Medical Driving Evaluations

Driving With Autism Spectrum Disorder

Posted by Joan Cramer on Aug 29, 2019 8:11:23 AM
Joan Cramer
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For the average person, learning to drive can be both an intimidating and a liberating experience. This can be even more true for individuals with an autism spectrum disorder (ASD). While over 70% of high school seniors have a driver’s license, this number drops to around 30% for those diagnosed with a form of autism. In some cases, the individual may feel overwhelmed at the sheer number of tasks and rules involved in driving and choose to postpone learning. For others, it may be their parents and guardians who are concerned about their abilities to safely drive and obey the laws, while the child sits home eager to get out on the road and experience the independence that they see their peers enjoying.

An overview of autism

Autism was once considered a very rare condition, affecting only 1 in 2500 children. Changes in how autism is defined, as well as increased awareness and emphasis on screening children, has increased that number to around 1 in 68 according to the Center for Disease Control. This does not necessarily mean that there are more people with autism than there have been in the past, simply that it is being diagnosed and treated far more frequently.

It used to be that autism was one of several separate disorders, including Asperger’s and PDD (pervasive developmental disorder). In recent years, these have been grouped into what are known as autism spectrum disorders. Those on this spectrum may or may not have any intellectual impairments and range from high functioning to profoundly handicapped. Despite the wide range of the spectrum, those with autism have several characteristics in common. One of the biggest traits they share is difficulty communicating or behaving appropriately during social interaction. They may have delays or deficits in speech and non-verbal communications skills and may struggle with repetitive behaviors. It is also common that they struggle with executive function. This is the set of mental processes that help to regulate behavior, self-control, planning, organization, and response to stimuli, among other things.

The levels of Autism

Autistic people can be grouped into three rough levels depending on the severity of their condition.

Those with level 1 autism are generally high functioning but may have difficulty maintaining a conversation, making friends, adapting to change, or keeping organized. They can often lead fairly independent lives.

Level 2 autism usually presents with greater difficulty communicating and more behavioral issues, so much so that it is often immediately apparent when meeting new people. They may also have very narrow interests and have high levels of difficulty adapting to change. They require more support than those with level 1 autism.

Level 3 autism may have very limited to no communication skills, have extreme emotional reactions to changes in their environment or their routine, and generally seem unable to maintain focus and attention. They require high levels of support to learn basic life skills.

 How can autism affect my child’s ability to drive?

As ASD diagnoses exist on a broad continuum, every person will have a unique set of symptoms with their condition. For those on the more severe end of the spectrum, they may have difficulty coping with the number of distractions you have to process while staying focused on the road. If they also have an intellectual impairment, they may struggle to learn the skills needed to drive or the rules of the road.

For those with little to no intellectual impairment, and with only milder autism, there may be little difficulty learning to drive, though studies have shown that autistic students may require a more gradual introduction to driving and a longer period of training before they master it. On the flip side, research suggests that some may eventually reach the point where they are actually safer on the road than their peers. This happens because autistic people tend to be more adamant about following rules and are less likely to take rule-breaking risks.

Because of their disability, they are likely to encounter a number of challenges with driving. Some may have difficulty learning technical terms associated with driving, such as “ignition,” “transmission,” or “suspension.” They may have difficulty with tasks that involve taking turns. While driving, it can mean not recognizing who has the right of way at an intersection. Or, they may have difficulty with sequences which can lead to problems remembering directions to get somewhere.

Another area they may struggle with is problem solving and judgment. This can mean misinterpreting clues as to what is about to happen, such as a driver approaching an intersection too fast who may not stop for a red light. It may also mean that adjusting to detours and route changes can be distressing.

What can I do to prepare my autistic child for driving?

You can start by talking about driving with your child. Discuss the rules of the road, the way to operate a vehicle, and the challenges they might encounter while learning. Be sure to bring up the fact that many drivers do not obey all the rules and that unexpected things happen. Tell stories of your experiences or mention specific scenarios and talk about the appropriate way to react. Share with them about the unofficial non-verbal communication that happens between drivers, such as flashing lights, using the horn, and gesturing. Talk about the things that could motivate them to drive, like having a job, visiting friends, or enjoying a hobby.

Take them on a drive with you and have these discussions on the road so they can connect your words with your actions and the environment around them. Ask them questions about the things they see and point things out to them to try and promote a sense of awareness.

As your child begins to learn the skills of driving, break these apart into smaller steps. For example, instead of telling them to start the car, explain to them that they must select the right key, put it in the ignition, turn it to the right until they hear the engine turn over, and then let go of the key.

Some have suggested using video games and driving simulators to help teach autistic children driving skills. While this can be helpful regarding the basic mechanics of steering, braking and accelerating if they use a steering wheel and pedals instead of a game controller, it may not be as beneficial as some hope. A study at the University of Rochester involving eye movement tracking showed that playing driving video games even with pedals and steering wheels, but without having experience in a real vehicle leads to a much smaller field of visual focus.  Participants in the study who had driven actual vehicles are more likely to visually scan their environment and have higher situational awareness, but those who only experienced simulated driving stared at a narrower area of the screen.

Another thing to keep in mind to prepare your autistic child for driving is what type of car they will be driving. Many newer cars come with backup sensors and a collision avoidance system that can provide an extra level of protection when a driver isn’t paying full attention. If it isn’t something that will distract them, having a GPS to help them stay focused on their route can be helpful, though this is not meant as a replacement for teaching them how to navigate on their own. Be sure to teach your child common routes they will need and point out to them key landmarks, as this may help them find their way more than giving them sequential directions.

How do I know if my child with autism will be able to drive?

Everyone with an ASD is unique. To guide yourself in this decision, it can be helpful to ask yourself some questions about your child. How flexible can they be when they encounter changes? Are they able to adapt relatively quickly, or do sudden deviations from their expectations cause them severe distress? Do they have the motor skills needed to safely operate a vehicle’s controls? Are they able to handle distracting environments while still making quick, appropriate decisions, such as handling the noise of a radio, the visual stimuli of cars and billboards, and still reacting to a vehicle cutting them off? Do they have sensory processing issues that would result in anxiety when they encounter lots of noise or shiny moving objects? Are they able to maintain focus on a task for long periods of time, or will they get quickly distracted from driving and forget what they are doing? Can they maintain focus while being aware of their surroundings? Can they maintain enough awareness to notice potential obstacles and plan how to react to them?

One good option is to have your child evaluated by a Certified Driver Rehabilitation Specialist. They will assess your child and help you determine if they are ready to drive, as well as help you develop a plan to reach their goal.

What Next Street looks for when assessing people with autism for driving

We work with each patient on an individual basis to determine what may be needed for them to learn to drive or to help them plan transportation without a driver’s license. We evaluate the patient’s cognitive functions and reaction speed, as well as assess vision and physical health. We may also give them a behind-the-wheel evaluation.

Possible driving outcomes

Drive on

For people with autism, the biggest hurdle can be learning to drive. If they do not have serious intellectual impairments, this can be possible, though it may require a more gradual introduction to the concepts and skills of driving than typical students require. Over time, they can move on to drive as normally and safely as anyone else on the road.

Drive with restrictions

In some cases, autistic students may be able to learn to drive well enough to handle it in simple situations, such as driving to work or to the store, but may lack the skills needed to handle high stress driving environments such as freeways, or struggle with reaction skills that would make driving at night or at high speeds more difficult.

Unable to drive

There are some circumstances where people with autism may not be allowed to drive a motor vehicle. They may lack the awareness, responsibility, or focus needed to safely handle being on the road. In these settings, it is often still possible for them to find alternative means of transportation, such as family members or specialty transit companies that allow them to still have mobility.

No matter where your child is at, Next Street can help you prepare them for their future behind the wheel or put a plan in place to meet their transportation needs.  


Topics: driver rehab, driving evaluations, autism, ASD, medical driving

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Our Driver Rehabilitation program works with patients whose change in health may affect their ability to safely drive. We have a team of Certified Driving Rehab Specialists that will work with patients on evaluating your driving abilities. We also have a team of professional instructors to help you gain or regain the skills you need to drive. We created this blog to talk about the various diagnoses we experience and how they may affect your experience behind the wheel. 

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