Objectives Child pedestrian injuries represent a significant public health challenge. Understanding the most complex cognitive skills required to cross streets helps us understand, improve, and protect children in traffic, as underdeveloped cognitive skill likely impacts children’s pedestrian safety. One complex component of street-crossing is the cognitive-perceptual task of judging time-to-arrival of oncoming traffic. We examined capacity of 7- and 8-year-olds to judge time-to-arrival for vehicles approaching from varying distances and speeds, as well as improvement in those judgments following intensive street-crossing training in a virtual reality (VR) pedestrian simulator. Methods 500 seven- and eight-year-olds participated in a randomized trial evaluating use of a large kiosk VR versus smartphone-based VR headset to teach street-crossing skills. Prior to randomization into VR training condition and also prior to initiation of any training, children engaged in a video-based vehicle approach estimation task to assess ability to judge traffic time-to-arrival. They then engaged in multiple VR-based pedestrian safety training sessions in their randomly assigned condition until achieving adult functioning. Soon after training and again 6 months later, children repeated the vehicle estimation task. Results Prior to randomization or training, children were more accurate judging time to arrival for closer versus farther traffic, and rapidly-moving versus slower-moving traffic, but those results were subsumed by a speed x distance interaction. The interaction suggested distance cues were used more prominently than speed cues, and speed had varying effects at different distances. Training group had minimal effect on learning and all children became significantly better at judging vehicle arrival times following training. Conclusions Children tend to underestimate vehicle arrival times. Distance cues are more impactful on time-to-arrival judgments than speed cues, but children’s estimations based both on manipulations of vehicle speed and manipulations of vehicle distance improved post-training. Improvements were retained six months later. This finding is consistent with psychophysics research suggesting vehicle approach judgments rely on optical size and looming, which are impacted both by vehicle speeds and distances. Implementation of VR-based training for child pedestrian safety is recommended, as it may improve children’s judgment of vehicle time-to-arrival, but it must be conducted cautiously to avoid iatrogenic effects.
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