Research In Action

Research In Action

driving with ADHD
Crash Risk Is Manageable for Adolescent Drivers with ADHD

Driving is a much anticipated rite of passage for most teens, including those with neurodevelopmental differences like attention-deficit hyperactivity disorder (ADHD). To help establish the evidence base for future development of tailored clinical, educational, and training interventions to help them learn to drive safely, I, along with my co-authors, conducted the first large-scale study to provide detailed information on the proportion of adolescents with ADHD who acquire a driver’s license and their crash risk as compared with other newly licensed drivers. Our findings are published today in JAMA Pediatrics.

We executed a unique linkage of more than 18,500 electronic health records (EHR) of children born from 1987-1997 residing in New Jersey to determine the associations between ADHD, licensure, and crash involvement. We identified 2,479 adolescents with ADHD and 15,856 without ADHD who were age-eligible for licensure to discover the associations between ADHD and licensing. Looking at only those licensed (1,785 with ADHD and 13,221 without ADHD), we analyzed factors related to crash involvement, such as gender, licensing age, and being prescribed medication in the 30 days before receiving a license.

What we found is that crash risk for adolescent drivers is much lower than previously reported:

  • Adolescents with ADHD are 35% less likely to get licensed six months after they become eligible for a license as compared with other adolescents.
  • After acquiring a driver’s license, adolescents with ADHD have an estimated 36% higher crash risk than other newly licensed teens. This crash risk persists during their initial driving years, regardless of gender or age when licensed.
  • Only 12% of the drivers with ADHD had been prescribed an ADHD medication in the 30 days before getting licensed.

Our research points to the need for further research to help understand how characteristics of ADHD, such as inattention, distractibility, impulsivity, and emotional regulation difficulties, may affect crash risk. We need to develop effective programs to manage that risk so that adolescents with ADHD who want to drive can do so safely.

Tips for Families

To help adolescents who want to drive and their families navigate the road to licensure, here are some recommendations from my co-author, Thomas J. Power, PhD, ABPP, director of the Center for Management of ADHD at Children's Hospital of Philadelphia (CHOP), and my colleague, Patty Huang,MD, a developmental and behavioral pediatrician at CHOP:

  • Parents should start the conversation about driving with their child early. A primary care provider or behavioral health specialist can help to guide that conversation with questions regarding readiness to drive. During this visit, be sure to address any concerns, such as attention issues or impulsivity, and whether ADHD medication may be helpful to ensure safe driving behaviors.
  • Families may want to consider seeking the advice of a certified driver rehabilitation specialist who has training in working with individuals with special needs or an occupational therapist who specializes in driving.
  • Clinicians should encourage families to add driving-related goals to their teen’s Individualized Education Plan (IEP) one to two years before the permit stage and to seek extra support from the school.
  • The Association for Driver Rehabilitation Specialists offers a fact sheet to help families better understand how ADHD may affect driving.
  • When beginning parent-supervised practice driving, be sure to log plenty of hours using evidence-based programs, such as the TeenDrivingPlan Practice Guide, created by the Teen Driver Safety Research team at CHOP.
  • Parents can find resources to help adolescents with ADHD transition to adulthood on the Center for Management of ADHD at CHOP website.

I feel fortunate to be involved in such an exciting area of research to help adolescents with ADHD learn to drive safely. Evidence-based guidance to families is urgently needed.

Read the study abstract.