AT AAP 16
SAN FRANCISCO (FRONTLINE MEDICAL NEWS) – Clinicians and parents should capitalize on a variety of resources and new technologies that help keep teen drivers safe behind the wheel, according to Dr. Joseph O’Neil, a pediatrician at the Riley Hospital for Children in Indianapolis.
“As I like to share with parents, this is the one developmental milestone that parents really want their kids to have that is potentially lethal. This could really kill them,” he said at the annual meeting of the American Academy of Pediatrics. “Believe me, that’s a conversation stopper; they sort of look at you funny. But it’s true.”
In fact, motor vehicle accidents remain the leading cause of death among teenagers. Roughly 1,700 teens died in crashes in 2014 (the most recent data available), and about 100 times that number were injured.
“But there is some good news. We have been paying attention,” Dr. O’Neil said. Concerted safety efforts and campaigns led to a halving of young driver fatalities between 2005 and 2014, although a recent analysis suggesting a reversal of that trend has generated some concern.
Numerous factors increase the risk of crashes and deaths for teen drivers, beginning with their developmental stage, according to Dr. O’Neil. Youth are characterized by their striving for autonomy, impulsivity, risk taking, and greater susceptibility to peer influences, compounded by poor judgment of hazards.
“We know that their executive function is still improving, still maturing, They really don’t start getting to adult levels, if they ever do, until about 25,” he commented humorously.
Other risk factors include speeding, drinking and substance use, sleep deprivation, and distractions that range from cell phones, to eating and grooming, to all the gizmos on the dashboard today. Not wearing seat belts also plays a role, as teens are the age group least likely to buckle up, and risk rises with the number of young passengers in the vehicle.
The rate of fatal crashes among young drivers is more than twice as high at night, compared with during the day, with the hours of 9 p.m. to midnight being most hazardous. And the riskiest meteorologic conditions are, not surprisingly, snow and ice – something that parents should take into account in their typical rush to get driver’s education out of the way in the summer months, he said.
“Most of the evidence points to inexperience as probably the single most important risk factor because with inexperience, you’re going to use cell phones, you’re going to be distracted, you’re not going to be paying attention because you don’t have the experience to know that you should,” Dr. O’Neil said.
Graduated driver’s licenses
A key resource in addressing teen drivers’ inexperience and the fact that their crash rate is highest in their first year of driving are graduated driver licenses (GDLs) . These licenses start with a learner’s permit mandating supervision and having many restrictions on conditions such as times when driving is permitted and number of passengers, and if there are no infractions, slowly lift these restrictions as the teen gains more driving experience, until he or she receives a full driver’s license.
“As I like to tell kids, you could all be born Jeff Gordons or Jimmie Johnsons, and you’re still going to have problems with inexperience because you are not going to be able to know how to handle certain conditions. And this is one of the beautiful things about GDLs, how you can take a young, inexperienced driver and under supervision, help [that teen] learn the skills to be a better driver,” Dr. O’Neil said.
Use of GDLs over the past 20 years or so been credited with a reduction of 10%-30% in the rate of motor vehicle fatalities among young teen drivers.
“The problem is that teens have smartened up; they are waiting until later, age 18, to start driving because they don’t want to go through the rigmarole of a GDL,” he said. “We know that that’s a problem because we have right shifted that curve, so we are not seeing as many 15- and 16-year-olds dying behind the wheel; we are seeing more of the 18- and 19-year-olds up to 25-year-olds.”
Clinicians should familiarize themselves with their state’s GDL, Dr. O’Neil recommended. As most states’ GDL laws end at age 18, legislators are now looking at options such as establishing a GDL requirement for all new drivers, regardless of age.
Clinicians also should also be aware of a host of new high-tech tools designed to make teen drivers safer, often by extending parents’ supervisory role, Dr. O’Neil advised. “Your parents in your practices are going to ask you about these,” he said.
So-called black boxes on vehicles collect a wealth of data about driving and conditions inside the vehicle that can be made available to parents. If black boxes are used correctly, they can enable parents to give feedback to the young driver and reduce overall crash risk, he said.
New GPS monitors will track a vehicle’s speed and range, with an optional feature called geofencing whereby parents can prespecify geographic limits on where their teen driver can go. If the teen ventures outside those limits, the monitor sends a notification.
Video monitoring systems now on the market will record footage both inside and outside of the car. Some record continuously, whereas others capture only events. Parents can obtain a summary report, generally through a monthly subscription, delivered by telephone or email to see how their teen is driving when solo.
Other in-vehicle monitoring technologies include direct-feedback systems, such as the tones that sound when the driver fails to fasten his or her seat belt, changes lanes, or gets too close to another car. Some systems can be configured to send a text or email when these alerts are engaged.
Parents who want to be more proactive can, for certain vehicles, invest in smart keys that are programmed to control vehicle parameters, such as the vehicle speed or the volume on the radio, according to Dr. O’Neil.
Finally, downloadable apps for cell phones will block the user’s ability to call (except in an emergency), text, surf, and take selfies while driving. “This doesn’t mean the child won’t be able to use someone else’s phone, but it does do a nice job for that particular installation,” he commented.
Parent-teen driving agreements
“We’ve talked about a lot of neat things that are out there, but what it all boils down to in the end are the parents – mom and dad. Parents truly are the gatekeepers of the keys,” Dr. O’Neil asserted. “We know that they can have an influence on their teens’ behavior. Parents can set restrictions and regulations on driving, and make sure [teens] follow all the traffic laws and set limits on high-risk driving situations.”
However, parents often underestimate the risks that their teens take behind the wheel. “Everyone always thinks that it’s the other kid who’s going to be driving wildly,” he said. “It’s okay for us to say, ‘I know he’s a great kid, but it’s not the bad kids who get into crashes. All kids get into crashes,’” he said. “It’s important to remind parents that all kids are at risk.
“One of the most valuable things that we can do as physicians to help parents navigate these crazy waters is talk about parent-teen driving agreements or contracts,” Dr. O’Neil said. “This has been shown time and time again to have a positive effect on driving behavior.”
These agreements list rules and expectations, and consequences for breaking the rules. “Both mom and dad, and the teen sign it. You put your name on the line, and that’s important because that really means something. This is probably the first contract this kid will ever sign, and it’s probably the most important one that [the teen] will ever sign.” He recommended that a paper version of the agreement be placed in a prominent location, such as on the refrigerator door, for maximal effectiveness.
A variety of parent-teen driving agreements are available online through initiatives such as the Checkpoints Program , Parents Are the Key to Safe Teen Drivers , I Drive Safely , and the AAP’s Parent-Teen Driving Agreement . Overall, their use has been shown to reduce the risks of traffic violations and crashes by 40%-50%.
Of note, these contracts complement rather than replace GDLs. Additionally, “the law of the land doesn’t trump the law of reality and the law of physics,” Dr. O’Neil pointed out. “We know that the laws in our states are not really always best practice, so as we advocate for best practice laws, what we can do is let the parents set better limits on the teen’s driving.”
“I usually start talking [with families] about driving when the child is 12 or 13,” Dr. O’Neil said. “Anticipatory guidance does work. We know that for a lot of other things that we do, but parents often need help in trying to figure out what to do.”
He recommended the AAP’s Healthy Children website as a source of good information and resources, including a Young Driver Tool for parents. “This has been vetted through the PROS [Pediatric Research in Office Settings] network, and it has been shown that parents do use it, parents do like it,” he noted. “And really it makes your job easier, because it takes time to talk about all these risk factors, and you can say, ‘Hey, I want you to go look at this website for teen driving. This will help.’ ”
Clinicians should generally cover with families the various risk factors, limit setting, use of GDLs, and parent-teen driving agreements. “Talk to parents about all these things. Talk to the teen; the teen will listen to you; you are an authority figure,” and “use interventional motivational techniques,” he said.
As parents control the vehicle their child drives, they should be counseled to give their teen the family’s safest car, preferably a newer, mid- to full-size vehicle with a small engine and modern safety features, according to Dr. O’Neil. “And we really do try to discourage teens buying their own cars because that sort of limits the parents’ leverage over them when they are starting to drive.”
Clinicians also should familiarize themselves with the driver’s education and similar resources in their community, including safe-driving initiatives spearheaded by groups such as Mothers Against Drunk Driving (MADD) . They also should work with schools and the police to support “risky driving” prevention efforts.
Special anticipatory guidance is warranted when the new teen driver has a relevant condition such as attention-deficit/hyperactivity disorder. These youth are two to four times more likely to have a motor vehicle accident than typical teen drivers.
They may benefit from extended-release ADHD medication or a booster dose of their medication to keep them covered while driving, according to Dr. O’Neil.
“You may want to talk to them about holding off. Maybe their brain hasn’t matured enough yet, and you want to delay their driving. You may want to do a longer period of supervised driving or consider other things we’ve talked about – electronic resources or using a bigger, safer vehicle,” he suggested. “And always, always, always encourage limiting of distractions while driving.”
Dr. O’Neil said he had no relevant conflicts of interest.