Ways to help ADHD teens to drive

Flaura Koplin Winston, scientific director of the Children's Hospital of Philadelphia's Center for Injury Research and Prevention, wrote this for the "Healthy Kids" blog.

While learning to drive is be a rite of passage for most teens, those with attention deficit hyperactivity disorder may need extra help. The symptoms of ADHD - difficulty with attention, challenges with emotion regulation, disorganization, and impulsivity - heighten a teen's risk for unsafe driving and crashes. ADHD raised a teen's crash risk by two to four times, placing them at a higher crash risk than adults who are legally drunk, according to a 2007 study.

Evidence is limited for proven ways to keep them safe during the learning period and beyond. But here are suggestions from experience.

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 to the most relevant road elements, grasps hazards, predicts changes in traffic and actions of other drivers, and draws from memory to avoid crashes. If your teen can't do all these steps well, take this seriously. Your teen will likely do them worse when you're not there.

As I tell my teen ADHD patients 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, parents should ask themselves:

Does your teen consistently show good judgment at home and at school?

Does your teen take constructive criticism?

Will your teen log at least 65 hours of supervised practice before taking the on-road test for a probationary license?

If you answered "yes" to all questions, your teen may be ready to drive. It's a good idea to partner with your teen's doctor to develop a plan. Ask if there are any medical or physical issues, besides ADHD, that may make driving dangerous. A stimulant drug may be appropriate to help improve focus.

You also may want to hire a driving instructor for your teen. Driver-ed.org has a directory, searchable by location. Although not usually covered by insurance, this may be worth the cost.

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. Expand privileges when your teen shows maturity and skill. Remove privileges or step in with more practice as needed. Here are other tips:

Check your teen's meds to find the optimal drug and dosage. The meds' effects occur while they are active in the body, so ask if your teen is "covered" when driving in the late afternoon or later. Finding the right mix can be hard, since most stimulants may affect sleep.

Discuss the process of licensure. Explain that he or she must show maturity and skill before taking the test. Solicit and acknowledge his or her input. Use this to develop your teen's self-evaluation skills.

Prepare for a longer learner period than the required 65 hours of supervised practice. Teens with ADHD and similar disabilities should log many more hours of practice.

Get it in writing. Drafting a parent-teen driving agreement and logging your teen's progress are key. Visit teendriversource.org for a driving-lesson timeline.

Monitor even after your teen is licensed. Share your wisdom with me @safetymd on Twitter.