Friday, October 9, 2015

Is your teen with ADHD ready to drive?

Teens with ADHD may need extra help in navigating the road to licensure. Here's a guide to determine if your teen with ADHD is ready to drive.

Is your teen with ADHD ready to drive?


Although learning to drive may be a rite of passage for most teens, teens with attention deficit hyperactivity disorder may need extra help in navigating the road to licensure. The symptoms of ADHD – difficulty with attention, challenges with emotion regulation, disorganization and impulsivity – heighten a teen’s risk for unsafe driving behaviors and crashes. The presence of ADHD increased a teen’s crash risk by two to four times, placing them at a higher crash risk than adults who are legally drunk, found a 2007 study

I am often asked by parents of teens with ADHD for advice on determining whether their child is ready to drive, what to focus on with practice driving, and how to keep their teen safe after the learner permit phase when driving without supervision. Unfortunately, the evidence base is limited for proven effective ways to keep them safe during the learning-to-drive period and beyond. As we learn more, I will share guidance, but for now, what I can offer are suggestions based on experience.

When observing your teen’s driving, keep in mind what safe driving requires for all drivers - situation awareness and appropriate response. To avoid a crash, a skilled driver perceives her environment, shifts attention dynamically to the most relevant road elements, comprehends potential hazards, predicts changes in the traffic environment and actions of other road users, and draws actions from memory to avoid crashes. If you observe that your teen is unable to perform any of these steps well, take this seriously.  Your teen will likely only perform them less well when you are not in the passenger seat.

As I like to tell my teen patients with ADHD and their parents, it’s not that they won’t be able to drive; it may just not be right now or not with full privileges. Before allowing your teen to learn to drive, I recommend parents ask themselves:

  • Does your teen consistently show good judgment at home and at school?
  • Does your teen act mature?
  • Is your teen able to take constructive criticism and instruction?
  • Do you think your teen is able to accept responsibility for her safety and for those around her?
  • Will your teen agree to log at least 65 hours of adult-supervised practice driving before taking the on-road test for a probationary license?

If you answered “yes” to these questions, then the next step is to make an appointment with your teen’s physician. During the visit, partner with the doctor to help develop a plan to safely teach your teen to drive. Ask if there are any medical or physical issues, besides ADHD, that may make driving a dangerous prospect. Ask about whether a stimulant medication would be appropriate to help improve focus and attention, to help your teen learn to drive safely.

When the time comes to teach your teen to drive, you may want to also consider seeking individual training for your teen with a driving instructor. This is what I typically recommend to families who have concerns about their teen’s driving. has a directory of driving specialists, which you can search by location. Although this intensive training is not usually covered by insurance, it may be worth the extra cost to help your teen develop the necessary skills to become a safe, competent driver.

Right before your teen receives his license, work with him to create a driving privileges plan. Start with local roads, no passengers during the daytime, and familiar routes. Carefully monitor driving progress, and only increase driving privileges when your teen demonstrates maturity and skill. Be prepared to remove privileges or step in with additional training or practice as needed. Some families may find in-vehicle or other monitoring devices helpful if used in a supportive way to enhance training.

Here are some other tips to pave the way for a smooth road for your teen with ADHD:

Check your teen’s medication dosage. Since each teen responds differently to stimulant medications to manage ADHD symptoms, be sure to check with your child’s pediatrician or psychiatrist to find the optimal medication and dosage. Since the beneficial effects of the meds occur while they are active in the body, you should also ask if your teen is “covered” when driving in the late afternoon or evening. Finding the right mix can be a challenge since most stimulant medications may interfere with sleep.

Discuss the process. Before the permit phase, talk to your teen about the various stages of licensure and revisit the topic throughout the supervised driving process. Explain that the behind-the-wheel test is not a given and that he or she must demonstrate maturity and skill before permitted to take it. Include your teen in these decisions, and solicit, listen, and acknowledge his or her input. Use these discussions to help develop your teen’s self-evaluation skills.

Be prepared for a longer learner period. Although 65 hours of behind-the-wheel adult-supervised practice is required before your teen can take the on-road test for a probationary license, researchers generally agree that teens with ADHD and other developmental disabilities should log many more hours of practice to develop critical driving skills, such as scanning to detect and respond to hazards, managing distractions, and speed management.

Get it in writing. Drafting a parent-teen driving agreement and logging your teen’s progress is key to managing the learning-to-drive process. It is important to ensure that your teen only drives in the conditions in which he can do so safely. Visit to download a driving lesson timeline and other helpful resources for teaching your teen to drive and managing post-licensure driving privileges.

Continue to monitor. Even after your teen receives his license, be sure you know who he will be with and when he will be back. It might be particularly important to limit passengers to those who you know are mature and non-distracting, even after your state’s Graduated Driver Licensing law allows passengers. Remember, you can also still ride along as a passenger to support safe driving behaviors and provide guidance in difficult driving situations like heavy city traffic and construction zones. You can also provide alternatives, like rides, to avoid unsafe driving situations.

Please share your wisdom regarding teaching your teen with ADHD to drive and what strategies worked for you for post-licensure monitoring.  Let me know @safetymd on Twitter.

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Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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