Learning to drive is tough for many teenagers, but tougher for those with an attention disorder or learning disability ? and for their parents. In today?s Science Times, I examine the situation for young people with attention deficit hyperactivity disorder. But learning to drive can also be or other forms of autism.
Two experts in the field have agreed to answer questions from readers about their children or their own experiences learning to drive. Dr. Patty Huang is a behavioral and developmental pediatrician at the Children?s Hospital of Philadelphia who works on issues related to special-needs youngsters and driving. Beth Rolland is a driver rehab specialist at the Kessler Institute of Rehabilitation in Saddle Brook, N.J. She is also the chairwoman of the research committee for the Association of Driver Rehabilitation Specialists. One of her clients was Jillian Serpa, who was profiled in the Science Times article.
Do you have a question about learning to drive with attention problems,nike air jordan, Asperger?s or other challenges? Post your questions below. Dr. Huang and Ms. Rolland will be responding to select reader questions later this week.
March 29, 3:43 p.m. Updated
Answers About A.D.H.D., Asperger?s and Learning to Drive
Earlier this week, I , a 21-year-old New Jersey woman with an attention disorder. Ms. Serpa??s attempts to learn when she was 16 ended badly,polo homme, and she put off trying again for four years. Before she started again, she took an exam that uncovered a visual processing problem and adjusted her medication; her new instructor was a driving rehab specialist, Beth Rolland of the Kessler Institute of Rehabilitation in Saddle Brook, N.J.
Even so, learning was not easy for Ms. Serpa. She failed in her first four tries at the road exam,polo homme, the last two times because she hit a cone while parallel parking. But she persisted, and on Thursday took the test again and passed.
??I just did everything normally, and I passed,???? Ms. Serpa said. ??I feel really, really good.????
She said she plans to practice more with her mother before easing into driving independently to get to work and back. Then she will put in some supervised work on highway driving and nighttime driving, which she still considers challenges.
Readers also posed various questions about issues related to special-needs youngsters and driving. Responses from Dr. Huang and Ms. Rolland are below.
Denying the Privilege of Driving?
Given that driving a car is a privilege, not a right, in order to protect us and themselves, shouldn?t everyone with the signs and/or symptoms of this diagnosis be denied this privilege?Paul F. Stewart, M.D., Belfast, Me.
Dr. Huang responds:
Driving is indeed a privilege. However, symptoms can range in both type and severity among those with A.D.H.D. or autism spectrum disorder diagnoses. Applying a broad ban on driving to everyone with an A.D.H.D. or autism spectrum disorder diagnosis might unnecessarily limit those who can be taught to drive safely and, in turn, significantly limit their independence.
Pennsylvania is one of the only states in which first-time applicants for a learner?s permit must receive medical certification that they do not have a condition that seriously impairs their ability to drive. I recommend that all teenagers with developmental disabilities like A.D.H.D. or an autism spectrum disorder who are interested in driving undergo a ?fitness to drive? physical as part of their routine follow-ups with their pediatricians, just as many undergo a sports participation physical to engage in team sports.
The Web site , from the Children?s Hospital of Philadelphia, may be helpful to guide families in discussing a teenager?s interest in driving with a pediatrician or family doctor.
Ms. Rolland responds:
Absolutely true ? driving is a privilege. It is also your independence, your autonomy, your connection to the community and a prerequisite to reaching many job opportunities. Denying the privilege has life-changing consequences. As symptoms and abilities vary greatly from person to person, it is important that these drivers are considered as individuals.
It would be prudent for each and every one of them to be evaluated by a specialist who could accurately and objectively assess their ability. I have also worked with clients who were vastly different in the car on medication than they were without medication. Many people with these diagnoses discontinue medication because of adverse side effects. However, good pharmacology can mean the difference between success and failure. That means not only the right medication, but the right dose and taking it consistently at the right time. While it may be tempting to make an easy decision and deny driving to all, it would be a vast disservice to those able to prove their ability.
Finding a Driving Specialist
Where can one locate a ??driving rehabilitation specialist???Kathleen Taggart,ralph lauren pas cher Cheong Yaoming, New Jersey
Ms. Rolland responds:
There is a national organization called ADED ? the Association for Driver Rehabilitation Specialists. The easiest way to find a specialist is to use the locator on the organization?s Web site, . Driving specialists often work with clients who have anxiety about driving. They are able to work with different learning styles and to be sensitive to the needs of various drivers, new or old.
On the Autism Spectrum
Now, autism is just not A.D.H.D., if you can?t focus on a single task for a long period of time, you might not be a great driver.
The benefit that many of us on the spectrum have is the ability to focus on a single task very well, if not better than many people. Most drivers can?t do this, they?re too busy changing radio stations, making phone calls, drinking coffee,polo femme, etc. I?m scanning the traffic and paying attention to every detail going on around me to an excess (it can get overwhelming), I can assure you most of the people I am paying attention to are not putting the same effort and attention into paying attention to where I am at. Thankfully,polo femme, I avoid a lot of accidents with cellphone drivers because I?m paying attention to their signals (or lack of).dunkin, Seattle
Dr. Huang responds:
Focus and attention are certainly necessary components of driving safely. For some with autism spectrum disorders or A.D.H.D., however, it may be more difficult to either shift focus or avoid getting ?lost in the details.? If families of teenagers with developmental disabilities are concerned about the effect of attention and focus on driving, they should speak with a physician, who may be able to recommend further evaluation with a driving specialist and/or medications.
Focusing Techniques
My teenager with A.D.H.D. is not impulsive, shows good judgment, takes meds and regularly expresses how serious driving is ? in fact, says he doesn??t want to drive till he is older. But his attention gets hyperfocused.
I am sure he would never talk on a cell or text ? he is scathing about drivers who do ? but we can picture him losing track while peering at an ambiguous sign, or noticing one important cue and having insufficient attention for others.
What kind of perceptual training would help any teenager learn to consistently sweep the visual field even if there is something they need to attend to in one location? It?s much harder to train than black-and-white rules like ?texting kills? or ?drive slower in wet weather.?
D.M., Brooklyn
Ms. Rolland responds:
You are right to perceive that driving requires not just sustained attention, but selective attention as well as shifting attention. My experience with clients who have A.D.H.D. or Asperger??s is that they often have difficulty sorting out what is important to look at in the driving environment. They need help to realize that the Denny??s sign is not something that requires their attention, while the truck braking two cars ahead does. When I train these new drivers, I use graphics to illustrate where things occur on the road, and visual aids to practice sizing up a driving scenario to pick out the details that are important in that moment. This often requires a significant amount of time and is crucial to later success.
Another great technique is to practice ??commentary driving.?? This is a method in which the new driver practices visual scanning and judgment as a passenger while the parent is driving. It helps him or her focus on the attention skills without also having to be in physical control of the car. I often start with one item to find (such as brake lights going on in a car one, two or three ahead), then add another (maybe stop signs/traffic light colors), then a third (find all the side streets on the left). After they are able to do up to four or five simultaneously without missing any, they can then get back behind the wheel. Parents of children with attention disorders should start practicing these activities even years before they are old enough to get a driving permit.
Anger and A.D.H.D.
My husband, who has had A.D.H.D. his whole life, is a good driver. But not without effort. Sufficient sleep, calming background noise (e.g. N.P.R.) and minimal distractions (phone off, GPS instead of a passenger navigating, minimal conversation) are key. Nonetheless, sometimes if he is convinced another driver is in the wrong, he will become irritated, distracted, and drive more recklessly. Irritation seems to negate all his other great coping strategies. Do you have any advice for these situations? Thank you.Marie, New York, N.Y.
My 14-year-old son has A.D.H.D. and has some issues with impulsiveness and anger and is on stimulant medication. We also live in a place where driving is a rite of passage and also think that it would be good for him to learn when we can impose restrictions and dictate the pace of taking on new challenges. Aside from taking it slow and insisting on lots of practice and significant restrictions, what advice would you offer? Also, how will we know when it is safe for him to drive on his own?Marc Robinson, Troy
Dr. Huang responds:
Extended practice and imposing restrictions are definitely a good start. If anger and impulsiveness remain a challenge, finding a therapist who can help teach more effective coping and emotional regulation skills may be helpful. An assessment with a driving specialist who is experienced in working with teenagers with developmental disabilities may be helpful to give guidance on whether your son is ready to drive independently.
A Son With Asperger?s
With regard to Asperger??s, it??s the idea of my son not always being seemingly able or unable to understand the consequences of his actions, in this case driving, and also when I was teaching him: the verbal nonsense, anti-authority; or rather not able to understand authority, or the appropriate language to use. Makes him a less able driver,air jordan, for obeying the laws.ARTLB, Canada
Dr. Huang responds:
Other individuals with Asperger syndrome may certainly share the difficulties you report in your son. If you have concerns about whether he can learn to drive safely, I recommend speaking with his pediatrician (assuming he is a teenager), or pursuing an assessment with a driving specialist before allowing him to drive independently.
Asperger?s in the City
I taught my daughter with A.D.D. to drive; she is an excellent driver. During 14 years she has had one minor accident, and that was early in her driving career. We wrote up a very detailed contract of when and where she could drive and whom she could have in the car ? also, consequences for violating the contract. She had to pay half of the insurance.
My son has had a learner??s permit for five years because he has Asperger?s. He is very high functioning, but driving has been a big challenge. He was tested by group that certifies neurologically impaired people to drive, and they thought he should be able to drive. His driving has gotten much better over the five years, but he sometimes zones out and misses cues or gets confused in new situations.
We think if he lived in a small town and not Atlanta he would be able to drive just fine. He really wants to drive and have his independence, but his mistakes scare him and he does not want to ruin his life (or others?) with an accident. Should he get his license or wait for the cars that drive for you?Crawford, Atlanta
Ms. Rolland responds:
From what you have written,polo ralph lauren At Comic-Con, a Mini-Mount Rushmore Version of Kiss and Other, it sounds to me as if your son is not ready to get his license. Driving is a huge responsibility, and errors can have significant consequences. I would never push a teenager to get licensed if he is voicing anxiety or concern.
I have worked with many clients who have an Asperger??s diagnosis. Getting confused in new situations is common. With a few of my clients I worked very hard on one or two routes near their home. We looked at every intersection and reviewed which lane to be in,polo femme, when to plan to get into it, where to look for traffic, and possible reactions of other drivers. Then the client was allowed to drive only those routes for a long while before we worked on different routes.
You can never plan for every possibility, but you can at least help a driver plan ahead for the things that are controllable. This takes many hours of patient work as well as a skilled eye to know if the risk is too great. Some of these clients may be limited to familiar routes for the rest of their driving careers. Others may eventually master new experiences while maintaining safety.
You may be right about Atlanta as well. He is in a place now where he probably has excellent transportation options, which are the right choice for him at this time.
Middle-Aged With Asperger?s
In my case, as a middle-aged female with Asperger?s, I have always struggled with dyspraxia (clumsiness) and proprioception (judging where my body is in space). For example, parking parallel, or in a lot with narrow stalls, is a real chore these days! I have noticed these issues getting worse as I grow older. In addition, my ability to see at night has diminished markedly, especially when it?s damp. I have always been somewhat overwhelmed by objects moving around me and as I age,chaussures air jordan, the stress of driving (especially on the freeway) has intensified. So over time I have limited my driving significantly.
I no longer take long car trips; they just wear me out too much. As for commuting, I have moved close to a large multiline bus stop so I can take the bus to work in the winter, since by the time I get off it?s dark; if it?s raining or foggy, the nighttime visibility is even worse. I do O.K. on the bus, although the other passengers can affect my sensory issues. However, I am a pretty nervous passenger when others drive me in their cars.
Over all,polo ralph lauren Union Square, I am finding that if I could just either stay home or go to places that I can walk to, I am much happier.
I write this message not only to give people an idea of how this issue can evolve as people with Asperger?s age, but also to ask if others on the spectrum have experienced similar limitations associated with driving and car travel.fairlady68, Sacramento
Dr. Huang responds:
Thank you for sharing your experience. Much more research is needed to understand the driving experience of individuals with autism spectrum disorders and other developmental disabilities. This research would inform guidelines to assist families and clinicians who are making decisions about learning to drive, and also help in the development of tailored interventions (medical and educational) aimed at improving the safety of young drivers.
Ms. Rolland responds:
Kudos to you for great awareness of your limitations and having found driving alternatives for those days when driving is difficult. You bring up the issue of knowing where you are in space. I have worked with many drivers with Asperger??s and A.D.H.D. and have found that there are often undiagnosed visual difficulties. Some drivers are uncomfortable moving their eyes; some have decreased awareness of the periphery or have very slow scanning speed. Others, like yourself, have poor spatial relations skills. In these cases I often refer to a neuro-optometrist and a good vision therapy program to improve these skills. It is much safer and less costly to work in the clinic with an occupational therapist than to work on those skills in the car. Often a student will come back to me after vision therapy with vastly improved skills that translate to parking, lane position,polo homme, smooth turning and space between the car and a parked car.
Asperger??s and A.D.H.D.
Hi, I was diagnosed with Asperger?s and A.D.H.D?.I have taken my learner?s permit and passed and have gone through driving and passed. I?m having difficulty continuing with practicing with my dad in the car as he?s always finding something wrong. He thinks I have a listening problem when that?s not the case.
What should I do to be able to concentrate more as he?s always finding something to yell at me about and I only have a month to get things ready for the driving test? I do have anxiety (on medication) and am on medication for A.D.H.D.Ashley Brown, Henderson, Nev.
Ms. Rolland responds:
There are some practical steps you can take to improve your attention in the car. First, be sure you have gotten adequate sleep. It is very difficult to attend when you are fatigued. Second, make sure you have eaten. Blood sugar drops can significantly affect attention. Third, avoid driving when your emotions are running high. This, too, negatively affects your ability to attend.
It may be helpful to try to practice with someone other than your parents. There are often feelings of judgment in that relationship, making driving more stressful. If you can find a neutral party with a good bit of patience, you may feel that person is more objective. Your father may have legitimate concerns. Driving with someone else would help you to see that he is not just trying to find fault.
Realize, too,polo ralph lauren, that sitting in the passenger seat where you do not have control of the car can be very frightening for a parent. I have often advised parents to install an instructor??s brake in their car so that they can calm down a bit while their child is driving and still feel that they have some control. The instructor brake can be removed when it?s no longer needed. You could also seek more practice with a driving school or, better yet, with a driving rehabilitation specialist.
Remember that your road test date is not set in stone. You can always wait until you have been able to have significantly more practice.polo ralph lauren At Comic-Con, a Mini-Mount Rushmore Version of Kiss and Other
Source: http://www.medicaltravelclub.com/qa/2012/09/polo-femme-march-29-343-p-m-updated/
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