Assessment of Driving-Related Skills

Last Updated

August 31, 2022

Purpose

The assessment of driving-related skills (ADReS) battery is a screening tool for safe driving that evaluates vision, motor function, and cognition.

Link to Instrument

ADReS score sheet and component tests in Clinical Team Resources Appendix on page 219.

Acronym ADReS

Area of Assessment

Attention & Working Memory
Cognition
Functional Mobility
Range of Motion
Strength
Upper Extremity Function
Vision & Perception

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$200.00

Cost Description

Certain items within assessment require separate certification and training including the Montreal Cognitive Assessment (MoCA) and Trail Making Test (TMT).
● MoCA: Certification & Training - $125
● Trail Making Test Manual & Scoring Sheets - $75
● Clinical manual: Free for clinicians

CDE Status

The ADReS is not a CDE. However, one component of the 8-item ADReS assessment battery—the Trail-Making Test, Part B—is a CDE (last searched 7/13/2023).

Older Adults and Geriatric Care

The ADReS is an 8-item assessment battery that covers visual, motor, and cognitive abilities. Impaired performance on any of the 8 items may indicate need for referral to cognitive, visual or motor services or comprehensive driving evaluation.
Physicians or other medical personnel can access the score sheet in the “Clinician’s Guide to Assessing and Counseling Older Drivers.” The test items are administered in the order listed below. A brief overview of administration instructions are as follows:
1. Visual Fields: The Visual fields testing screens for deficits in the participant’s visual fields. Refer if visual field defects are present.
2. Visual Acuity: The visual acuity test screens for poor eyesight and uses a Snellen chart at the 10-foot range. Cutoff score is visual acuity greater than 20/70.
3. Rapid pace walk (RPW): The RPW is a timed mobility test that measures balance and stamina. Cutoff score is greater than 9 seconds.
4. Range of Motion: The ROM test is a mobility test that screens for limited joint mobility. The following are measured: neck rotation, finger curl, shoulder and elbow flexion, ankle plantar flexion, ankle dorsiflexion. Refer if impaired ROM present.
5. Maze Test: The Maze Test is a pencil and paper test of attention, visual construction ability, and executive functions of planning and foresight. There is a limit of 3 minutes. Cutoff is if maze is completed 61 seconds or longer, or in 60 seconds with two or more errors
6. Montreal Cognitive Assessment (MoCA): The MoCA is a pencil and paper test of cognition, and all items of the standard MoCA are administered according to certification requirements. Cutoff score is 18 or less.
7. Trail-Making Test, Part B: Trails-B is a pencil and paper test that screens for cognitive, visual, and motor skill, and it consists of 24 circles on a piece of paper. Half of the circles contain the numbers 1-12 and the other half contain the letters A-L. Cutoff time is greater than 180 seconds
8. Clock-drawing Test: The Clock-drawing test is a pencil and paper test that measures cognitive, visual, and motor skills. The participant is given a paper with a circle on it and tasked with drawing the numbers on the clock and the hands to show 10 minutes after 11. Cutoff score is less than 8.

Number of Items

Total of 8 items:

2 Visual Abilities:
(1) Visual Fields
(2) Snellen chart to determine visual acuity

2 Motor Abilities:
(1) Rapid Pace Walk or Time Up and Go test
(2) Range of motion testing

4 Cognition:
(1) Maze Test
(2) MoCA
(3) Trail-Making Test, Part B
(4) Clock Drawing Test

Snellen chart
10-ft measure
Stopwatch
Pen
Paper

15-20 minutes

Required Training

Reading an Article/Manual

Required Training Description

Reading an article/manual for most tests; completing a training course for the Montreal Cognitive Assessment (MoCA).

Elderly Adult

65 +

years

Instrument Reviewers

Amy Schneider; Jenny Gonser, Maddy Hamilton, and Merideth MacRae, Master of Occupational Therapy students of faculty mentor Danbi Lee, PhD, OTD, OTR/L, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle

Body Part

Head
Neck
Upper Extremity
Lower Extremity

ICF Domain

Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
Cognition
General Health
Motor

Professional Association Recommendation

The ADReS is not recommended in its entirety by any professional association. A component of the ADReS--The Montreal Cognitive Assessment (MoCA)--is recommended by the Parkinson EDGE Task Force for research and also for entry-level physical therapy instruction in the area of body structure and function. The MoCA was recommended by the TBI EDGE Task Force as a body structure/function measure for patients with traumatic brain injury and also as an outcome measure with which entry-level students should be familiar. (Last searched 7/13/2023)

Considerations

The ADReS is intended for quick screening and does not require neuropsychological skills for administration.
English is the only available translation.
Administrators of the ADReS should be well-versed in all the assessments within the battery.
There is a clock-drawing test in the ADReS that is in addition to the clock-drawing item on the MoCA, and ADReS administrators should be aware of the different scoring criteria.
Older versions of the assessment included manual muscle testing (MMT) but this assessment was excluded since it did not correlate with driving performance (Chaudhary et al., 2013).
The current assessments within ADReS have lower sensitivity compared to alternative batteries (Ott et al., 2013). Many of the assessments included in the battery have separately been associated with driving outcomes but there is a lack of evidence on the combination of these assessments (Chaudhary et al., 2013).
There is insufficient research on the most recent version of the battery which now includes the MoCA. More prospective studies should be done to properly evaluate older drivers’ skills and the clinical guide recommends ADReS scores should be considered with patient medical history and medication use (Woolnough et. al., 2013).
The addition of the Mini-Mental State Examination (MMSE) and maze drawings along with the subtraction of strength testing and clock drawing improved the predictive ability of the ADReS at the expense of an additional 10-15 minutes administration time (Ott et al., 2013).

Cut-Off Scores

Older Adults: (Ball et al., 2005; n = 1910; mean age = 68.55 (7.95) years; 92 involved in Motor Vehicle Crash (MVC), 1808 not involved in MVC)

Participants aged 78 and older were 2.11 times as likely to be involved in an at-fault MVC than younger participants after adjusting for annual mileage
Those who took > 147 seconds to complete Trail Making Test-B (TMT-B) were 2.01 times more likely to be involved in at-fault MVC
Those who made four or more errors on the Motor-Free Visual Perception Test (MVPT) were 2.10 times as likely to be in a vehicle crash than those with three or fewer errors
Participants who took 353 ms or longer on subtest 2 of the Useful Field of View Test (UFOV) were 2.02 times more likely to have an at-fault MVC than those who took less than 353 ms

Older Adults: (McCarthy & Mann, 2006; n = 50; mean age = 74.3 (6.8))

< 5 points on Clock Drawing Test (CDT) resulted in higher number of driving errors during behind the wheel test (sensitivity 100%; specificity 42%)
Cutoff score of 7/8 may be too high, 6/8 is recommended and would have improved specificity to 62.4%
- For CDT only, this change would produce a sensitivity of 87.5% and specificity of 78.6%

Older Adults: (Oswanski et al., 2007; n = 232; senior drivers age = 55 and over; males = 120; 131 determined to be capable drivers and 101 determined to be incapable drivers on driving test)

>= 3 errors on Clock Test: optimal cut off for predictability of driving ability (sensitivity 70.0%; specificity 65.0%)

Normative Data

Older Adults: (Shih et al., 2019; n = 36; male sample; young adults: n = 15, mean age = 27 (IQR = 24-31); middle aged adults: n = 11, mean age = 43 (IQR = 43-51); older adults: n = 10, mean age = 67 (IQR = 66-73); SD not reported; minimum of one year driving experience and driving at least one time per week with normal field of vision)

Cognitive and motor function test results related to car driving skills in 3 age groups (Median (IQR))

	Young Drivers (n = 15)	Middle-aged Drivers (n = 11)	Older Drivers (n = 10)
Cognitive Task
Trail Making Test-B (s)	44.10 (34.68-50.02)	50.10 (39.86-62.28)	101.24 (80.33-107.98)
Clock Drawing Test (s)	17.99 (14.59-23.26)	31.52 (25.26-36.89)	27.66 (22.49-46.74)
Motor Task
Rapid Pace Walk (s)	5.41 (4.71-5.58)	5.48 (5.28-5.57)	6.10 (5.43-7.36)
Hip Flexion (lb)	47.00 (39.00-50.00)	39.00 (35.00-47.00)	30.50 (27.75-39.75)
Knee Extension (lb)	29.00 (25.00-32.00)	20.00 (18.00-30.00)	19.00 (17.50-22.50)
Ankle Dorsiflexion (lb)	20.00 (16.00-23.00)	17.00 (13.00-20.00)	16.00 (14.00-19.25)
Ankle Plantar Flexion (lb)	20.00 (17.00-22.00)	19.00 (18.00-24.00)	17.50 (16.00-21.25)

Interrater/Intrarater Reliability

Older Adults & Geriatric Care: (Posse, McCarthy & Mann, 2006; n = 14; age range = 65 to 88; mean age = 74.36 (6.51); female = 57.1%)

Excellent interrater reliability among physicians, nurses, and occupational therapists: Interrater agreement ranged from 0.82-0.91.

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Older Adults: (McCarthy & Mann, 2006)

Excellent predictive validity for ADReS identification of drivers failing the Behind the Wheel test (BTW)
Poor predictive validity for ADReS identification of drivers passing the BTW

Older Adults: (Ott et al., 2013; n = 122; age range = 60 to 90; mean age = 74.8 (7.2); male = 43.4%; 47 with normal cognition, 75 with cognitive impairment;)

Adequate predictive validity of discriminating safe from unsafe drivers (ROC = 0.71)

Construct Validity

Convergent validity:

Older Adults: (Woolnough et. al., 2013; n = 1,230; age = 70 or older; 1,167 with no history of collision involvement, mean age = 77.1 (4.8); 63 with history of collision involvement, mean age = 76.0 (5.1))

Poor construct validity: participants who were involved in a MVC in the last two years did not have significantly lower scores in ADReS subtests than those who were not in a MVC (p > 0.01)

Older Adults: (McCarthy & Mann, 2006)

Poor construct validity for visual acuity intervention: pass/fail on the Snellen chart testing visual acuity was not significantly related to pass/fail rating on the BTW test (p = .297)
Poor construct validity for visual field intervention: pass/fail on the visual field confrontation testing was not significantly related to pass/fail rating on the BTW test (p = .414)
Excellent construct validity for Range of Motion (ROM): 5/6 drivers who failed the ROM testing and were recommended for interventions failed the BTW test, and pass/fail rating on the ROM was significantly related to pass/fail on the BTW test (p > .001)
Poor construct validity for strength: only one driver was found to have a muscle strength rating of fewer than 4/5 for any body part tested and pass/fail on the strength testing was not significantly related to pass/fail rating on the BTW test (p = .160)
Excellent construct validity for Rapid Pace Walk: the drivers failed to meet the cutoff of 9 seconds for the RPW also failed the BTW test; pass/fail for Rapid Pace Walk significantly related to pass/fail for BTW (p = .023)
Poor construct validity for Trail Making Test-B (Trails-B): those who failed Trails-B also failed Clock Drawing Test, but the pass/fail on the Trials-B was not significantly related to pass/fail rating on the BTW test (p = .176)
Excellent construct validity for Clock Drawing Test : passing/failing to draw a clock correctly was significantly related to pass/fail on the BTW test (p = .026)

Bibliography

Ball, K. K., Roenker, D. L., Wadley, V. G., Edwards, J.D., Roth, D. L., McGwin, G., Raleigh, R., Joyce, J. J., Cissell, G.M., & Dube, T. (2005). Can high-risk older drivers be identified through performance-based measures in a department of motor vehicles setting? Journal of the American Geriatrics Society, 54, 77-84. https://doi.org/10.1111/j.1532-5415.2005.00568.x

Chaudhary, N. K., Ledingham. K. A., Eby, D. W. & Molnar, L. J. (2013). Evaluating older drivers’ skills. (Report No. DOT HS 811 733). Washington, DC: National Highway Traffic Safety Administration.

McCarthy, D. P., & Mann, W. C. (2006). Sensitivity and specificity of the assessment of driving-related skills older driver screening tool. Topics in Geriatric Rehabilitation, 22, 139-152. https://doi.org/10.1097/00013614-200604000-00006

Oswanski, M. F., Sharma, O. P., Raj, S. S., Vassar, L. A., Woods, K. L., Sargent, W. M., & Pitock, R. J. (2007). Evaluation of two assessment tools in predicting driving ability of senior drivers. American Journal of Physical Medicine & Rehabilitation, 86 (3), 190-199. https://doi.org/10.1097/phm.0b013e31802b7de5

Ott, B. R., Davis, J. D., Papandonatos, G. D., Hewitt, S., Festa, E. K., Heindel, W.C., Snellgrove, C. A., & Carr, D. B. (2013). Assessment of driving-related skills prediction of unsafe driving in older adults in the office setting. Journal of the American Geriatrics Society, 61 (7), 1164- 1169. https://doi.org/10.1111/jgs.12306

Posse, C., McCarthy, D. P., & Mann, W. C. (2006). A pilot study of interrater reliability of the assessment of driving-related skills older driver screening tool. Topics in Geriatric Rehabilitation, 22, 113-120. https://doi.org/10.1097/00013614-200604000-00003

Shih, H., Chu, I. Wang, C., Liaw, L., Hsu, H., & Wu, W. (2019). Cognitive and physical factors affecting high-speed driving ability in older adults. Topics in Geriatric Rehabilitation, 35, 300-305. https://doi.org/10.1097/tgr.0000000000000227

Woolnough, A., Salim, D., Marshall, S.C., Weeger, K., Porter, M. M., Rapoport, M. J., Man-Son-Hing, M., Bédard, M., Gélinas, I., Korner-Bitensky, N., Mazer, B., Naglie, G., Tuokko, H., & Vrklijan, B. (2013). Determining the validity of the AMA guide: A historical cohort analysis of the assessment of driving related skills and crash rate among older drivers. Accident Analysis & Prevention, 61, 311-316. https://doi.org/10.1016/j.aap.2013.03.020