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Motor vehicle crash risk for teens with ADHD much lower than previously reported

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Adolescent drivers with attention-deficit hyperactivity disorder (ADHD) have a 36 percent higher crash risk than other newly licensed teens. Although elevated, this risk is far lower than previous reports of being four times higher. This is the first large-scale study to provide detailed information on crash risk of adolescents with ADHD compared to other newly licensed young drivers.

The study appears today in JAMA Pediatrics.

Researchers from Children's Hospital of Philadelphia (CHOP) conducted a unique linkage of more than 18,500 electronic health records (EHR) of children born from 1987 through 1997 and New Jersey driver licensing and crash data to determine the associations between ADHD, licensure, and crash involvement. Of the 18,500 records, nearly 2,500 patients were diagnosed with ADHD. Researchers also examined whether these associations varied by factors such as gender and licensing age, and found crash risk persists during the initial driving years, regardless of gender or age when licensed.

"Our results indicate that newly licensed adolescents with ADHD have a greater risk of crashing than other young drivers, but that this is a manageable risk," says the study's principal investigator Allison E. Curry, PhD, MPH, a senior scientist at the Center for Injury Research and Prevention (CIRP) at CHOP. "Our findings point to the need to develop evidence-based training and education for adolescents with ADHD who want to drive."

Recent studies have emphasized the potential importance of medication in reducing crash risk for individuals with ADHD. However, based on EHR data, CHOP researchers found only 12 percent of the drivers with ADHD were prescribed medication in the 30 days before getting licensed.

"We were surprised to find so few drivers in the study with an active prescription from CHOP doctors for an ADHD medication," says the study co-author Thomas J. Power, PhD, ABPP, director of the Center for Management of ADHD at CHOP. "Although research indicates that medication likely reduces crash risk, the treatment can only be effective if teens are using it when driving." Adolescents with ADHD may have characteristics that place them at a higher risk for unsafe driving behaviors, such as inattention, distractibility, impulsivity, and emotional regulation difficulties. Researchers say their findings point to the need for further research to help understand how ADHD affects teens' crash risk. With this knowledge, tailored clinical, educational, and training programs can then be developed to manage that risk.

Until then, the research team recommends that caregivers of teens with ADHD who are considering driving schedule a doctor's appointment to address concerns, such as attention, impulse control, or communication issues. They may also want to seek the advice of a behavior therapist, an occupational therapist who specializes in driving, or a driver rehabilitation specialist who has training in working with individuals with special needs.

Dr. Curry and her colleagues, who are part of CHOP's Teen Driver Safety Research team, are currently conducting rigorous research on adolescents with developmental disabilities. Funding for this study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (NIH). The views and recommendations in this publication do not necessarily reflect those of the NIH.

Resources for parents and professionals to support teens with ADHD can be accessed on the Center for Management of ADHD at CHOP website and on the Association for Driver Rehabilitation Specialists website.

The Center for Injury Research and Prevention at CHOP has tools that can help guide families through the learning-to-drive process, including the TeenDrivingPlan Parent Guide, on the teendriversource.org website.

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Allison E. Curry, PhD; Kristina B. Metzger, PhD; Melissa R. Pfeiffer, MPH; Michael R. Elliott, PhD; Flaura K. Winston, MD, PhD; Thomas J. Power, PhD. "Motor Vehicle Crash Risk Among Adolescents and Young Adults with ADHD," JAMA Pediatrics. Published online June 12, 2017.

About Children's Hospital of Philadelphia: Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 546-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu

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