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The Cognitive-Behavioral Intervention for Driving (CBID) teaches executive functioning skills (sustaining attention, attention shifting, contextual awareness, multiple processing, flexible thinking , problem-solving and planning) and emotion regulation skills (positive thinking, emotional awareness, emotional regulation, and calming actions) as required while driving. It uses cognitive enhancement and behavioral strategies taught in a group setting with one-on-one driving simulator practice for exposures and skill practice opportunities. The driving simulator specifically provides for extended time to practice driving skills, immediate feedback, opportunities to correct mistakes, and application of skills taught in graded, sequential steps.
The goals of the CBID program are to increase foundational skills of executive functioning and emotional regulation and decrease driving apprehension for teens/adults with ASD.
Background Research in Support of CBID
Driving plays a large role in development and functional independence. Acquiring a driver’s license is associated with increased participation in education and employment (Huang et al. 2012). Research on driving for individuals with ASD shows limited driving and driving apprehension with only 24% of able drivers obtaining their license (often later in life) and driving regularly (O’Neil 2012).
Difficulties in driving may be caused by executive dysfunctioning and emotional dysregulation found in ASD (Ross et al. 2015); both challenges resulting in dangerous driving behaviors. Adolescents with ASD were found to be less likely to identify socially relevant road hazards (Sheppard et al. 2010) and diminished monitoring of visual fields (Reimer et al. 2013). Previous research indicated that including executive functioning training is warranted in driving programs for ASD (Cox et al 2016), as well as with neurotypicals, elderly and ADHD populations. Additionally, studies have found that executive functioning training transfers to driving performance (Ball et al 2010) and simulated driving experiences increase skills and driving outcomes (Brooks et al. 2013).
Additionally, individuals with ASD are at risk due to their anxiousness while driving (Taylor et al. 2007). Recent evidence suggests that driving anxiety/apprehension may be more pervasive than previously recognized (Taylor & Deane, 2000). As reported by Chapp et al, 2011, anxious driving behavior has been conceptualized as an increase, decrease, or general disorganization of behavior as a consequence of anxiety. Driving apprehension can result in negative consequences for both driver and other motorists, hence should be recognized and addressed.