When teens first get their driver’s license, everyone hopes that the driver’s education training they had will be successful in making them safe and appropriately cautious drivers. But what happens when a teen with attention deficit hyperactivity disorder (ADHD) gets their license? Does their impulsivity mean they throw caution to the wind even if on medication for this behavioral disorder?  Curry et al. (10.1542/peds.2018-2305) decided to find out and share their findings with us in a study being early released this month.  The authors performed a retrospective cohort study of close to 15,000 teens in New Jersey linking their electronic health records (EHRs) to state databases that had information on licensing, crash and moving violations, as well as suspensions at baseline and at 12- and 48-months post-licensure.  The adolescents studied were separated into those with ADHD (based on diagnostic codes from their EHR) and those without. 

These authors had previously shown that few teens are still on their ADHD medication at the time of licensure. (pmid:15950006).  Now they show that teens with ADHD (medicated or not) have higher crash rates, especially alcohol-related crashes, moving violations, and license suspensions than those without ADHD. In addition, delaying licensure due to ADHD does not appear to make a difference.  So can we do anything about these findings?   We asked Drs. Sudha Raman, Matthew Engelhard, and Scott Kollins from Duke (10.1542/peds.2019-0820) to take the wheel and share their thoughts in an accompanying commentary.  They note, as do Curry et al., the importance of focusing on non-pharmacologic educational awareness strategies that will hopefully reduce the incidence of motor vehicle crashes occurring to with young drivers with ADHD.  The fact that the data in an EHR can help identify those adolescents at risk for an automobile crash or violation,  such as those with ADHD,  may be enough to put a worrisome forward trajectory toward a motor vehicle crash into reverse, through shared decision-making or other preventive educational strategies with teens and their caregivers.  Get your motor running and check out this study and commentary to learn more.