Is my teen with ADHD ready to drive?

For most teens, obtaining a driver license remains an important goal.  Parents ask me how they should approach this when their teen has attention-deficit hyperactivity disorder. Parents correctly recognize that characteristics of ADHD – inattention, distractibility, impulsivity, and emotional regulation difficulties – may challenge a teen’s ability to learn to drive or drive safely.

Our recent research provides good news to families of teens with ADHD. Although newly licensed adolescents with ADHD may have a greater risk of crashing than other young drivers, this risk is much lower than previously reported and manageable, according to my Children’s Hospital of Philadelphia colleague Allison E. Curry, PhD, MPH and her co-authors. Adolescents with ADHD have an estimated 36 percent higher crash risk than other newly licensed teens regardless of gender or age when licensed.

How should families best manage this risk?  To start, they need to determine whether their child is ready to drive, spend extra time in a wide variety of setting during practice driving, and set clear rules (and monitor compliance) to keep them safe after the learner permit phase when driving without parent 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, here are tips from CHOP experts in ADHD:

  • Schedule a doctor’s appointment. During the visit with your child’s primary care physician or behavioral health specialist address any concerns, such as attention, impulse control, or communication issues. Ask if there are any medical or physical issues, besides ADHD, that may make driving a dangerous prospect. Also ask about whether a stimulant medication would be appropriate to help improve focus and attention to help drive safely. If so, be sure to find the optimal medication and dosage. Since the beneficial effects of the meds occur while active in the body, 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.
  • Add goals about driving into your teen’s Individualized Education Plan. This should be done one to two years before your teen reaches the age to apply for a learner permit. Parents should also seek extra support from the school.
  • Consider seeking specialized driver education advice. A certified driver rehabilitation specialist who has training in working with individuals with special needs or an occupational therapist who specializes in driving can help families tailor driving practice to meet their teen’s individual needs. 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. The Association for Driver Rehabilitation Specialists offers a directory to help you locate a specialist in your area.
  • Log plenty of parent-supervised practice driving hours. Use an evidence-based program, such as the TeenDrivingPlan Practice Guide created by the Teen Driver Safety Research team at CHOP, to plan your practice driving. 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.
  • 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. 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.

As I like to tell my teen patients with ADHD and their parents, most teens with ADHD WILL be get licensed and will earn full privileges to drive independently; it just might take them a bit longer to get there than typically developing teens. The Association for Driver Rehabilitation Specialists offers a fact sheet to help families better understand how ADHD may affect driving, and the Center for Management of ADHD at CHOP offers resources for parents to help adolescents with ADHD transition to adulthood.