The greatest risk to the health and safety of young people is a motor vehicle. Of all possible risks -- including illness, substance use, and even violence -- none is more likely to cause serious injury or even death than a motor vehicle accident. Motor vehicle accidents are the biggest killer of young people aged 16 to 24 in the U.S., accounting for more than 7,500 deaths and 350,000 injuries in 2010.1, 2
Greater Risks for Teens with ADHD
For teenagers with ADHD, driving risks are increased by ADHD's core symptoms of distractibility, inattention, and impulsivity.3 Compared with their peers, teens and young adults with ADHD are at greater risk for vehicle accidents and are more likely to receive traffic tickets for speeding, failure to obey traffic laws, and reckless driving.4 They also are more likely to drive without a license or on a suspended license.5 And, even more sobering is the fact that young people with ADHD are overrepresented among crash and fatality statistics than their non-ADHD peers.
All this makes sense when we understand that ADHD involves challenges in executive function. Poor judgment, risk-taking and thrill-seeking tendencies increase the risks for accidents, injury, or other negative driving outcomes. Risks increase even further when a teen drives with other teens as passengers and no adult is present.
Treatment Improves Safety
The development of safe driving habits that incorporate a multimodal treatment plan 6 is essential for the safety of young drivers, as well as the safety of their passengers, other drivers, and pedestrians.
Research shows that teens who are treated for ADHD are better drivers than teens receiving no treatment. Teenagers who have never been treated with stimulant medication are involved in more vehicle crashes than those who have had at least three years of medication treatment.
Teens and parents should remember that driving is a privilege, not a right. It's a privilege that society regulates by ensuring that everyone who gets behind the wheel knows how to operate the vehicle and has had their ability tested before being licensed.Teen driving privileges should be discussed within the context of overall ADHD treatment. Co-existing disorders (60-70 percent of people with ADHD have an additional condition), changes in medication effectiveness throughout the day, and issues with alcohol and substance use should all be considered before any teen gets the keys to a car. Parents should set expectations and rules to help their teens practice safe driving behavior.
Know Your State's Law
States differ on licensing requirements, so parents should know the specifics of their state law regarding driver education, learner's permits, provisional licenses, and other limits on teen licenses. Operating a vehicle safely requires a set of skills that teens generally learn from an experienced adult. Teens who are reluctant to get their learner's permit or driver's license should not be rushed. Many driving-aged teens affected by ADHD lack the maturity needed to drive safely and could benefit from waiting to learn to drive or taking the driving exam. How long to delay depends on the teen and his/her parents, but the teen should demonstrate sufficient maturity in other areas of life.
New drivers benefit from taking driving courses that teach traffic laws and reinforce driving skills. For teens affected by ADHD, taking a driver education program designed for their specific needs is especially helpful.7 Parents should check with the local school district for driver education courses or look in their communities for driving schools that are familiar with the needs and requirements of a young person affected by ADHD. Many states have graduated or tiered licensing programs for all teen drivers and parents are expected to enforce the law's requirements.
The ADHD Safe Driving Program developed by researchers Russell Barkley, PhD, and Daniel Cox, PhD, offers a step-by-step approach for teens to earn driving privileges and for parents to keep a careful eye on their teen's developing driving skills. The following is adapted from the ADHD Safe Driving Program:
Three levels of independence:
Level one (0 to 6 months): Drive only during daytime.
Level two (6 to 12 months): Extends driving time through the evening hours.
Level three (12 to 18 months): Drive freely while following agreed upon rules.
How to get the keys:
Young drivers keep a log of each driving experience. Entries include medication (if prescribed), destination, route/miles, contact name and phone number, time/out and time/returned, and odometer. They must also follow the Everyday Rules:
Take medication as prescribed.
Fill out the log every trip.
Keep music low
Use preset radio stations only
No texting or mobile phone use
No other teens in the car
Absolutely NO alcohol or other intoxicants
Steps to get started:
New drivers and their parents enter into a contract that spells out their responsibilities. Teens are responsible for accepting ADHD as a neurobehavioral disorder that affects driving.
Teens agree to abide by the driving rules, and must understand that they can move to the next level only when they succeed for six months in a row at their current level.
Parents agree to driving privileges if rules are followed. Parents and teens also agree that parents have the responsibility to check the accuracy of the teen's driving log, to find out whether rules were followed, and if not, to give appropriate consequences, including loss of driving privileges.
Becoming easily distracted is a big risk for the young driver affected by ADHD. Most states and local communities have distracted driver laws, along with laws forbidding texting and talking on a hand-held mobile phone while driving. In 2010, over 3,000 people died in what the National Highway Traffic Safety Administration describes as "distraction-affected" crashes, a measurement of crashes caused by texting, phoning or answering a call while driving.8
Safe driving requires focus and concentration -- the exact things that are challenges for people with ADHD. Distraction can be found in simple things, including changing radio stations, checking make-up, eating, talking with another person in the car, as even daydreaming. When coping with the symptoms of ADHD, these behaviors increase the risks of poor driving and can lead to car accidents.
Teen drivers should limit their distractions before starting the engine. Cell phones and other devices should be turned off and put away. Food or drink should also be put away so that complete focus is on operating the vehicle safely. Teens and their parents should map driving routes ahead of time. Parents need to make their expectations clear for their teens' driving behaviors and set reasonable limits. Visit the U.S. Department of Transportation's website, distraction.gov, for additional safety suggestions.
Safe driving begins before teens get behind the wheel. To improve safe driving, teens and their parents should:
Know state traffic laws.
Attend and pass a driver education program that addresses ADHD concerns.
Follow an ADHD treatment plan and consider the role medication has been shown to play in improved driving ability.
Limit passengers while a teen is learning to drive or has just received a license.
Reduce distractions within the car.
Select a vehicle that has few exciting options on the dashboard. Parents may want to consider research showing manual transmission to be a better choice because of the need for increased attention in driving habits.9
Teens and adults affected by ADHD need to be aware of inattention, impulsivity and distractibility and create a driving environment that allows them to better focus on the task of driving safely.
Before a teen receives a learner's permit, parents should know the insurance laws for their state and find out if they will need additional insurance coverage once their teen starts driving. Parents and teens should meet with an insurance agent or representative from a reputable company to discuss all aspects of liability and collision insurance. Including the teen with ADHD in this conversation helps reinforce that driving a car is serious business. The needs of the family as well as the teen driver should be considered. Additional umbrella liability policies can offer protection from personal injury lawsuits. Insurance issues and costs should be discussed at length with the teen and a family plan for insurance costs decided upon.
2. Fatality Analysis Reporting System (FARS). National Center for Statistics and Analysis, National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation, Washington, DC. 2010.3. Jerome, Laurence, MB.Ch.B., M.Sc., M.R.C., Psych., F.R.C.P.C.; Segal, Alvin, Ph.D.; Habinski, Liat B.Sc. (2006 August) What We Know About ADHD and Driving Risk: A Literature Review, Meta-Analysis and Critique. J Can Acad Child Adolesc Psychiatry 15:3, pp.105-1254, Barkley, Russell A; Murphy, Kevin R; and Kwasnik, Denise (1996 December). Motor Vehicle Driving Competencies and Risks in Teens and Young Adults with Attention Deficit Hyperactivity Disorder. Pediatrics. 98(6 PT 1), pp. 1089-1095.5. Cox DJ, Merkel RL, Moore M, et al. (2006 September). Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with Attention-Deficit/Hyperactivity Disorder attention-deficit/ hyperactivity disorder. Pediatrics. 118(3), pp. e704-e710.6. Barkley, Russell A; Guevremont, David C; Anastopoulos, Arthur D; DuPaul, George J; and Shelton, Tern L. (1993 August). Driving-Related Risks and Outcomes of Attention Deficit Hyperactivity Disorder in Adolescents and Young Adults: A 3- to 5-Year Follow-up Survey. Pediatrics 92:2, pp. 212-218 7. Katz, Mark, PhD. AD/HD Safe Driving Program: A Graduated License Plan (2007 December). Attention. pp 6-7.8. Tison, J., Chaudhary, N., and Cosgrove, L. (2011 December). National phone survey on distracted driving attitudes and behaviors. (Report No. DOT HS 811 555). Washington, DC: National Highway Traffic Safety Administration.9. Cox, Daniel; Mohan, Punja; Powers, Katie;et al. (2006 November). Manual transmission enhances attention and driving performance of ADHD adolescent males: pilot study. Journal of Attention Disorders, 10(2), pp. 212-216.