COMMENTARY

Should Some Autistic Kids Drive?

Flaura K. Winston, MD, PhD

Disclosures

March 26, 2012

Editorial Collaboration

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Hello. I'm Dr. Flaura Koplin Winston. I am a pediatrician, an engineer, and I direct the Center for Injury Research and Prevention at the Children's Hospital of Philadelphia. In this video, I will be discussing driving in teens with high-functioning autism disorders.

Over the past decade, an increasing number of children have been diagnosed with autism, Asperger syndrome, and other spectrum disorders with a prognosis for high functioning. As these children reach driving age, it is increasingly common for our developmental pediatricians to be asked by parents if their teens with high-functioning autism should drive. I'm sure you've gotten these questions too.

In Pennsylvania, the law requires teens to obtain medical certification before they can get a learner's permit. The predriving examination becomes an excellent time to address medical and other concerns that could affect safe driving. In states that do not have this requirement, physicians should be prepared to address driving issues with families during routine care.

High-functioning autism may affect the teen's ability to learn to drive safely because it is characterized by subtle impairment in social interaction, communication, and motor coordination skills, as well as difficulty in regulating emotions, all of which come into play when driving. Driving is a multidimensional, complex task that requires not only operational skills, like driving straight, but also cognitive and higher-order thinking skills.

To drive safely, teens need mature executive functioning and cognitive ability to attend to and detect hazards and quickly choose a safe response. They need social interaction skills to interpret the body language and actions of other drivers and road users, and communication skills to convey their actions to others. They need coordination to quickly put in place actions to avoid crashes. Teens with development disabilities, such as high-functioning autism, may have challenges with any or all of these requirements. Very little is known about how high-functioning autism affects one's ability to drive.

In a step to better understand this relationship, our Young Driver Research Team surveyed almost 300 parents of teens diagnosed with high-functioning autism and found that two thirds of these teens, who are of legal driving age in their state, are either current drivers or plan to drive. They also identified a few predictive characteristics among those teens who are likely to become drivers:

  • They are at least 17 years old;

  • Are enrolled in full-time regular education;

  • Plan to attend college;

  • Have held a paying job outside the home;

  • Have a parent who has taught another teen to drive; and

  • Have driving-related goals included in their individualized educational plan.

If a patient is nearing driving age and fits many of these criteria, pediatricians should be sure to ask their plans regarding driving and provide some anticipatory guidance to help them decide whether to proceed with learning to drive or to prepare their teen for putting it off for a while. Ask parents to honestly consider their teen's abilities. They know their kids best. Children with high-functioning autism have been shown to have more difficulty with hazard-detection skills.

You might want to suggest a professional driving instructor to help teach some of these very difficult skills through driving lessons. Suggest that they add driving goals to their child's individualized educational plan. If parents have doubts about their child's readiness to drive, you might suggest an evaluation by an occupational therapist. There is a lot more research needed on how to best prepare teens for safe driving, but there are evidence-based actions that we, as pediatricians, can do today.

To get started with appropriate counseling for driving among teens with special needs, go to teendriversource.org and search for "special needs." It is a great resource for families to learn how to teach critical driving skills and manage the driving process for kids with special needs. Check back over time for new developments.

Thank you very much.

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