Driver licensing trajectories and motor vehicle crash rates among adolescents with autism spectrum disorders

background: Two-thirds of adolescents with Autism Spectrum Disorder (ASD) without intellectual disability plan to drive, but deficits in attention, cognition, and executive function may impact their ability to drive safely. Almost nothing is known about licensure and crash rates among these adolescents. Our objective was to compare these rates for adolescents with and without ASD.

methods: We linked two unique data sources: (1) electronic health records for 59,142 NJ residents born 1987-1994 who were patients of The Children’s Hospital of Philadelphia healthcare network within 4 years of driving-eligible age; and (2) a database containing the full licensing, citation, and crash history of all NJ drivers through 2012. Licensing rates and crash risk were compared for 618 patients with ASD and 58,524 without ASD.

results: Adolescents with ASD were much less likely to obtain a driver’s license by age 21 (29% vs. 80%, p<0.001) and did so later (median: 17.7 vs. 17.0 years old, p<0.001). Among those licensed, adolescents with ASD had a slightly lower (non-significant) risk of crashing (14% vs 17%, RR=0.78 [0.52, 1.18]) or being issued a moving violation (15% vs 17%, RR=0.87 [0.59, 1.29]) within 1 year of licensure.

conclusions: This is the first study to report objective license and crash data for a cohort of adolescents with ASD. Additional research is needed to further understand reasons for the discrepancy between the proportion of adolescents who plan on becoming licensed and those who actually do (e.g., lack of support) and to account for driving exposure in effect estimates.