Research In Action

In "Teen Driving", our recently published article in December’s issue of Pediatric Clinics of North America, my co-author Brian Johnston and I set out to synthesize the current evidence on teen driving risk and to clarify the role pediatric clinicians can play in preventing motor vehicle–related injury and death among adolescents.

Although learning to drive is a milestone that offers teens independence and opportunity, it remains the most dangerous activity most adolescents undertake. Our central message is that driver inexperience—not age alone—is the dominant risk factor, and that clinical guidance, family engagement, and policy-level protections can meaningfully reduce harm during this vulnerable period.

We reviewed epidemiologic trends that frame teen driving as a persistent public health crisis. Despite decades of progress through engineering advances and graduated driver’s licensing (GDL) laws, teen crash fatalities have risen sharply since 2019. These increases are not evenly distributed: rural teens, American Indian and Alaska Native youth, and adolescents from lower socioeconomic backgrounds experience disproportionate risk. This inequity underscores the need for clinicians to recognize driving safety as part of comprehensive adolescent health care rather than solely a transportation issue.

We highlight how the neurocognitive demands of driving intersect with adolescent development. Novice drivers are still acquiring hazard perception, speed judgment, and attentional control, making the transition from supervised to independent driving particularly dangerous. Specific behaviors—speeding, distraction, nighttime driving, peer passengers, and seat belt nonuse—can substantially elevate crash risk. Accumulating supervised driving experience across diverse environmental conditions is the most effective intervention available.

A major focus of the article is driving among teens with neurodevelopmental differences, particularly ADHD and autism spectrum disorder. Contrary to older assumptions, teens with ADHD are not catastrophically unsafe drivers but do have a modestly elevated crash risk, especially in the first year after licensure. Autistic teens, by contrast, often demonstrate lower rates of risky driving behaviors, though they face challenges with specific maneuvers such as yielding and left turns. These nuances reinforce the importance of individualized risk assessment rather than blanket restrictions.

Finally, we review emerging tools—including in-vehicle monitoring systems and virtual driving assessments—that can extend supervision and improve risk stratification. Throughout, we argue that pediatric clinicians are uniquely positioned to guide families, optimize medical management, and advocate for delayed or graduated licensure when appropriate.

In my own clinical practice, I continue to translate these messages into concrete guidance for patients and families as teens approach licensure, emphasizing that driving readiness is a process rather than a single milestone. At the same time, this work has reinforced how much remains unknown. We need more research focused on underrepresented populations, including adolescents with intellectual disability, who are often excluded from driving studies despite facing meaningful barriers and risks. In addition, patients do not always fit neatly into diagnostic categories; a teen on the autism spectrum may also meet criteria for ADHD, for example, and may experience a unique constellation of strengths and challenges that requires nuanced, personalized consideration rather than a one-size-fits-all approach.