REVIEW OF: Curry AE et al, J Am Acad Child Adolesc Psychiatry 2021;60(7):913–923

STUDY TYPE: Retrospective cohort study

Driving is an important skill for autistic patients; however, clinicians and families worry about the risk of accidents. To address this concern, researchers completed the first longitudinal comparison of autistic and non-autistic drivers. The study linked statewide driver licensing and hospital-reported crash databases in New Jersey. It compared the driving records of autistic and non-autistic drivers, looking at how many crashes were caused by the driver in their first four years on the road.

In all, 163 of 486 autistic drivers (33.5%) and 27,018 of 70,990 non-autistic drivers (38.1%) were involved in police-reported crashes. While there were similar or lower rates of crashes among autistic drivers compared to non-autistic drivers, autistic drivers had far fewer moving violations and were half as likely to crash due to unsafe speeds. Autistic drivers also had more accidents from not yielding to the right of way and while making left turns and U-turns.

The authors suggest that these differences reflect challenges with executive skills, visual processing speed, and visual-motor integration. Autistic drivers might be prone to focus ahead and drive where they are looking rather than seeing the whole context, and they may miss road hazards that involve motorists and pedestrians.

The study had some limitations. Autistic drivers were identified by hospital records, not with formal assessments. The authors did not assess the abilities of these drivers (eg, the combination of nonverbal communication and visual-motor function needed to anticipate and execute safe left turns). The authors also did not discuss the ages at which the drivers obtained their licenses or their hours of driving experience. This is important since there is a rapid decline in crash rates after the first few years of driving. Moreover, New Jersey’s geography skews toward urban driving, and its driving age requirement (17) is higher than most states. This may limit the ability to generalize the study results to younger drivers and those living in rural parts of the country.

Carlat Take

This study suggests that autistic drivers are at least as safe on the road as everyone else. Just as you counsel neurotypical teen drivers about speeding, talk with autistic drivers about how to stay aware of everything happening around them. When appropriate, recommend programs such as Autism Behind the Wheel (www.sellmax.com/driving-with-autism/) that provide specialized support to autistic drivers (Myers RK et al, Am J Occup Ther 2021;75(3):7503180110p1–p11).