Statement of purpose ADHD often persists into adolescence when motor vehicle crash risk peaks. Small studies have suggested that adolescents with ADHD have more driving errors and increased crash risk. We compared monthly rates of police-reported crashes, traffic-related citations, and license suspensions over the first four years of licensure for adolescents with and without community-identified ADHD.

Methods/approach We identified New Jersey residents who were born 1987–1997 and were patients of the Children’s Hospital of Philadelphia’s NJ primary care practices within four years of driving-eligible age. Electronic health records were linked to NJ’s licensing and crash databases from 2004–2014. Subjects with an ICD-9-CM diagnostic code of ‘˜314.x’ at an office visit or on their list of chronic conditions were classified as having ADHD (Gruschow, 2017). Crash, citation, and suspension rates were compared for 1769 licensed drivers with ADHD and 13 167 without ADHD.

Results The crash rate in the first month post-licensure was 65% higher for drivers with ADHD than those without ADHD (294 vs. 188 per 10 000 drivers, respectively; adjRR=1.65, 95% CI: 1.45, 1.87). Crash rates remained significantly higher for drivers with ADHD over the first four years post-licensure. Citation rates were also consistently higher among drivers with ADHD over four years (adjRR=1.41 [1.30, 1.52]). Finally, drivers with ADHD had higher license suspension rates than drivers without ADHD over the first year of licensure (2.7 and 1.3 suspension days per driver-year, respectively; adjRR=1.31 [1.27, 1.36]).

Conclusions Adolescent drivers with ADHD had higher crash, citation, and suspension rates than drivers without ADHD over the first four years of licensure. The adjusted crash rate ratio was highest immediately after licensure.

Significance and Contribution This unique longitudinal study provides the most detailed information on post-licensure crash risk of adolescents and young adults to date; future analyses will examine crash circumstances among drivers with ADHD.