Giving Teens With ADHD the Keys to Safer Driving

Hello. I'm Dr Thomas Power, a psychologist and director of the Center for Management of ADHD at Children's Hospital of Philadelphia.

My colleagues and I recently published a study in JAMA Pediatrics^[1] reporting that the crash risk of young drivers with attention-deficit/hyperactivity disorder (ADHD) is elevated but not as high as what some previous studies have reported. After receiving an intermediate driver's license, adolescents with ADHD experience about a 36% increased risk as compared to the general population. This is much lower than the 200%-400% increased risk that had been reported in previous studies.

As a general rule, the risk seems to be manageable for most youth with ADHD, although it's still a reason for concern. Nonetheless, I should point out that there are subgroups of youth with ADHD for whom there is great concern, including those with antisocial behavior problems or substance use disorders. For those individuals, we would be very concerned and want to make sure that their problems are being addressed before we advance them to the learning-to-drive stage.

Youth with ADHD usually are a bit delayed in getting their initial license, which we think generally might be a good thing, as they take a little longer to prepare to drive than the general population. To get ready for driving, parents should start the conversation with their children early, probably at least a year, if not two, before the teen begins to learn to drive. The conversation should focus on how to improve communication and problem-solving skills, which are going to be critically important for youth and their parents to work out the challenges that arise when youth actually start to drive.

In addition, it's important for the family to discuss treatment options with the teen's doctor. If this includes medication, the family and the youth should also have a discussion with the behavioral health provider, if one is involved. Medication can be an effective treatment in improving driving and promoting safety, and overall it seems to reduce crash risk. I should point out that medication is only effective at doing this when youth are taking it and it is active in their system. When the medication wears off, obviously it would not be effective.

Many students with ADHD—hopefully most of them—have Section 504 plans or individualized education plans. If so, it would be appropriate for the family to collaborate with school professionals by including in these plans recommendations for helping the teen learn to drive. For those teens who are struggling in getting ready to drive or with the on-the-road work, we recommend that parents consider a certified driving rehab specialist who can help conduct an evaluation, identify strengths and weaknesses, and provide additional coaching for the teen.

We have provided a number of resources that may be helpful to families in working through some of these issues. Thank you very much.