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ADD and teen driving (cross posted in chat)


MegP
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My teen son (17 next month) has his permit and now has to drive 50 hours with parents until he take take the tests to get his license.

 

He has ADHD (diagnosed when he was ten) and is not currently (and has not for years) taking any meds for this. It has seemed mild to me and I have not pushed him and he has not wanted meds.

 

 

Ok so in the past two weeks when he was driving with me, he-

 

1. Hit a neighbor's trash can (the passenger side mirror hit the trash can, and the trash can did not fall over.  He did not hit it hard, but still)

 

2. Almost ran a red light. The light had turned yellow and the car ahead of us continued on, but that driver was very close to the light. We were not that close at all and my son did not even break and it seemed he had no intention of stopping. I yelled for him to  stop and he slammed on his brakes and stopped. He later told me that because the car ahead of him went through the light, he thought it would be ok for him to do so as well. 

 

3. Today while driving, after having gotten take out food, he was following the car ahead of him too closely  and when the car stopped, he slammed on his brakes (he did not have to slam them on but I think he panicked) and when he did, the food went flying. Then he turned his head to look at the backseat at the food and when he did that, he took his foot off the brake and almost HIT the car in front of us. I had to again yell at him and he did slam the brakes on again and VERY NARROWLY missed hitting the car. We are talking inches.

 

So what do I do?  He is almost 17. He also has dyslexia and slow processing speed issues. I know he is not ready for his license at all.

 

Do I insist that he start taking ritalin or something like that again? I will not put him and others at risk by the way he is driving. So we need help...but I don't know where to go or what to do. 

 

ETA-no, he has not had a neuropsych-waiting list here is a year. His last eval was in 2015-and they did the WICS and WIAT, IIFC.

 

He has had vision therapy.  

Edited by MegP
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Since he's already had VT, I would get the meds, yes. The stats are apparently pretty bad on unmedicated ADHD drivers. If he isn't willing to take meds, then he's going to need to wait a while. He's not currently ready to be on the road, sounds like. That's not really within the realm of sensible, learning to drive, ready to drive. 

 

Has he done driver's ed and behind the wheel with an instructor? I would not take him out any more till he has done that, that's for sure.

 

It will take you a few months to get the meds and get things stable. There's no rush. I didn't get my driver's license till I was 21 turning 22 in grad school. :D I'm pretty sure I curled my mother's hair when she tried to teach me at that age. Really, I would do meds or wait. Or both.

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Edited by OhElizabeth
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Thanks!

 

He  took driver's ed on line and after that, did 6 hours of driving with the instructor. After that, she gave him his permit (that is how it works in my state).

 

I know you guys are not doctors, but can anyone suggest a good ADHD med? He did take Ritalin (wore off after 4 hours) but I know there are a lot more options.

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You're going to need a doctor. Ped, family practice, whatever you want, but a doctor. And around here they want the Quotient, which takes a couple weeks to schedule, another long appt with the doc for an hour, blah blah. It basically takes a couple months to do all the appts and jump the hoops. LIke people talk about how it's given out like candy, and at least around here it's really not!

 

I'd encourage you to go ahead and schedule, even if you think you might rethink.

 

As far as meds. Coursera had a course on ADHD that talked meds. Really, the docs looking at teens want XR meds. If he's got long days, they'll even do an XR med (8 or 12 hour) and then ANOTHER 4 hour med on top of that to finish off their long day. If your teen is going to be out driving at 6pm, he still needs his meds working, kwim?  

 

So no, I don't think you're looking at 4 hour meds like what you had before. They're probably going to strongly recommend an XR med. So go ahead, read up on the systems, see what your insurance will discount, and see what your doc thinks. Some of it is trial and error, so they'll try one (whichever one is cheapest with your insurance) and see how it goes. 

 

Personally, I think Vyvanse is astonishing. It's a pro-drug, so it's going to have the smoothest delivery, the most stable levels of any of the meds. It's an amphetamine instead of methylfenidate. Some people really don't like that. For a percentage of people, it really doesn't matter and any of the meds would work. 

 

Good luck with the meds! It's a hard decision to make, but really you might see astonishing results.

Edited by OhElizabeth
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He  took driver's ed on line and after that, did 6 hours of driving with the instructor. After that, she gave him his permit (that is how it works in my state).

 

 

Forgive me for skipping some of the responses but - this is an almost 17yr old with less than, what, 10 hours of actual driving experience? He needs to drive more. And then some more. And then some more. And then more! Practice will make him better. Start with quiet neighborhoods/non-rush hour areas/times of day. Once he has driven for more than 50 hours, reassess his needs for medications.

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You can do the meds AND get the driving experience safely. The new med deliveries are really smooth. If they were at all beneficial before, he might find he really likes how he functions on them. He'll finally be old enough to SAY that.

Edited by OhElizabeth
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After the 6 hours, he began driving with DH and me. He has driven about   30  hours with us. Legally he needs to drive 50 hours with his parents before he can take the tests for drivers license.

 

My oldest just got his license in November - he's 21. (He waited til he was seizure-free for over 2 years, as he finally stopped growing and the meds were finally dosed properly.) He's been driving for about a year, and failed the exam the first time. He's driven probably near 100 hours since he first got his permit, and he's only just getting the real hang of it. (The first 20hrs were with an instructor.)

 

It took a long time and a lot of practice. He has epilepsy, inattentive-type ADHD and NVLD. He is not medicated for the ADHD due to the significant amount of seizure meds he already takes. He just needed more practice than a neurotypical kid would.

 

Good luck to you both. 

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I don't have any advice about meds, but I agree that much more guided practice is in order. Obviously you have him driving, but with his near-misses I'd take a few steps back. With my son, we spent weeks driving around the neighborhood. Then we moved to the neighborhoods around our neighborhood and spent weeks driving around those. Gradually we expanded our driving area--as he got comfortable and became proficient, we went a little farther. It's been almost a year now that he's been driving with us. He could take the driver's test now and get his license, as he now drives even on the very busy interstates in our area, but we feel he is not ready for the snap decisions that come up when driving alone yet. As others have said, it has definitely been my experience that he has needed more practice than the neurotypical kid. No big suprise, since this is true with most things in his life, but also true that while there was a point in his life that I was worried that he would be able to accomplish the task of driving, he is actually doing very well and I am confident that, with a little more practice, he will be fine.

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Have him practice a lot. My almost 24 year old has ADD and is not medicated. I wish he was because he has had many fender benders, run several red lights (and been ticketed) as well as stop signs. Thankfully no major accidents, but I am always fearful. We tried medication when he was younger and they made him sick. He is not willing to try again even though I have told him there are new/improved ones.

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My 17yo DS passed his driving test in December. He works with a CBT and has been performing some work to help improve working memory and EF. He spent 6 hours with a driving instructor and has been driving DH and me around for 2 years. He passed the written and driving portion of the exam on the first try.

 

Our subdivision is parked squarely in the middle of a farming community, pastures, and a busy two lane rural highway. Handing DS the keys to my car is about the biggest act of faith that I have ever mustered. DS drives himself to class, Wed night youth activities, dental appointments, and recently he attended some high school sporting events. I'm limiting where he goes for the time being. He is not allowed beyond an 8 mile radius. I would prefer 5 miles, but we have to drive at least 10 minutes to reach a Dollar General store. DS hasn't done anything super foolish in the car in awhile.

 

If DS were not willingly working with a CBT, he would not be allowed to drive. The only reason he drives now is because DH took him to get the license. Our car insurance increased by 227% when we added him to our policy. Good luck. I recently started using a daily devotional by Nancy Guthrie.

 

Eta: Maybe set goals and clear guidelines about what you want to see your DS do. Hire a driving instructor to perform additional driving with him. I would definitely talk to a CBT and find a child psych who can advise, medicate, and test attention.

Edited by Heathermomster
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Those seem like new driver mistakes to me. I have kids with ADHD (oldest 14) and am following this thread with interest because I had planned to delay oldest child's getting of her license. However, breaking too hard is a common mistake in new drivers getting a feel for the mechanics of it all. Releasing the break as you turn around is a mistake, but a lesson learned. And how many neurotypucal adults with years of driving experience have grazed the neighbor's garbage cans? Many have fully hit them!

 

I would continue to observe before going to meds. I am not anti med at all, but I just think the examples you have could have been most any kid's experience.

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Thanks everyone! I cross posted on the chat forum and got great advice there as well. Someone recommended an adaptive driving program, and I found one in my area, and called them. Then I called our family doc to get a referral. They will do an OT cognitive driving evaluation and look at his memory, vision, reaction time, cognition, perception, memory, concentration, attention, judgment, processing, etc.  That is 90 minutes and costs $150. If he passes that, then they will do a driving assessment which costs $100. They make recommendations based on their findings.

 

So we are going to start there, as well as step back from busy city driving and focus more on subdivisions and rural areas.

Edited by MegP
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We're coming up on this stage with DD15, who has ADHD and other issues but thankfully her ADHD is mild but we'll definitely be keeping an eye on the attention aspect of things. 

 

In your situation I would go ahead and make an appointment to talk to the doctor about meds (we've done Focalin with success). Then I'd sign him up for an additional driver's ed course, the full kind that gives them the 50 hours they need. If he does that and does some practice with you in addition that should give him the extra time he needs and give you and an objective third party a chance to really see whether he can handle his license right now. 

 

We have a good friend who has severe adult ADHD and is on medication most of the time but as you know it fades. Anyway, he's a pretty erratic driver I have to say. Way too fast and way too inattentive. He did get in several accidents in his 20's but as he ages it's gotten better and as far as I know there haven't been any real significant accidents in the past decade or so. 

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MegP,  you asked what a 'pro-drug' is?

 

 

Drugs can come in 2 forms, active and inactive.

For example, with Ritalin it is an 'active' form and starts working straight away.

 

But with Vyvanse, it is 'inactive' and bacteria in our gut need to metabolise it. Before it starts working. 

Which can take 1 to 2 hours.  

So that any drug that is 'inactive' when taken, is called a Pro-drug.

 

It is an important difference.  

As Ritalin starts working quicker, and also wears of quicker.

But Vynanese takes longer to start working, and will then keep working for longer.

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And the dose is regulated by the natural enzyme or whatever, making it a more stable dispensing mechanism. Many of the drugs have really uneven dispensing, when you look at the charts. There's research correlating the rise in use of stimulant meds with the rise in diagnosis of juvenile bipolar. While there are a LOT of other reasons to look at there, I definitely think it's sane to wonder if the ups and downs of the uneven dosing methods are contributing. A while back we had a thread looking at that issue. So if you have bipolar in the family, it's a really, really good reason to consider a very even, stable approach to stimulant meds.

 

Adding: Although some people are 1-2 hours with the Vyvanse, some people are much faster. You won't know how it is in your particular dc's body till you try. I hadn't heard it was linked to gut bacteria. I had been told enzymes. Probably all connected, lol. Anyways, that explains why it could vary then, because people's gut bacteria vary. 

Edited by OhElizabeth
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This probably isn't all that encouraging, but...

my husband has ADD, and has been on medication sometimes, and sometimes not (depending on other health factors). He is a *terrible* driver, and it does not matter how much practice he gets - he is still awful. Runs stop signs or forgets to brake until he has to slam on them; has no clue what the speed limits are, even on very familiar routes; or will forget that he brought a kid or two with him to the hardware store (they are old enough to get themselves out of the van!).

I do 95% of the driving because my husband is a self-admitted terrible driver. It's the only solution that has worked.

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  • 2 weeks later...
  • 4 weeks later...

My daughter is neurotypical and is 17 and has hit two cars (going five miles an hour) and has run a red light, has gotten lost countless times even in her own neighborhood, has cut off people twice by accident... she has been driving a year now and is starting finally to get the hang of it.  Driving is an automatic skill that needs constant practice to MAKE it automatic, and while kids are still working on it EVERY decision they make while driving has to be thought about because they just don't have the muscle memory yet.  It takes a LONG time. That is why car insurance is so much higher for teenagers.  They just aren't good at it yet.  

 

*She did all these things AFTER the required 45 hours driving with us and 10 hours driving with the instructor.  

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  • 3 weeks later...

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