasts are in the rightmost column

Table 6  Exploratory BRIEF ASRS

correlations (r) between the
Driving Quotient and subscales Shift Emotional control Organization Social motivation Restricted inter-
on the BRIEF and the ASRS of materials ests and repetitive
behavior

Correlation − .742* − .668* − .705* − .731* − .675*

p level .022 .049 .034 .025 .046

p values indicate that all correlations in the table are statistically significant

who was viewing video playback of each participant’s simu-
lated drive, reported feeling less comfortable as a potential
passenger with new drivers with ASD than with new NT or
Experienced drivers (p = 0.04).
On‑Road Driving Performance
Driving data were lost for five experienced drivers, two new
drivers with ASD, and two new NT drivers due to techni-
cal error. As a result, 6 new drivers with ASD, 6 new NT
drivers and 11 experienced drivers, had data available for
on-road analyses. Driver behavior on public roads was exam-
ined using a series of metrics that analyzed driver eye-glance
behavior and vehicle control, including speed, lane position,
and intersection completion time. Significant results are
summarized in Table 7 below and presented in more detail
following.
Glance Behavior
Driver eye-glance behavior during on-road driving was
coded frame-by-frame at 15 Hz by trained raters using video
of the driver’s face. Two dependent metrics were derived:
glance entropy (see Eq. 1), which measures the degree to
which drivers scan the environment, and percentage of time
the eyes were forward, measuring the amount of time drivers
looked at the forward roadway compared to looking else-
where. Entropy has been used in prior driving performance

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Journal of Autism and Developmental Disorders
Table 7  Summary of Simulated driving variables
statistically significant on-road
metrics
Mean speed (km/h)
 Country road segment
Lane position (distance from center line in cm)
 Whole trip
studies (e.g. Bao and Boyle 2009) to gain a single-value
understanding of how much information drivers acquire
about their environment using visual scanning.
n tioned significantly further to the right (edge) of the roadway
∑
Entropybits = − (pi log pi )
i=1
No significant differences were found in glance entropy
or eyes-forward behavior between new drivers with ASD
compared to new NT or experienced drivers.
Time to Complete Intersections
To analyze vehicle control behavior through intersections,
we examined, across groups, the mean time it took drivers
to complete an intersection traversal as well as the mean
peak speed through intersections. A significant difference
between groups was found for mean traversal time, F(2,24)
= 4.96, p = 0.02; however, this effect was due entirely to
two high-duration outliers in the group of new drivers with
ASD. In one case, the driver had to stop for a pedestrian in
the T-intersection (the only instance of this in the data); in
the other, it was unclear why the participant traversed the
intersection as slowly as she did. With these two outliers
removed, mean values for all three groups were extremely
similar and no significant differences were found. No sig-
nificant differences were found across groups for peak speed
achieved during intersection traversal; however, there was
a trend for new drivers with ASD to have the lowest peak
speed across all three intersections.
Mean Speed
Mean speed was evaluated for all individual driving seg-
ments to enable controlled comparisons across groups. New
drivers with ASD had significantly lower speed than expe-
rienced adult drivers in the country road segment (F(2,24)
= 4.15, p = 0.03). No other differences among groups were
significant.
Lane Position
Machine-vision lane trackers were used to determine lane
position relative to the center line. While these data were
Driver type F(2,24) p
New ASD New NT Experienced
39.2 43.9 45.1 4.15 0.03*
193.8 188.6 176.4 4.93 0.01*
limited to times when the camera system had good confi-
dence in its assessment of line position (on average, 44% of
trip duration), new drivers with ASD were, on average, posi-
than experienced drivers (F(2,24) = 4.93, p = 0.01).
(1)
Previous Driving Mishaps
The number of driving mishaps reported by new ASD and
NT drivers and calculated for a 12-month period was 2.0 and
0.5 respectively (p = 0.26). Drivers who achieved a Tactical
Driving Composite score above 1.2 reported 0 driving mis-
haps. Six new NT drivers and one new ASD driver achieved
Tactical Driving Composite scores higher than 1.2.
Discussion
The findings from the different measures and methodolo-
gies used in this study reveal interesting convergences and
contrasts. First, the results from self-reports, parent reports,
and physiological measures of autonomic arousal (HR and
GSR) and micro-movements of the steering wheel converge
to suggest that new drivers with ASD are more apprehen-
sive about driving than new NT drivers. This conclusion is
consistent with previous reports (Ross et al. 2018; Reimer
et al. 2013). In both simulated and on-road driving, the ASD
drivers drove closer to or over the right lane line, possibly
reflecting conservative driving due to apprehension concern-
ing on-coming traffic. Additionally, both the simulator and
on-road assessments found no problems targeting critical
issues based on eye-tracking data when comparing ASD to
non-ASD drivers.
As with novice ASD drivers, the current new ASD driv-
ers performed worse on all of the individual simulator vari-
ables, except for tailgating. Worse simulator driving within
the ASD sample was correlated with parent symptom reports
(BRIEF and ASRS). Exploratory correlations suggest that
worse driving of the simulator was associated with:
• Inability to move freely from one activity or situation to
another; to tolerate change; to switch or alternate atten-
tion.
• Inability to regulate emotional responses appropriately.
13

• Inability to order in work, play and storage spaces (e.g.,
desks, lockers, backpacks, and bedrooms).
• Low motivation to participate in social interactions with
others.
• stereotypy and circumscribed interests
Future a priori research may investigate whether such
symptoms relate to the acquisition of a driver’s license and/
or involvement in driving mishaps.
Given the current findings of relatively poorer simulator
driving performance along with the findings of impaired
performance relative to neurotypical teens in prior studies
(Cox et al. 2016), this apprehension may be justified and
possibly protective. However, performance as a function of
apprehension follows an inverted U-shaped curve (Martens
and Landers 1970), with excessive apprehension leading to a
narrow focus that potentially contributes to impaired driving
performance. Our sample size was too small to investigate
subgroups of drivers with varying amounts of apprehension,
but this topic would be valuable to investigate in the future.
We previously reported that driver training in a low-risk
environment or a driving simulator was found to improve
driving performance and reduce driving apprehension (Ross
et al. 2018), but it is unclear whether these improvements
were independent or dependent of one another, and if the
latter, the direction of causality. While future research is
necessary, at this point it appears prudent to focus ASD
driver training on both improving driving skills and reduc-
ing driving apprehension for those who demonstrate elevated
apprehension.
However, it would appear that driving apprehension is
not related to visually attending to driving relevant informa-
tion, as operationalized in both the simulation and on-road
driving. As operationalized in this study, gaze behavior may
be insensitive to any ASD-specific deficits, there may not
have been sufficient critical visual events to elicit differences
among groups in gaze behavior, or gaze behavior may not
equate to actual perception of driving-crucial information.
It may be that drivers with ASD look in the right directions,
but do not process the significance of what is being looked
at. In other words, this study did not rule out the role driv-
ing apprehension may have in regards to visual perception
of critical driving information.
Interestingly, many of the differences found between
teens with ASD and the other drivers during simulated
driving were not found during on-road driving. It should
be noted that it was not possible to calculate an overall
on-road performance score that was equivalent to the
driving composite in simulated driving, so overall driv-
ing performance was not compared across methods. With
respect to individual driving skills, new drivers with
ASD were no different than other participants in on-road
measures of glance entropy, percent of time drivers’ eyes
13
Journal of Autism and Developmental Disorders
faced forward, variability in lane position, or variability in
speed. However, teens with ASD did tend to drive slower
when traversing certain road segments, and they tended to
drive closer to the right side of the road compared to the
neurotypical participants. These on-road differences could
be interpreted as reflecting either poorer driving perfor-
mance or perhaps more cautious driving in response to the
increased apprehension that drivers with ASD experience.
There are several potential explanations for the discrep-
ancies between simulator and on-road findings, which are
not necessarily mutually exclusive. One possibility is that
the in-car instrumentation was not precise enough to dis-
criminate differences in driving performance among the
groups of drivers. This is unlikely, as the same instrumen-
tation has previously been used to successfully analyze
driving performance in teen drivers (Klauer et al. 2014,
2017). A second possibility is that on-road performance
differences may have been obscured by variability in the
driving environment, where traffic, lighting and environ-
mental conditions can change considerably from drive to
drive, thus inducing variability in course difficulty across
participants. We attempted to control environmental fac-
tors by testing participants at similar times of day and only
in dry weather. Since it was impossible to tightly control
all environmental variables, differences in performance
could have been masked by varying roadway and traffic
conditions. A third factor that could have limited the dis-
criminability of on-road ASD and NT drivers is low power
due to the small sample size. Future studies with larger
sample sizes would be better positioned to determine
meaningful real-world differences in the driving perfor-
mance of new teens with and without ASD.
This study is the first to use both simulated and on-road
driving in a multi-method approach to compare the driv-
ing performance of new drivers with ASD, new NT drivers,
and experienced adult drivers. Although the results from the
two primary methodologies were inconsistent, each method
contributed to our emerging understanding of driving with
ASD. The surveys and physiological measures indicated that
teens with ASD exhibited more stress while driving, the
simulator measures suggested that they had poorer vehicle
control and judgment, and the on-road measures showed
that some aspects of their presumably poorer driving may
reflect increased caution. Since this was a pilot study, a
larger sample of drivers and longer driving times are needed
to establish reliable and meaningful differences in driver
performance so that more specific recommendations can be
made regarding driver training.
Acknowledgments  This work was made possible by a Grant to Daniel
Cox and Justin Owens from the 4VA Research Grants Program. The
team is grateful to Camilla Schanche-Perret Gentil for coding eye-
movement data from the simulator and for providing subjective ratings
of driving performance.
Journal of Autism and Developmental Disorders
Compliance with Ethical Standards  Daly, B. P., Nicholls, E. G., Patrick, K. E., Brinckman, D. D., &
Conflict of interest  The authors declare that they have no conflicts of
interest.
Ethical Approval  All procedures performed in studies involving human
participants were in accordance with the ethical standards of the insti-
tutional 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 indi-
vidual participants included in the study. Additional informed consent
was obtained from all individual participants for whom identifying
information is included in this article.
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