The Center for Injury Research and Prevention (CIRP) at Children’s Hospital of Philadelphia (CHOP) is collaborating with the Center for Management of ADHD at CHOP to establish the scientific foundation for driving safety among teens with attention-deficit hyperactivity disorder (ADHD) and other neuro-diverse conditions. As part of this growing line of research, today we published a large scale longitudinal study in Pediatrics that is the first to provide detailed information on specific types of crashes, traffic violations, and license suspensions for newly licensed drivers with ADHD as compared with other newly licensed drivers.
Building on a previous JAMA Pediatrics study we conducted that found crash risk for adolescent drivers with ADHD is much lower than previously reported, we implemented a unique linkage of more than 14,900 electronic health records of children who got licensed during the study period with NJ driver licensing, traffic violations, and police-reported crash data. Within this group we identified 1,769 adolescents with childhood-diagnosed ADHD and compared their crash outcomes and traffic and moving violations with those of the drivers without ADHD.
What we found suggests that we need to go beyond current recommendations to reduce crash risk for adolescent drivers with ADHD:
- Crash rates were 37 percent higher for young drivers with ADHD regardless of licensing age for the first four years after licensure as compared to their peers without ADHD. Thus, guiding families of adolescents with ADHD to simply delay licensure may not be enough to reduce their crash risk.
- Adolescent drivers with ADHD experienced higher rates of specific crash types, including driving with passengers, at-fault, single vehicle, injury, and alcohol-related crashes, as well as higher rates of traffic and moving violations, including speeding, nonuse of seat belts, and electronic equipment use. These findings suggest that they engage in preventable risky driving behaviors at higher rates than their peers without ADHD. Because these behaviors are amenable to change, there is great opportunity to intervene. Specific guidelines are needed to help clinicians and families work with teens to change these behaviors to reduce their crash risk. Medication is not enough.
More Research Needed
We plan to conduct additional prospective research to better understand what happens right before adolescents with ADHD crash. Further research is also needed to understand the specific mechanisms by which ADHD symptoms influence crash risk. Armed with this knowledge, we can develop comprehensive preventive approaches to reduce crash risk for adolescent drivers with ADHD.
We may find through research that interventions designed for adolescents with ADHD may also work for typical adolescents. What we already know through research conducted at CIRP is that more individualized approaches are more effective in teaching all adolescents to drive safely.
More research is also needed in regard to medication use in helping adolescents with ADHD manage driving. Stimulant medications may help them better focus on the road, but little is known about whether they would also reduce risky driving behaviors such as seat belt nonuse and speeding.
Guidance for Families
For families that decide to pursue licensure for their teens with ADHD after they have aged out of most states’ Graduated Driver Licensing (GDL) programs, they should develop strong house rules for driving. These house rules should include GDL restrictions on nighttime driving and peer passengers. Parents should also continue to carefully monitor their teens’ driving for about two years after getting licensed. They also may want to partner with their child’s clinician to assess readiness to drive well before the age when eligible for a learner’s permit and a certified driving rehabilitation specialist once they decide to pursue licensure.
Clinicians should also be encouraged to have transportation-related conversations with families well before their adolescents with ADHD reach driving age. These conversations should stress the importance of safe passenger behavior, always wearing a seat belt, and not driving while drunk, drugged, or drowsy.
We need to help families promote independent, responsible driving behavior for adolecents with ADHD. ADHD is the most common neuro-diverse condition, affecting nearly 1 in 10 children in the United States, and safe mobility is crucial as they transition to adulthood.
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