Background Two-thirds of teens with ASD without intellectual disability (ID) reported that they 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 teens. We conducted a longitudinal study within a large paediatric healthcare network to compare the rate of obtaining a driver’s license and risk of motor vehicle crash involvement among teens who have ASD without ID and a comparable group of teens who do not.

Methods We linked two unique data sources: (1) electronic health records for 68,592 New Jersey (NJ) residents born 1987–1995 who were patients of the CHOP network within 4 years of driving-eligible age; and (2) a database containing the full licensing and crash history of all NJ drivers through June 2012. Subjects were classified as having ASD using ICD-9-CM diagnosis codes and known chronic conditions from their EHR; those with ID were excluded. Licensing rates and crash risk were compared for 682 patients with ASD and 62,719 without ASD using Cox regression to estimate adjusted hazard ratios (HR).

Results Subjects had a median [interquartile range] of 6 [2, 17] CHOP visits, were 16.7 [14.7, 18.5] years old at their last visit, and were 20.8 [18.8, 22.9] at the end of the study. Although teens with ASD were much less likely (39% vs. 84%) to obtain a driver’s permit by age 21, the majority (91%) of those who obtained a permit went on to become licensed. Overall, the crash rate for subjects with ASD was lower than for those without ASD (21% vs 33%) with an adjusted HR of 0.75 (95% CI: 0.55, 1.03).

Conclusions This is the first study to report objective license and crash data for a cohort of teens with ASD. These findings suggest families decide about independent driving primarily before teens get behind the wheel. Future studies will examine parent-teen interactions and account for driving exposure in effect estimates.