Cognitive components of simulated driving performance: Sleep loss effects and predictors

Driving is a complex task, which can be broken down into specific cognitive processes. In order to determine which components contribute to drowsy driving impairments, the current study examined simulated driving and neurocognitive performance after one night of sleep deprivation. Nineteen professional drivers (age 45.3 ± 9.1) underwent two experimental sessions in randomised order: one after normal sleep and one after 27 h total sleep deprivation. A simulated driving task (AusEd), the psychomotor vigilance test (PVT), and neurocognitive tasks selected from the Cognitive Drug Research computerised neurocognitive assessment battery (simple and choice RT, Stroop Task, Digit Symbol Substitution Task, and Digit Vigilance Task) were administered at 10:00 h in both sessions. Mixed-effects ANOVAs were performed to examine the effect of sleep deprivation versus normal sleep on performance measures. To determine if any neurocognitive tests predicted driving performance (lane position variability, speed variability, braking RT), neurocognitive measures that were significantly affected by sleep deprivation were then added as a covariate to the ANOVAs for driving performance. Simulated driving performance and neurocognitive measures of vigilance and reaction time were impaired after sleep deprivation (p < 0.05), whereas tasks examining processing speed and executive functioning were not significantly affected by sleep loss. PVT performance significantly predicted specific aspects of simulated driving performance. Thus, psychomotor vigilance impairment may be a key cognitive component of driving impairment when sleep deprived. The generalisability of this finding to real-world driving remains to be investigated.     

Distracted driving in elderly and middle-aged drivers

Automobile driving is a safety-critical real-world example of multitasking. A variety of roadway and in-vehicle distracter tasks create information processing loads that compete for the neural resources needed to drive safely. Drivers with mind and brain aging may be particularly susceptible to distraction due to waning cognitive resources and control over attention. This study examined distracted driving performance in an instrumented vehicle (IV) in 86 elderly (mean = 72.5 years, SD = 5.0 years) and 51 middle-aged drivers (mean = 53.7 years, SD = 9.3 year) under a concurrent auditory–verbal processing load created by the Paced Auditory Serial Addition Task (PASAT). Compared to baseline (no-task) driving performance, distraction was associated with reduced steering control in both groups, with middle-aged drivers showing a greater increase in steering variability. The elderly drove slower and showed decreased speed variability during distraction compared to middle-aged drivers. They also tended to “freeze up”, spending significantly more time holding the gas pedal steady, another tactic that may mitigate time pressured integration and control of information, thereby freeing mental resources to maintain situation awareness. While 39% of elderly and 43% of middle-aged drivers committed significantly more driving safety errors during distraction, 28% and 18%, respectively, actually improved, compatible with allocation of attention resources to safety critical tasks under a cognitive load.     

Older driver distraction: A naturalistic study of behaviour at intersections

This study examined older driver engagement in distracting behaviours (secondary activities) at intersections using naturalistic driving data from a larger study based in Melbourne, Australia. Of interest was whether engagement in secondary activities at intersections was influenced by factors such as driver gender and situational variables, in particular, those relating to the complexity of the driving environment. Specifically we expected that when making left/right turns, older drivers would reduce the proportion of time engaged in secondary behaviours at intersections which required gap judgements (partly controlled or uncontrolled) compared with intersections that were fully controlled by traffic signals. Consideration was given to engagement in secondary activity with hands off the wheel and when the vehicle was moving versus stationary. Older drivers aged between 65 and 83 years drove an instrumented vehicle (IV) on their regular trips for approximately two weeks. The IV was equipped with a video camera system, enabling recording of the road environment and driver and a data acquisition unit, enabling recording of trip distance, vehicle speed, braking, accelerating, steering and indicator use. Driving experience and demographics were collected and functional abilities were assessed using the Useful Field of View (UFOV), Trail Making Test B, Mini Mental Status Examination (MMSE), visual acuity and contrast sensitivity. The study yielded a total of 371 trips with 4493 km (99.8 h) of naturalistic driving data including 1396 left and right turns. Trips were randomly selected from the dataset and in-depth analysis was conducted on 200 intersection manoeuvres (approximately 50% left turns, 50% right turns). The most frequently observed secondary activities were scratching/grooming (42.5%), talking/singing (30.2%) and manipulating the vehicle control panel (12.2%). Glances “off road” 2 s or longer were associated with reading, reaching and manipulation of the vehicle control panel. Hands off the wheel was associated with reading. Key parameters associated with the percent of intersection time that drivers engaged in secondary activities were intersection complexity, vehicle status (moving vs. stationary) and traffic density. In conclusion, older drivers appeared to engage selectively in secondary activities according to roadway/driving situations, supporting the notion that drivers self-regulate by engaging in secondary tasks less frequently when the driving task is more challenging compared with less challenging manoeuvres.     

Does attention capacity moderate the effect of driver distraction in older drivers?

With age, a decline in attention capacity may occur and this may impact driving performance especially while distracted. Although the effect of distraction on driving performance of older drivers has been investigated, the moderating effect of attention capacity on driving performance during distraction has not been investigated yet. Therefore, the aim was to investigate whether attention capacity has a moderating effect on older drivers’ driving performance during visual distraction (experiment 1) and cognitive distraction (experiment 2). In a fixed-based driving simulator, older drivers completed a driving task without and with visual distraction (experiment 1, N = 17, mean age 78 years) or cognitive distraction (experiment 2, N = 35, mean age 76 years). Several specific driving measures of varying complexity (i.e., speed, lane keeping, following distance, braking behavior, and crashes) were investigated. In addition to these objective driving measures, subjective measures of workload and driving performance were also included. In experiment 1, crash occurrence increased with visual distraction and was negatively related to attention capacity. In experiment 2, complete stops at stop signs decreased, initiation of braking at pedestrian crossings was later, and crash occurrence increased with cognitive distraction. Interestingly, for a measure of lane keeping (i.e., standard deviation of lateral lane position (SDLP)), effects of both types of distraction were moderated by attention capacity. Despite the decrease of driving performance with distraction, participants estimated their driving performance during distraction as good. These results imply that attention capacity is important for driving. Driver assessment and training programs might therefore focus on attention capacity. Nonetheless, it is crucial to eliminate driver distraction as much as possible given the deterioration of performance on several driving measures in those with low and high attention capacity.     

Age and inconsistency in driving performance

Research in cognitive neuropsychology suggests that investigation of the within-person variability, or inconsistency, of cognitive performance may provide valuable insights into ageing mental processes. It is rare though, for this interest in intraindividual variability to extend to everyday activities. As this may provide important information about driving behaviour, we therefore assessed age differences in driving inconsistency in younger (n = 24, M age = 21.29 years) and older (n = 21, M age = 71.24 years) persons who drove in residential, urban and motorway conditions in a fully immersive driving simulator. In measures of headway (maintaining a safe distance to a preceding vehicle) and lateral lane position, older drivers exhibited significantly greater performance inconsistency, and this was particularly marked in the faster motorway condition. Older drivers also recorded greater perceived mental demands associated with driving, and greater within-person variability across a range of cognitive measures. The findings suggest that age-related deficits in attentional and executive control may affect the consistency of driving performance in older persons. Discussion considers interventions to introduce in-vehicle systems to help maintain attention in older drivers, and to intervene when safety-critical boundaries are exceeded.     

Risky car following in abstinent users of MDMA

Ecstasy (MDMA) use raises concerns because of its association with risky driving. We evaluated driving performance and risk taking in abstinent recreational MDMA users in a simulated car following task that required continuous attention and vigilance. Drivers were asked to follow two car lengths behind a lead vehicle (LV). Three sinusoids generated unpredictable LV velocity changes. Drivers could mitigate risk by following further behind the erratic LV. From vehicle trajectory data we performed a Fourier analysis to derive measures of coherence, gain, and delay. These measures and headway distance were compared between the different groups. All MDMA drivers met coherence criteria indicating cooperation in the car following task. They matched periodic changes in LV velocity similar to controls (abstinent THC users, abstinent alcohol users, and non-drug users), militating against worse vigilance. While all participants traveled approximately 55 mph (89 kph), the MDMA drivers followed 64 m closer to the LV and demonstrated 1.04 s shorter delays to LV velocity changes than other driver groups. The simulated car following task safely discriminated between driving behavior in abstinent MDMA users and controls. Abstinent MDMA users do not perform worse than controls, but may assume extra risk. The control theory framework used in this study revealed behaviors that might not otherwise be evident.     

Distraction-induced driving error: An on-road examination of the errors made by distracted and undistracted drivers

This study explored the nature of errors made by drivers when distracted versus not distracted. Participants drove an instrumented vehicle around an urban test route both while distracted (performing a visual detection task) and while not distracted. Two in-vehicle observers recorded the driving errors made, and a range of other data were collected, including driver verbal protocols, forward, cockpit and driver video, and vehicle data (speed, braking, steering wheel angle, etc.). Classification of the errors revealed that drivers were significantly more likely to make errors when distracted; although driving errors were prevalent even when not distracted. Interestingly, the nature of the errors made when distracted did not differ substantially from those made when not distracted, suggesting that, rather than making different types of errors, distracted drivers simply make a greater number of the same error types they make when not distracted. Avenues for broadening our understanding of the relationship between distraction and driving errors are discussed along with the advantages of using a multi-method framework for studying driver behaviour.     

The influence of music on mental effort and driving performance

The current research examined the influence of loud music on driving performance, and whether mental effort mediated this effect. Participants (N = 69) drove in a driving simulator either with or without listening to music. In order to test whether music would have similar effects on driving performance in different situations, we manipulated the simulated traffic environment such that the driving context consisted of both complex and monotonous driving situations. In addition, we systematically kept track of drivers’ mental load by making the participants verbally report their mental effort at certain moments while driving. We found that listening to music increased mental effort while driving, irrespective of the driving situation being complex or monotonous, providing support to the general assumption that music can be a distracting auditory stimulus while driving. However, drivers who listened to music performed as well as the drivers who did not listen to music, indicating that music did not impair their driving performance. Importantly, the increases in mental effort while listening to music pointed out that drivers try to regulate their mental effort as a cognitive compensatory strategy to deal with task demands. Interestingly, we observed significant improvements in driving performance in two of the driving situations. It seems like mental effort might mediate the effect of music on driving performance in situations requiring sustained attention. Other process variables, such as arousal and boredom, should also be incorporated to study designs in order to reveal more on the nature of how music affects driving.     

Video-based road commentary training improves hazard perception of young drivers in a dual task

This study used a video-based hazard perception dual task to compare the hazard perception skills of young drivers with middle aged, more experienced drivers and to determine if these skills can be improved with video-based road commentary training. The primary task required the participants to detect and verbally identify immediate hazard on video-based traffic scenarios while concurrently performing a secondary tracking task, simulating the steering of real driving. The results showed that the young drivers perceived fewer immediate hazards (mean = 75.2%, n = 24, 19 females) than the more experienced drivers (mean = 87.5%, n = 8, all females), and had longer hazard perception times, but performed better in the secondary tracking task. After the road commentary training, the mean percentage of hazards detected and identified by the young drivers improved to the level of the experienced drivers and was significantly higher than that of an age and driving experience matched control group. The results will be discussed in the context of psychological theories of hazard perception and in relation to road commentary as an evidence-based training intervention that seems to improve many aspects of unsafe driving behaviour in young drivers.     

The effect of a low and high resource intervention on older drivers’ knowledge,behaviors and risky driving

This study aimed to compare an in-class Seniors on the MOVE (Mature Operators Vehicular Education) interactive multi-session driving curriculum with a self-guided MOVE curriculum for older adults. Using a two group randomized design, we sought to determine if there are between-group differences in older drivers’ knowledge and safety behaviors among participants. Forty-four participants with an average age of 79 years (SD = 7.1) were randomly assigned to the original MOVE program (SOM-A) or a lower resource (SOM-B) self-guided intervention. SOM-A is a four session program designed to improve older drivers safety knowledge and better understand skills for safer driving. SOM-B is a self-guided program with one required in-class session and one optional session. Subsequent to completion of both curricula, participants were offered CarFit, a comprehensive check of how well a senior driver and their vehicle work together. Baseline, post-intervention and 6-month follow up questionnaires were completed by participants. We found significant differences (p = .01) in the mean driving safety knowledge scores when comparing participants in SOM-A (3.7, SD 2.0) to those in SOM-B (0.87, SD 2.6). With regard to behavioral outcomes, we focused on always wearing a seatbelt, talking with a health care provider about driving ability, and sitting 10–12 inches from the steering wheel. The vast majority of participants reported always wearing their seat belts (SOM-A 100%, SOM-B 92%, p = 1.0), and very few reported talking with their doctors (SOM-A Baseline – 0%, Follow up 1 – 0%, p = n/a). Mean behavior change scores for participants sitting 10–12 inches from the steering wheel were significantly more likely among SOM-A (mean = .65, SD = .5) participants than those in SOM-B (mean = .29, SD = .5, p = .01) at first follow-up. Taken together, these findings suggest that the more intensive program is more effective and that driving safety programs focused on behaviors to self evaluate driving abilities continue to be needed to help older drivers remain safer on the road as they age. The involvement of health care providers in such efforts may be an untapped potential.     

Are drivers aware of sleepiness and increasing crash risk while driving?

Drivers are advised to take breaks when they feel too tired to drive, but there is question over whether they are able to detect increasing fatigue and sleepiness sufficiently to decide when to take a break. The aim of this study was to investigate the extent to which drivers have access to cognitive information about their current state of sleepiness, likelihood of falling asleep, and the implications for driving performance and the likelihood of crashing. Ninety drivers were recruited to do a 2 h drive in a driving simulator. They were divided into three groups: one made ratings of their sleepiness, likelihood of falling asleep and likelihood of crashing over the next few minutes at prompts occurring at 200 s intervals throughout the drive, the second rated sleepiness and likelihood of falling asleep at prompts but pressed a button on the steering wheel at any time if they felt they were near to crashing and the third made no ratings and only used a button-press if they felt a crash was likely. Fatigue and sleepiness was encouraged by monotonous driving conditions, an imposed shorter than usual sleep on the night before and by afternoon testing. Drivers who reported that they were possibly, likely or very likely to fall asleep in the next few minutes, were more than four times more likely to crash subsequently. Those who rated themselves as sleepy or likely to fall asleep had a more than 9-fold increase in the hazards of a centerline crossing compared to those who rated themselves as alert. The research shows clearly that drivers can detect changes in their levels of sleepiness sufficiently to make a safe decision to stop driving due to sleepiness. Therefore, road safety policy needs to move from reminding drivers of the signs of sleepiness and focus on encouraging drivers to respond to obvious indicators of fatigue and sleepiness and consequent increased crash risk.     

Temporal perspective on individual driver behavior using electronic records of undesirable events

This paper explores In-Vehicle Data Recorders (IVDRs) information about the count of undesirable driving events (such as hard braking, lane changing, and sharp turning) of 148 individuals. The information was logged over three years and included time stamp information about the occurrence of undesirable driving events in each trip (N = 573,238). The objective was to gain deeper understanding about the heterogeneity among drivers with respect to behavior change over time, the effect of trip duration and the distribution of events count. Our findings show that in some respects drivers are similar: for all drivers, the variance of the events count was larger than the mean, indicating that the negative binomial distribution is suitable to model the distribution of events count per trip. Most drivers (95%) had lower events rate during longer trips, suggesting that a ‘simple’ events rate index is problematic when comparing between those driving longer trips and drivers driving short trips. In addition, most drivers (87%) improved their driving behavior throughout the measurement period. However, there are important differences among drivers in terms of the frequency of behavior change and the trends in behavior over time. These findings demonstrate the need for personalized examination of individual drivers. Several tools for such personalized examination were developed and discussed in this study.     

Route familiarity breeds inattention: A driving simulator study

Inattention is a major cause of traffic accidents. Here, we show that, contrary to common-sense expectation, familiarity with a route is itself a source of driving impairment. This effect may be attributed to increased mind-wandering along familiar routes. In the present work, participants followed a vehicle along a route with which they were either familiar or unfamiliar. During the experimental session, the lead-vehicle braked at random locations, forcing participants to brake to avoid a collision. Participants were also required to respond with a button press when they noticed pedestrians heading toward the road from a sidewalk. In Experiment 1 we found that familiar drivers follow the lead vehicle more closely and are slower to notice approaching pedestrians. In Experiment 2, with following distance held constant, reaction times to central and peripheral events were longer for familiar drivers. Consistent with the mind-wandering hypothesis, all these effects were eliminated in Experiment 3 when drivers were made to focus on the driving task.     

Age differences in cognitive and psychomotor abilities and simulated driving

The current study investigated the relationship between drivers’ abilities in various cognitive and psychomotor domains and their driving performance. The goal was to identify test measures that could be used to develop a fitness-for-driving test battery, particularly for older drivers. Licensed drivers over 40 years of age (M = 65.56 years, SD = 13.02) were recruited from university leisure courses (n = 18) and drivers under 40 (M = 22.20 years, SD = 3.79) were recruited from undergraduate and graduate courses (n = 44). Participants were given a battery of standard neuropsychological tests used to assess ability in the domains of cognitive processing speed, psychomotor functioning, visuospatial performance, sustained attention, and executive functioning. Participants’ driving ability was assessed in a simulator with data collected in three categories of driving performance: (a) driver control maintenance behaviors, (b) accidents and violations, and (c) attention and reaction time. Younger participants outperformed older participants in 4 out of the 5 domains of neuropsychological testing (all but sustained attention). Age differences were found in simulator driving accidents and violations and driving performance was significantly correlated with neuropsychological test performance. The results are discussed in terms of the potential to use these tests to assess older drivers seeking license renewal or for selecting professional drivers for the transportation industry.     

Driver behavior following an automatic steering intervention

The study investigated driver behavior toward an automatic steering intervention of a collision mitigation system. Forty participants were tested in a driving simulator and confronted with an inevitable collision. They performed a naïve drive and afterwards a repeated exposure in which they were told to hold the steering wheel loosely. In a third drive they experienced a false alarm situation. Data on driving behavior, i.e. steering and braking behavior as well as subjective data was assessed in the scenarios. Results showed that most participants held on to the steering wheel strongly or counter-steered during the system intervention during the first encounter. Moreover, subjective data collected after the first drive showed that the majority of drivers was not aware of the system intervention. Data from the repeated drive in which participants were instructed to hold the steering wheel loosely, led to significantly more participants holding the steering wheel loosely and thus complying with the instruction. This study seems to imply that without knowledge and information of the system about an upcoming intervention, the most prevalent driving behavior is a strong reaction with the steering wheel similar to an automatic steering reflex which decreases the system's effectiveness. Results of the second drive show some potential for countermeasures, such as informing drivers shortly before a system intervention in order to prevent inhibiting reactions.     

Substance use and social,health and safety-related factors among fatally injured drivers

Objective

The aim of this study was to examine different socio-demographic, health and safety-related factors, and psychoactive substance use among fatally injured drivers in road traffic accidents in Finland during 2006–2008.

Methods

An accident information register maintained by the Traffic Safety Committee of Insurance Companies (VALT) of the Finnish Motor Insurers’ Centre was used as basic data, and the basic data were complemented with further toxicological analytical information retrieved from autopsy reports from the Department of Forensic Medicine, Helsinki University. The data included all the drivers (n = 556) who were driving a motor vehicle and who died in a road traffic accident in Finland during 2006–2008.

Results

Of all the 556 fatally injured drivers 43% (n = 238) had psychoactive substance findings. 51% (n = 121) of substance positive drivers had a finding for alcohol only, the rest had a finding for one or more illicit/medicinal drugs impairing driving ability, and possibly also alcohol. Fatally injured drivers with alcohol findings were significantly younger (mean age 34 years) than sober drivers (mean age 44 years) or drivers with findings for drugs (mean age 45 years). Socio-demographic background did not differ substantially among drunken/drugged and sober drivers, although drivers with alcohol findings had a slightly lower education and socioeconomic position. Previous substance abuse problems were highly prevalent among drivers with substance findings and mental or both mental and physical health problems were more common among drivers with drug findings. The non-use of safety equipment and driving at a high speed were more common among fatally injured drivers with substance findings.

Conclusions

Substance abuse and mental health problems, as well as reckless driving behavior were more pronounced among fatally injured drivers with substance findings when compared to sober drivers. Thus, prevention and early intervention concerning substance abuse, mental health problems and DUI are essential. Improved traffic safety cannot be achieved by means of traffic policy only, but integration with other policies, such as health and social policy should be strengthened.     

Concurrent processing of vehicle lane keeping and speech comprehension tasks

With the growing prevalence of using in-vehicle devices and mobile devices while driving, a major concern is their impact on driving performance and safety. However, the effects of cognitive load such as conversation on driving performance are still controversial and not well understood. In this study, an experiment was conducted to investigate the concurrent performance of vehicle lane keeping and speech comprehension tasks with improved experimental control of the confounding factors identified in previous studies. The results showed that the standard deviation of lane position (SDLP) was increased when the driving speed was faster (0.30 m at 36 km/h; 0.36 m at 72 km/h). The concurrent comprehension task had no significant effect on SDLP (0.34 m on average) or the standard deviation of steering wheel angle (SDSWA; 5.20° on average). The correct rate of the comprehension task was reduced in the dual-task condition (from 93.4% to 91.3%) compared with the comprehension single-task condition. Mental workload was significantly higher in the dual-task condition compared with the single-task conditions. Implications for driving safety were discussed.     

MMSE as a predictor of on-road driving performance in community dwelling older drivers

Screening tools such as the MMSE have been used extensively in driving research studies to determine mild cognitive impairment or dementia. While some studies have shown the MMSE to correlate with driving performance, few studies have shown the predictive validity of the MMSE in determining on-road performance. In a sample of 168 community dwelling older adults, including 20 with Parkinson's disease (PD), the primary objective was to determine the validity of the MMSE to predict pass/fail outcomes of an on-road driving test using receiver operating characteristics curves. The area under the curve (AUC), an index of discriminability, for the total sample was .654, 95% CI = 0.536–0.772, p = .009. Meanwhile, the AUC for the PD group was 0.791, 95% CI = 0.587–0.996, p = .036. The total sample showed statistically significant yet poor predictive validity. However, the PD group showed statistically significant and good predictive validity of the MMSE to predict pass/fail outcomes on the road test, but caution is warranted as the confidence intervals are wide (due to small sample) and the positive and negative predictive values are less than desirable due to the associated error. The findings show that using the current cut-off point of ≤24 on the MMSE is not adequately sensitive to predict on-road performance in both community dwelling older drivers and in drivers with PD. This study offers strong evidence to support the current best practice of not using the MMSE in isolation to predict on-road performance.     

Self-rated driving and driving safety in older adults

Many U.S. states rely on older adults to self-regulate their driving and determine when driving is no longer a safe option. However, the relationship of older adults’ self-rated driving in terms of actual driving competency outcomes is unclear. The current study investigates self-rated driving in terms of (1) systematic differences between older adults with high (good/excellent) versus low (poor/fair/average) self-ratings, and (2) the predictive nature of self-rated driving to adverse driving outcomes in older adults (n = 350; mean age 73.9, SD = 5.25, range 65–91). Adverse driving outcomes included self-reported incidences of (1) being pulled over by the police, (2) receiving a citation, (3) receiving a recommendation to cease or limit driving, (4) crashes, and (5) state-reported crashes. Results found that older drivers with low self-ratings reported more medical conditions, less driving frequency, and had been given more suggestions to stop/limit their driving; there were no other significant differences between low and high self-raters. Logistic regression revealed older drivers were more likely to have a state-reported crash and receive a suggestion to stop or limit driving. Men were more likely to report all adverse driving outcomes except for receiving a suggestion to stop or limit driving. Regarding self-rated driving, older adults with high ratings were 66% less likely (OR = 0.34, 95% CI = 0.14–0.85) to have received suggestions to limit or stop driving after accounting for demographics, health and driving frequency. Self-ratings were not predictive of other driving outcomes (being pulled over by the police, receiving a citation, self-reported crashes, or state-reported crashes, ps > 0.05). Most older drivers (85.14%) rated themselves as either good or excellent drivers regardless of their actual previous citation or crash rates. Self-rated driving is likely not related to actual driving proficiency as indicated by previous crash involvement in older adults. Suggestions from other individuals to limit or cease driving may be more influential on self-ratings.     

The use of adaptation to reduce simulator sickness in driving assessment and research

The technical advancement of driving simulators has decreased their cost and increased both their accuracy and fidelity. This makes them a useful tool for examining driving behavior in risky or unique situations. With the approaching increase of older licensed drivers due to aging of the baby boomers, driving simulators will be important for conducting driving research and evaluations for older adults. With these simulator technologies, some people may experience significant effects of a unique form of motion sickness, known as simulator sickness. These effects may be more pronounced in older adults. The present study examined the feasibility of an intervention to attenuate symptoms of simulator sickness in drivers participating in a study of a driving evaluation protocol. Prior to beginning the experiment, the experimental groups did not differ in subjective simulator sickness scores as indicated by Revised Simulator Sickness Questionnaire scores (all p > 0.5). Participants who experienced a two-day delay between an initial acclimation to the driving simulator and the driving session experienced fewer simulator sickness symptoms as indicated by RSSQ total severity scores than participants who did not receive a two-day delay (F(1,88) = 4.54, p = .036, partial η² = .049). These findings have implications for improving client well-being and potentially increasing acceptance of driving simulation for driving evaluations and for driving safety research.