TEEN HEALTH:

Driving and Distraction

by Dr. Ann L. Engelland

(February 25, 2007)

• What activity is considered an American rite of passage for teenage Americans, an essential coming of age hurdle, and a hallmark of growing up?
• What is the number one cause of death among teens in the United States?
• During which activity do many of us have our best conversations with our kids?

If you guessed “driving” for all three questions, you were right.

On most days around 3 pm I am witness to the driving practices of the seniors as they squeal out of the Mamaroneck High School parking lot across from my office. On warm days music is blaring. Frequently a jovial gaggle of friends have piled into a car, often with arms out the windows. Usually they whiz by too fast for me to identify anyone in particular, and I am left just wagging my head like an older, wiser, experienced person worrying about their safety.

Joy-riding? Sure it is. But we know that the fatality rate for drivers ages 16-19 is four times that of drivers ages 25-69. Although we have correctly and diligently campaigned against drinking and driving, the data shows that speed, not alcohol is implicated in a greater proportion of fatal teen crashes compared to other age groups. Other risk factors besides speed that we know of include:

*driving in a more risky fashion when teenage passengers are on board. This is the reason for the rules in the graduated driving law that require a licensed driver over 21 to be in the car for the first six months.

*taking the wheel without enough sleep. The majority of drowsy driving-related crashes are caused by drivers under 25 years.

In a 2006 study by the Children’s Hospital of Philadelphia and State Farm Insurance, 5,665 nine through eleventh graders in 68 randomly selected US schools were surveyed about their driving practices. Some of the interesting results of this survey are:

*90% of the teens surveyed said they have seen or been involved in speeding, often racing with others.

*75% say they have seen fellow teens driving while in “heightened emotional states”: upset, stressed, angry, sad or very happy. Combine this normal range of emotional states with cell phone use while driving and the risk soars.

*Teens have the lowest seatbelt use of any driving group. The survey data showed that almost 8 in 10 teens report “often or always” wearing a seatbelt. That is good news. On the other hand, we know that 60% of teen drivers who are killed in accidents were not wearing them.

Another high risk group of teens includes those with ADHD or attention deficit hyperactivity disorder. According to an article from the University of Virginia published in the February 2007 Consultant for Pediatricians: “Teenage drivers with ADHD are 8 times more likely to lose their license, 4 times more likely to be involved in a collision, 3 times more likely to sustain a serious injury, and 2 to 4 times more likely to receive a moving vehicle violation.” As they point out, given that the key symptoms of ADHD are inattention, impulsivity and hyperactivity, it is not surprising that these kids are at much higher risk.

Although parents sometimes balk at using medication for ADHD given the recent headlines purporting over-diagnosis, severe side effects and abuse among non-ADHD friends, these parents and students need to be reminded that it is during the teenage years when the ADHD behaviors graduate from annoying or bothersome to potentially life threatening. Unsafe driving, irresponsible sex, risky recreation, illegal activities and reckless substance use all characterize kids with ADHD who are improperly or inadequately treated. This is the time when ADHD teens need to be reminded to continue to take their medications, even in the evening (driving ) hours and to take them seven days a week. It’s no longer just about paying attention in math class, but on I-95 as well.

Another possibly helpful tool for high risk drivers is to have them keep a private “driving diary” that makes them ask themselves the hard questions about their driving techniques.

Examples of questions include:

Did I:

• Go over the speed limit?
• Swerve?
• Get distracted by things inside the car(food, radio, friends, music)?
• Get distracted by things outside the car(pedestrians, other drivers, signs)?
• Yell or curse because of crazy drivers?
• Tailgate?
• Drive through a stop sign or red light?
• Go through a yellow light that turned red?
• Hesitate when I should not have?
• Take risks because I was in a hurry?
• Use my cell phone illegally?

Self monitoring may help drivers, of any age actually, to inventory their habits. Some clinicians use this type of inventory to gauge whether impulsive, reckless patients are adequately medicated for their ADHD.

What is a parent to do?

Some have recently suggested putting bumper stickers on teen cars like those on large trucks: “If this vehicle is being operated in an unsafe manner, please call:……..” I would leave this idea up for discussion, a matter of personal parenting style.

Above all, we should model safe driving behavior ourselves. Hands-on cell phone use, multi-tasking, distracting conversations, driving while buzzed after a glass or two of wine, distracting road “rage” and burning the yellow lights are all transgressions that many of us are guilty of. Let’s remind ourselves that most kids are learning driving etiquette from us way before we sign them up for Formula One driving school.

Although we adults imagine the loss of life or limb as the most dire consequence of an accident, for teens it is the potential loss of license that threatens most. Research has shown that teen drivers are more worried about monetary penalties (withheld allowance, paying for repairs, paying for increased cost of insurance) than about physical risk. So it stands to reason that the penalties and consequences of safety violations should be spelled out early on in a driver’s career. In spite of this, the CHOP/State Farm survey showed that fully 40 percent of teen drivers said they bore no responsibility for car insurance, parking violations, gas, maintenance, or damage for the cars they drive.

Maybe we should restore the car to its role as a rite of passage and not a right. Lecturing most teens about the preciousness of life may have less impact than having the keys revoked or paying the next insurance bill.

Dr. Engelland has a practice in Mamaroneck devoted to Adolescent Primary Care. She can be reached at 698-5544.