Purpose We aimed to examine the joint and independent associations of attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD, which includes oppositional defiant disorder and conduct disorder) with adverse driving outcomes among adolescents over their initial years of licensure.

Methods/Approach We utilized electronic health records to identify New Jersey residents born 1987–1997 who were patients of the Children’s Hospital of Philadelphia pediatric healthcare network’s NJ primary care practices within four years of driving-eligible age. Records were linked to NJ’s licensing and crash databases from 2004–2014. ICD-9-CM diagnosis codes were used to identify adolescents with ADHD (‘314’) and DBD (‘313.81’ or ‘312’). At-fault crash rates in the four years after licensure was compared for adolescents with: ADHD only (n=2,052); DBD only (n=388); ADHD and DBD (n=427); and neither condition (n=15,477). Rate ratios were adjusted for age at licensure, sex, and race/ethnicity.

Results Compared with adolescent drivers with neither condition, adjusted rate ratios for at-fault crashes were: 1.51 (95% CI: 1.37, 1.66) for drivers with only ADHD; 1.44 (1.17, 1.79) for drivers with only DBD; and 1.90 (1.55, 2.33) for drivers with ADHD & DBD. Among drivers with ADHD, drivers who also had DBD had an increased at-fault crash rate compared to those without DBD (1.26 [1.01, 1.56]).

Conclusions ADHD and DBD are independently associated with increased rates for at-fault crashes. Rates for adolescents with ADHD is further heightened by co-occurring DBD. Ongoing analyses will fold in additional years of data, improving sample size, and look further at multiplicative and additive effects. Future research should focus on specific mechanisms by which these conditions influence crash risk.

Significance/Contributions This study is the largest and first longitudinal study focused on examining the risk of adverse driving outcomes among adolescents with diagnosed ADHD and/or DBD, a common co-occurring condition with ADHD, using a population-based sample.