Rules of the Road: Driving and ASD

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Rules of the Road: Driving and ASD By Teresa Foden, IAN Assistant Editor and Connie Anderson, Ph.D., IAN Online Community Facilitator Kennedy Krieger Institute Email: ian@kennedykrieger.

1 Rules of the Road: Driving and ASD By Teresa Foden, IAN Assistant Editor and Connie Anderson, Ph.D., IAN Online Community Facilitator Kennedy Krieger Institute Date First Published: November 24, 2009 Getting behind the wheel of a car is a rite of passage for many teenagers, but for high-functioning individuals with autism spectrum disorders (ASDs) this task may prove particularly difficult. Along with the impulsivity, inexperience, and other traits of adolescence and young adulthood that can make driving a challenge, an individual with ASD may find him- or herself struggling with potential obstacles posed by autism itself. Can he or she quickly intuit and react to the "big picture" of any given driving situation? Can he or she interpret and respond to the actions, attitudes, or intentions of other drivers? Can he or she keep calm, neither overly anxious nor angry? Can he or she avoid "zoning out"? This is an important area to explore, particularly as the high number of children with ASD 1 2 transition to adulthood. Related research in the area of mobility of individuals with other disabilities, or of the elderly, shows that the ability to get from place to place enhances health, improves overall quality of life, and promotes participation in the community. 3 From an economics perspective, mobility also can reduce the need for public supports. 4 After all, to keep a job, you have to be able to get there. For some, driving will not be an option. Others may have the potential to drive, but find the prospect too overwhelming. For many, using public transportation will be taught as a life skill -- a good idea whether they are planning to learn to drive or not. Transportation needs may also be addressed as part of disability services. Still, there are some individuals with ASD who can learn to drive, especially if given sufficient support. Typical teens, plus A typical adolescent is an inexperienced driver by definition, and is hampered to some extent by a brain that is not finished developing. The prefrontal cortex -- the part of the brain that is home to executive function skills, such as planning, setting priorities, inhibiting impulses, and weighing the consequences of actions -- is not mature when most teens get their first driver's license. 5 This may help explain why they are about four times more likely to be involved in a vehicle crash than a more experienced older driver, according to the annual Fatality Facts recently released by the Insurance Institute for Highway Safety. 6 Adolescent drivers are more likely to speed, tailgate, and otherwise increase their accident risk. At the same time, their inexperience makes it difficult for them to recognize the less obvious signs of a potential hazard. 7 Also, while young drivers are less likely than adults to drive after drinking alcohol, their crash risk is substantially higher when driving under the influence. 8 When it comes to sitting in the driver's seat for the first time, a young person with ASD faces all the same issues a typically developing adolescent does, as well as additional difficulties posed by ASD. There are definitely some aspects of driving that he or she may need special help to master. Imitation, coordination, and planning the next move It often has been observed that individuals with ASD have a difficult time copying others' gestures or movements. How much of this is because of impaired motor skills and how much is because of difficulty -1-

2 with the process of imitation is not yet known n any case, clumsiness or problems with coordination have long been noted, especially in people with Asperger's syndrome. Research also has shown that individuals on the spectrum may have trouble "chaining motor acts into a global action." 13 In other words, people with ASD can find it hard to plan all the steps to carry out an action from a to z all at once. Instead, they may do this in smaller, less global steps. Taking all of the above into account, we may speculate that individuals with ASD will need some extra help learning the skills necessary to drive. There is not yet research on what techniques are ideal, but it is likely that breaking down driving skills into component parts and allowing more time than the typical beginner might need to master them will be required. Seeing the 'big picture' Studies show that one of the biggest strengths for many with ASD is attention to detail. What is more of a challenge is grasping the "gist" of a situation In fact, according to the weak central coherence theory many individuals with ASD tend to focus on details rather than the overall meaning of information. To use a common metaphor, they may see each and every tree in the forest without clearly perceiving the forest as a whole. An ability to see "the forest" is important to quick and accurate decision making in tasks such as driving. For example, an individual driving a car over a winding road, approaching a bridge, in the pouring rain on a winter's night, with the silhouette of a pedestrian emerging from the shoulder up ahead, may be required to sort through the relevant details -- darkness, a winding roadway, a bridge where water tends to freeze first, the pedestrian's body language (is he about to step out onto the road?) -- in order to arrive at a decision to proceed more slowly than the posted speed limit. Using eye-tracking technology, a driving simulator, and other strategies, an Australian study is taking a look at how this difference in processing may affect visual strategies in inexperienced drivers with ASD compared with inexperienced drivers without a disability Exploring this aspect of ASD is important if we are to understand how possible interventions may work in various situations, such as learning to drive. 18 Identifying and teaching visual strategies to individuals with ASD could ultimately promote independence and participation in the community. 19 The 'body language' of traffic Individuals with ASD can have a hard time reading the "body language" of other people: expressions, gestures, stances. Traffic has its own "body language." A car with a confused elderly driver at the wheel may move slowly and drift over the yellow line, while a car driven by someone intoxicated may move at a high rate of speed or careen before the driver regains control. A tailgating car may indicate impatience in the driver, irritation that the car in front is traveling at the speed limit in the fast lane, disapproval of a political bumper sticker, an overall aggressive attitude, or simply a lack of courtesy. Experienced drivers can pick up on the anger, upset, aggressiveness, or confusion of other drivers. They usually can recognize when a car is about to turn or change lanes, even when the driver doesn't use a turn signal. Recognizing these and other subtle traffic behaviors becomes second nature, and plays a key role in how expert drivers respond during emergencies. How do novice drivers become expert drivers? At what point do they internalize this important skill of "reading" other vehicles and drivers? Can these skills be broken down and taught to an individual with ASD, much as they might be taught about human body language or personal space? Researchers are beginning to explore these and related questions. -2-

3 Staying cool...and focused Additional concerns often raised as a family thinks about whether their child with ASD is ready to drive are emotional regulation and the ability to focus. Some individuals with ASD can be irritable, anxious, or have meltdowns Some individuals have difficulty maintaining attention. Quite a few have been diagnosed with anxiety, attention deficit, or other issues in addition to their ASD, while others suffer from seizures. 25 Any of these issues may impact the ability to drive. Furthermore, it is clear that some individuals may be taking medications that could interfere with that ability. Although these issues and their relation to driving aptitude have not yet been addressed by researchers, they are clearly important to consider. If a person with ASD cannot keep his focus on the road, or stay calm enough to drive responsibly, he may not be ready for this rite of passage. On the other hand, if he is able to stay calm and focused, whether thanks to treatment or simply growing maturity, driving may be a real possibility. People with ASD often have an extraordinary strength when it comes to driving: They are often sticklers for rules and regulations, and may obey traffic laws better than typical drivers. What may be more of a problem is coping with the transgressions of neurotypical people far more comfortable with bending or breaking the rules. Research in the future, adults in the now Many individuals with ASD, like many of their parents, are not inclined to wait for the results of research studies. Teenagers and adults visiting WrongPlanet.net ( -- an online community for people with autism and Asperger syndrome -- expressed a host of frustrations, worries, and feelings of accomplishment in recent discussions about driving. One young man, a good driver but nevertheless nervous about having to parallel park during his upcoming driver's test, wondered: "How did other Aspies deal with obtaining their licenses? Was it very stressful? Were you relieved afterwards? Also, is [it] common for high functioning autistics to have licenses?" 28 Another poster, having recently earned her driver's license, offered him this advice, "I had the same worries you [do] about parallel parking. Most instructors will see you know what you're doing, and won't expect a 'blindfold perfect' parking job. They know that the test is very nerve wracking. Just make sure to follow the rules of the road, and you'll be fine. Make sure it looks as if you're aware of your surroundings (glancing around, checking mirrors before backing, etc)." 29 A young man likewise offered reassurance and posted an exhaustive list of the specific skills involved in driving, including more than two dozen items broken down by subject heading. 30 The following day, the original poster wrote: "Today, at 3:40, I obtained my drivers license! I am so happy right now..." 31 Some shared such happy endings, while others said the obstacles had been too much to overcome. Society has few, if any, scientifically based interventions to offer them as they consider learning to drive. Much of today's research focuses on early interventions that will be critical for the future of infants and young children with ASD, but research that addresses critical life skills in adolescence and adulthood also is needed. There are vast numbers of young people growing up to join the already large number of adults with ASD. Fortunately, in the United States, interest in adults with ASD, their abilities, and their needs is growing. A national town hall was recently held by a new organization, Advancing Futures for Adults with -3-

4 Autism (AFAA), with the aim of setting a national agenda regarding housing, employment, and community life opportunities for adults on the spectrum. At the same time, researchers are beginning to address issues faced by adults with ASD, including how to help them learn to drive. For example, Children's Hospital of Philadelphia is currently conducting a study on the "learning to drive" experience of teens with ASDs. The researchers hope to learn enough to develop guidelines to help families decide whether their child is ready to drive, as well as educational tools to support families of teens or young adults with ASDs during the learning-to-drive process. Hopefully, future teens with ASD and their families will have much more information and many more resources available as they approach this and other important milestones on the path to adulthood. Related Resource The Interactive Autism Network (IAN) Project has begun to include adults with ASD in its national online autism research program. Critical information on adult experiences and needs is being collected through this program. Independent adults with ASD and guardians of dependent adults are eligible to participate. Parents of independent adults are welcome to facilitate their son or daughter's involvement, as well. Rules of the Road: Driving and ASD References 1. Kogan, M. D., Blumberg, S. J., Schieve, L. A., Boyle, C. A., Perrin, J. M., Ghandour, R. M., et al. (2009). Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007 [Electronic version]. Pediatrics. View Abstract 2. U.S. Centers for Disease Control and Prevention. (2009, October 5). CDC statement on autism data. Retrieved November 24, 3. Falkmer, T. (n.d.). Visual perceptual abilities in children and adults with autism spectrum 4. Falkmer, T. (n.d.). Visual perceptual abilities in children and adults with autism spectrum 5. U.S. Department of Transportation, National Highway Traffic Safety Administration. (2006). Teen Unsafe Driving Behaviors: Focus Group Final Report. Retrieved November 24, 6. Insurance Institute for Highway Safety. (2008). Fatality Facts 2008: Teenagers. Retrieved November 24, 7. Insurance Institute for Highway Safety. (2008). Fatality Facts 2008: Teenagers. Retrieved November 24, 8. Insurance Institute for Highway Safety. (2008). Fatality Facts 2008: Teenagers. Retrieved November 24, 9. Mostofsky, S. H., Dubey, P., Jerath, V. K., Jansiewicz, E. M., Goldberg, M. C., & Denckla, M. B. (2006). Developmental dyspraxia is not limited to imitation in children with autism spectrum disorders. Journal of the International Neuropsychological Society, 12(3), View Abstract 10. Dziuk, M. A., Gidley Larson, J. C., Apostu, A., Mahone, E. M., Denckla, M. B., & Mostofsky, S. H. (2007). Dyspraxia in autism: Association with motor, social, and communicative deficits. Developmental Medicine and Child Neurology, 49(10), View Abstract 11. Ghaziuddin, M., & Butler, E. (1998). Clumsiness in autism and Asperger syndrome: A further report. Journal of Intellectual Disability, 42(Pt. 1), View Abstract 12. Weimer, A. K., Schatz, A. M., Lincoln, A., Ballantyne, A.O., & Trauner, D. A. (2001). "Motor" impairment in Asperger syndrome: Evidence for a deficit in proprioception. Journal of Developmental and Behavioral Pediatrics, 22(2), View Abstract 13. Fabbri-Destro, M., Cattaneo, L., Boria, S., & Rizzolatti, G. (2009). Planning actions in autism. Experimental Brain Research, 192(3), View Abstract -4-

5 14. Iarocci, G., Burack, J. A., Shore, D. I., Mottron, L., & Enns, J. T. (2006). Global-local visual processing in high functioning children with autism: Structural vs. implicit task biases. Journal of Autism and Developmental Disorders, 36(1), View Abstract 15. Frith, U. (2003). Autism: Explaining the enigma (2nd ed.). Oxford: Blackwell. 16. Jönköping University, School of Health Sciences, Sweden. (2009, January 28). Research Fellowship to Falkmer. Retrieved November 24, 17. Falkmer, T. (n.d.). Visual perceptual abilities in children and adults with autism spectrum 18. Falkmer, T. (n.d.). Visual perceptual abilities in children and adults with autism spectrum 19. Falkmer, T. (n.d.). Visual perceptual abilities in children and adults with autism spectrum 20. Dominick, K. C., Davis, N. O., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with a history of language impairment. Research in Developmental Disabilities, 28(2), View Abstract 21. Smith Myles, B., & Southwick, J. (1999). Asperger syndrome and difficult moments: Practical solutions for tantrums, rage, and meltdowns. Shawnee Mission, Kansas: Autism Asperger Publishing. 22. Hofvander, B., Delorme, R., Chaste, P., Nydén, A., Wentz, E., Ståhlberg, O., et al. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9, 35. View Abstract 23. Matson, J. L., & Nebel-Schwalm, M. S. (2007). Comorbid psychopathology with autism spectrum disorder in children: An overview. Research in Developmental Disabilities, 28(4), View Abstract 24. Stahlberg, O., Soderstrom, H., Rastam, M., & Gillberg, C. (2004). Bipolar disorder, schizophrenia, and other psychotic disorders in adults with childhood onset AD/HD and/or autism spectrum disorders. Journal of Neural Transmission, 111(7), View Abstract 25. Canitano, R. (2007). Epilepsy in autism spectrum disorders. European Child & Adolescent Psychiatry, 16(1), View Abstract 26. Rosenberg, R. E., Mandell, D. S., Farmer, J. E., Law, J. K., Marvin, A. R., & Law P. A. (2009). Psychotropic medication use among children with autism spectrum disorders enrolled in a national registry, [Electronic version]. Journal of Autism and Developmental Disorders. View Abstract 27. Rapoport, M. J., & Baniña, M. C. (2007). Impact of psychotropic medications on simulated driving: A critical review. CNS Drugs, 21(6), View Abstract 28. thelilasimov. (2009, October 27). Tomorrow is my driving test [Msg 1]. Message posted 29. veiledexpressions. (2009, October 27). Tomorrow is my driving test [Msg 4]. Message posted 30. duke666. (2009, October 27). Tomorrow is my driving test [Msg 9]. Message posted 31. thelilasimov. (2009, October 27). Tomorrow is my driving test [Msg 9]. Message posted -5-

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