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Teen Drivers with AD/HD: Realities and Risk Factors

By: Marlene Snyder, Ph.D.

Automobile crashes are the leading cause of serious injury and death among American teenagers. From national statistics, we know that two out of five deaths among teens in the United States result from motor vehicle crashes. The risk for motor vehicle crashes is higher among 16- to 19-year-olds than any other age group. In fact, per mile driven, drivers in this age group are four times more likely than older drivers to crash (Insurance Institute for Highway Safety, 2003).

The figures for teenage drivers with Attention-Deficit/Hyperactivity Disorder (AD/HD) are even more sobering. In this first of three articles, we will examine the factors that contribute to these statistics — for teenagers in general as well as for teens with AD/HD.

Teenage Drivers: Inexperienced, Immature, and “Invincible”

Lack of driving experience, immature judgment, and the characteristic teenage “risk taking” attitude are obstacles to safe driving that all parents of teenagers should be concerned about. Driving safely is a complicated skill that takes time and practice for any teen to master. At the same time, the common teenage attitude that “nothing will happen to me” creates a situation where teens are more likely than older, more experienced drivers to underestimate the dangers in hazardous situations. For example, even though most teenagers understand that wearing seatbelts is important for safety, only 33 percent of high school students report they always wear seat belts when riding with someone else (Centers for Disease Control and Prevention, 2001).

AD/HD Increases Driving Risk

While all parents should be concerned with the statistics on teenage drivers, parents whose teens have AD/HD need to understand how the disorder increases driving risk for their teenagers . Studies indicate that young people diagnosed with AD/HD, who often find it difficult to sustain their attention and control their impulses, have abnormally high rates of traffic violations, accidents, and instances of driving without a license. One study 1, funded by the National Institute of Child Health and Human Development, published in July, 2002, reported that of 105 people with AD/HD who were studied, about 20 percent had had their license suspended or revoked — the same number who had received 12 or more traffic citations or had caused more than $6,000 in damage in their first crash. Those figures are two to four times the norm for young adult drivers.

Several research studies have shown that, compared to other teens, teenage drivers with AD/HD:

  • are more likely to have received repeated traffic citations, most notably for speeding.
  • sustain three times as many car crash injuries as teens without AD/HD.
  • are less likely to be practicing sound driving habits in their current driving performance, as reported by their parents.
  • are nearly four times more likely to have had an accident while they were the driver of a vehicle.
  • are found to be at fault for car crashes 4 times more often than peers without AD/HD.
  • are 6 to 8 times more likely to have their license suspended or revoked for poor driving behavior.
  • are more likely to have driven an automobile without adult supervision prior to becoming licensed drivers.

When you’re helping your own teenager with AD/HD become a safe and experienced driver, these startling statistics suddenly become personal and can motivate you to do more to protect your own teenager from becoming another statistic! Becoming educated about the issues that put young drivers at risk and the impact AD/HD has on driving skills is the first step to helping your teen become a safe driver.

Traits of Teenage Drivers with AD/HD

If your teenager has AD/HD, you and he must understand that the core symptoms of inattention and impulsivity (the inability to inhibit behavior) have serious implications for driving safety. It takes only one occasion of inattention or impulsivity while driving a motor vehicle to have devastating consequences. Teens with AD/HD are often less mature than their peers, which can affect their ability to drive safely. Let’s take a look at these traits in more detail.

Inattentive Driving

Two of the most common traffic violations for individuals with AD/HD are speeding and failure to yield. When teens are inattentive (e.g., they “space out” or daydream , or are distracted), they’re more likely to exceed the speed limit or miss a stop sign. Many teens with AD/HD lose track of time and are often late. Mistakenly, they think they can make up the time by driving faster, which can cause them to lose control of their vehicles. Teenager drivers are also prone to lapses in attention while they change CD discs or the radio station.

Impulsive Driving

Being impulsive means that one acts first and thinks about it later — or perhaps not at all. So even if your teen knows the rules, he may take the chance that he can get by anyway. An example of impulsive driving is cutting around another car stopped at a stop sign — even driving up on the curb to avoid waiting. Another example would be using the car for thrills or showing off — such as drag racing or towing a friend on a skateboard — perhaps on a dare.

Delayed Maturity

It is well known that many teens with AD/HD are immature in their ability to inhibit their behavior that is inappropriate to the task at hand. Dr. Russell Barkley often cautions parents that youth with AD/HD may be as much as one-third their chronological age behind their peers. This means that a 15-year-old may be more comparable to a 10-year-old in terms of ability to control his impulses. As a parent, you need to assess your teenager’s maturity level honestly and perhaps delay his application for a driver’s license until he is more mature. Having your teen drive with a learner’s permit for a longer time — or with a graduated licensing system — will allow you more opportunities to observe his driving behaviors and help with problem areas.

Medication and Teen Drivers with AD/HD

For many individuals with AD/HD, taking appropriate medications can help improve their behavior. Daniel Cox, Ph.D., Professor, Department of Psychiatric Medicine, University of Virginia Health System, has been conducting specific research on the impact of medication on the driving ability of young adults with AD/HD. Since methylphenidate (e.g., Ritalin® and Concerta®) is the most commonly prescribed medication for AD/HD, he questioned if those medication benefits would carry over to improve driving skills. He conducted three small but groundbreaking studies, which are summarized below.

In the first study Ritalin was compared to a sugar pill (placebo). Driving skills of college students with and without AD/HD were tested on a sophisticated driving simulator. On placebo, males with AD/HD drove five times worse than those without AD/HD. Ritalin significantly improved the driving of those with AD/HD, but not the control group drivers (those individuals without AD/HD). While on Ritalin the drivers with AD/HD drove with skills equivalent to drivers without AD/HD.

A second study2 compared the effects of Ritalin taken three times a day (at 8 a.m., noon, and 4 p.m.) and methylphenidate when delivered in a sustained-release Concerta capsule once a day (at 8 a.m.). Male high school drivers with AD/HD were tested on two days, once on Ritalin and once on Concerta. The interesting thing in this study was that driving ability was tested at 2 p.m., 5 p.m., 8 p.m., and 11 p.m. Overall, driving performance was significantly better when the drivers were taking Concerta once a day compared to Ritalin three times a day. More specifically, driving performance on Concerta and Ritalin was similar at 2 p.m. and 5 p.m., but performance was significantly worse on Ritalin at 8 p.m., and these negative differences continued to 11 p.m. Most notable was that teens at 8 p.m. when taking Ritalin were making driving errors similar to errors made by men 80+ years of age. At the same time, participants on Concerta demonstrated driving skills comparable to men between the ages of 55-59 years of age, a much lower driving crash risk group.

A third study3 compared male teenagers with AD/HD driving on a road course involving rural, highway, and city driving. They drove the course on two separate days, at the same time of day under similar weather conditions. On one occasion they drove after taking Concerta and on the other occasion after taking no AD/HD medication that day. A rater, who did not know if the driver had or had not taken medication, sat in the back seat and rated the occurrence of driving errors. On average, inattentive driving errors occurred 7.5 times per driver when not on medication. By contrast, inattentive driving errors were significantly reduced (an average of 4.2 errors per driver) after subjects had taken Concerta. An interesting finding in this study was that the higher dose the driver had taken the greater the reduction in inattentive driving errors.

These studies demonstrate that, in the subjects tested:

  • Driving performance was worse among drivers with AD/HD not taking medication, compared to drivers who don’t have AD/HD.
  • Medications appear to differ in their effectiveness in improving driving skills during the evening hours (both on a simulator and when driving real cars).

Additional research is underway to assess the effect of medication on the driving ability of teenagers with AD/HD. Regardless of research results, as a parent you would be wise to observe and document the effect of medication on your teenager’s driving ability while you ride with him at various times of the day and evening.

Proactive Parenting: A Driving Force in Teen Safety

There is much more to learn about the impact of AD/HD upon driving skills.4 The bottom line is that individuals with AD/HD need to pay particular attention to their driving ability and take advantage of appropriate treatments to improve their driving behaviors. As a parent, you will need to become educated about AD/HD treatments and risk factors in driving to be able to guide your teen in becoming a safe driver.

Youth with AD/HD can become safe drivers, but extra training and thought must go into the process! My next two articles on teenage drivers with AD/HD will offer strategies to help you maintain your teenager’s driving safety while he is learning to drive and after he has earned his driver’s license.