A Perfect Storm

August 12, 2013

There is convincing evidence that individuals with attention deficit hyperactivity disorder (ADHD) are at heightened risk for unsafe driving behaviors, including teens. Despite a “perfect storm” of inexperience, adolescence, and ADHD that increases crash risk, only emerging research about potential interventions exists for these teens with ADHD. This can be frustrating for both parents and clinicians, like myself, who frequently discuss the risk of driving with these teens but have little information to offer about specific ways to keep them safe.

In an editorial published today in JAMA Pediatrics, my CIRP@CHOP colleagues Flaura Winston, MD, PhD and Catherine McDonald, PhD, RN address this need head-on. Along with Daniel McGehee, PhD, director of the Human Factors and Vehicle Safety Research Division at the University of Iowa Public Policy Center, they recommend a tailored individualized approach to prevent serious crashes for teens with ADHD and for teens that perform risky driving behaviors (such as texting while driving). This approach builds on current Graduated Driver Licensing (GDL) provisions by matching teens’ risks to proven interventions.

Teens with ADHD and other developmental disabilities may be at risk for unsafe driving behaviors for a variety of reasons, including inexperience, immature brain development, and condition-specific symptoms such as inattention, impulsivity, and emotional regulation differences. To date, GDL is the only intervention proven effective in reducing fatal teen crashes; but, because of the unique and varying risk factors for unsafe driving among teens with developmental disabilities, there’s an urgent need to build on this foundation with additional effective interventions tailored to these specific needs.

Drs. Winston, McDonald, and McGehee also suggest that, although different research methods (e.g., database analysis, on-road assessments) offer unique benefits, driving simulators provide a safer alternative to on-road studies for examining poor driving performance caused by distraction and ADHD. Driving simulators are also a great tool for exploring the general driving behaviors of teens with developmental disabilities.

The editorial also discusses the urgent need for medical and public health communities to prioritize driving behavior as a core component of adolescent preventative healthcare. In Pennsylvania, if a teen wants to receive a driver permit, he has to see a physician to certify that he does not have a condition that seriously impairs his ability to drive. Just as we pediatricians already complete physicals to ensure the safety of teens who engage in team sports, we should place the same emphasis and vigilance on driving, as it can be a matter of life or death. As we develop interventions to keep our teens with ADHD and other special needs safe, Drs. Winston, McDonald, and McGehee remind us that the “one size fits all” approach will not work for individuals with such elevated crash risk.