Driving

Adolescence is characterized by milestone after milestone on a route that starts with early puberty and progresses to virtually complete autonomy by young adulthood. Obtaining a driver’s license is among the most meaningful steps along this path in terms of independence, responsibility, and risk. Learning to drive is a pragmatic, almost unique opportunity, as it often brings together a highly motivated teenager and concerned parents working together on a task over considerable time.

Teaching a teenager to drive encompasses teaching a skill, demonstrating an attitude, and communicating values concerning safety, peer relationships, paying for added expenses, and "adult" responsibility with rewards and consequences in the real world where not even parents can fix potential harms.

Driving is a major issue in pediatric primary care, as automobile accidents are the leading cause of morbidity and mortality in children under 18 years. Pediatricians can offer parents critical guidance about helping their children master this skill, appreciate the level of risk involved, add to their growing sense of the value of money, and balance new privileges with added expectations.

Pediatricians should be aware of their state’s laws regulating when adolescents may get a driver’s permit, what they have to do to get their driver’s license, and even additional regulations around when adolescents can drive unaccompanied or with friends. One guideline to optimize safety is for the "learner" to get as many miles of practice as possible under parental supervision. The first year or two of driving carries the highest risk of accident; extensive practice may mitigate that risk. Many adolescents take "drivers ed," but these limited hours may be more effective after many informal driving lessons with a parent or other trusted relative.

All parents have vivid memories of how they were taught to drive. Pediatricians might ask parents what learning to drive was like and what it meant to them. Do the parents want to repeat or modify their own experience when they have a "second" chance with their teenager? Parents bring unique knowledge of their child’s strengths and vulnerabilities as well as their own adolescent experiences to help guide any additional rules they may wish to put in place.

Some adolescents, because of their anxiety, will be in no hurry to get their driver’s license. If your family lives where public transportation is good, there may be no need to push him faster than he can comfortably handle. But it can be helpful for parents to wonder with these adolescents what could be helpful about driving, such as whether it might be useful for building peer relationships, commuting to a summer job, or college. And the parent can be curious about what his teenager’s greatest anxiety about driving is. It may be easily addressed ("What if I run out of gas?"), or more profound. In either case, giving an anxious adolescent a chance to articulate what he is concerned about and to consider when the advantages of driving will outweigh the risks, can help him to feel he is actively choosing when to drive, not just passively waiting to feel less scared. This is an important distinction that can have resonance with later choices that may be intimidating, but necessary to normal development.

Then there are the parents in your practice who wish their adolescent were a bit more anxious. Their child is the eager, confident, leap-before-you-look type, which poses a different set of challenges with driving. This adolescent would benefit from a more methodical, structured approach to getting her driver’s license. Extensive driving practice should help to provide enough concerning moments to temper her bravado. Stricter rules (and consequences for breaking those rules) around practicing and driving will help the intrepid adolescent develop self-control as she expands her skills gradually.

Among the most worrisome teenagers are those who are very impulsive, including those with attention-deficit/hyperactivity disorder. It may be wise to require that this teen take his ADHD medication before driving, or have additional rules about friends and phones to minimize distractions; creating more structure and rules around this privilege can make a lifesaving difference for the impulsive teenager. During extensive practice sessions, there will be clear evidence of ADHD behaviors and how they impact driving, and these are teachable moments to build the adolescent’s self-awareness.

Driving safely is hard enough, and special efforts are necessary concerning the highest-risk behaviors. Parents are both regulators and role models on driving – with speed, courtesy, seat belts, cellphones, alcohol use, etc. It is hard to stay credible when parental behavior and teaching are not consistent.

Cell phones deserve a special discussion from parents, whether or not their children are highly distractible. Adolescents tend to be more frequently on the phone, texting, or updating their Facebook status. Having a phone available while alone in the car is a great safety plan, in case there is an accident or problem with the car. But parents need to have an explicit conversation about good car habits. It may be helpful for parents to ask that their children text once before driving and then when the car is off, or to keep the phone in the glove compartment in order to resist the urge to answer or return a call or text. There should be very strict consequences for texting while driving, in addition to any legal ones, ideally losing the privilege for a long enough time to be memorable. It is not overly dramatic for parents to have a conversation with their child about the likelihood of dying or killing someone as a result of something as simple as sending a text, and to use local reports of accidents to reinforce this standard.

The conversation about good driving habits also should focus on drugs and alcohol. Parents need to be able to tell their children about the serious dangers and legal consequences of driving drunk. But they also should be clear that any drug could impair their driving skills; marijuana is no safer to use before driving than alcohol. They should have a clear plan in place that will either rigidly follow the rule concerning the "designated driver" or facilitate their child calling them or a cab if they ever have used alcohol or drugs when out driving, without fear of significant repercussions. It is critical to establish that safety always comes first, and that it will always be helpful to be honest with parents when managing difficult situations.

Parents should consider whether driving privileges should require some financial contribution from their new driver to the car, gas, or insurance payments. This is a good time to step back and consider the parents’ values concerning money, the direction of the teenager’s attitudes, and how the costs of gas, insurance, or even an additional car fit into the values and priorities of the family. Contributing to the costs of a car can be very motivating to a teenager who might otherwise not be enthusiastic about working. For a busy and productive adolescent (and where the family can afford the costs), there may be less need to use car costs as leverage. Certainly, contributing money or service to the family is all part of new adult responsibilities that come with a license. Driving is an adult responsibility, and presents an ideal opportunity to teach adolescents about the balance between privileges and responsibilities, and about the family’s values about money.

Like other milestones in adolescence, driving can be an opportunity to add to the warmth and trust of an increasingly adult relationship between parent and teenager. Alternatively, driving can become a bitter struggle between parental control and the developmental push to autonomy. There will be errors and mistakes with both the technical and judgment aspects of this new territory.

Parents’ job is to protect teens from mistakes that are irreparable, while facilitating their expanding independence. In setting rules and expectations, parents can emphasize their confidence in their adolescent’s capacity to handle all the requirements of driving, while also impressing upon their teen the seriousness of this new privilege.

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also chief clinical officer at Partners HealthCare, also in Boston. E-mail Dr. Swick and Dr. Jellinek at [email protected].

Adolescence is characterized by milestone after milestone on a route that starts with early puberty and progresses to virtually complete autonomy by young adulthood. Obtaining a driver’s license is among the most meaningful steps along this path in terms of independence, responsibility, and risk. Learning to drive is a pragmatic, almost unique opportunity, as it often brings together a highly motivated teenager and concerned parents working together on a task over considerable time.

Teaching a teenager to drive encompasses teaching a skill, demonstrating an attitude, and communicating values concerning safety, peer relationships, paying for added expenses, and "adult" responsibility with rewards and consequences in the real world where not even parents can fix potential harms.

Driving is a major issue in pediatric primary care, as automobile accidents are the leading cause of morbidity and mortality in children under 18 years. Pediatricians can offer parents critical guidance about helping their children master this skill, appreciate the level of risk involved, add to their growing sense of the value of money, and balance new privileges with added expectations.

Pediatricians should be aware of their state’s laws regulating when adolescents may get a driver’s permit, what they have to do to get their driver’s license, and even additional regulations around when adolescents can drive unaccompanied or with friends. One guideline to optimize safety is for the "learner" to get as many miles of practice as possible under parental supervision. The first year or two of driving carries the highest risk of accident; extensive practice may mitigate that risk. Many adolescents take "drivers ed," but these limited hours may be more effective after many informal driving lessons with a parent or other trusted relative.

All parents have vivid memories of how they were taught to drive. Pediatricians might ask parents what learning to drive was like and what it meant to them. Do the parents want to repeat or modify their own experience when they have a "second" chance with their teenager? Parents bring unique knowledge of their child’s strengths and vulnerabilities as well as their own adolescent experiences to help guide any additional rules they may wish to put in place.

Some adolescents, because of their anxiety, will be in no hurry to get their driver’s license. If your family lives where public transportation is good, there may be no need to push him faster than he can comfortably handle. But it can be helpful for parents to wonder with these adolescents what could be helpful about driving, such as whether it might be useful for building peer relationships, commuting to a summer job, or college. And the parent can be curious about what his teenager’s greatest anxiety about driving is. It may be easily addressed ("What if I run out of gas?"), or more profound. In either case, giving an anxious adolescent a chance to articulate what he is concerned about and to consider when the advantages of driving will outweigh the risks, can help him to feel he is actively choosing when to drive, not just passively waiting to feel less scared. This is an important distinction that can have resonance with later choices that may be intimidating, but necessary to normal development.

Then there are the parents in your practice who wish their adolescent were a bit more anxious. Their child is the eager, confident, leap-before-you-look type, which poses a different set of challenges with driving. This adolescent would benefit from a more methodical, structured approach to getting her driver’s license. Extensive driving practice should help to provide enough concerning moments to temper her bravado. Stricter rules (and consequences for breaking those rules) around practicing and driving will help the intrepid adolescent develop self-control as she expands her skills gradually.

Among the most worrisome teenagers are those who are very impulsive, including those with attention-deficit/hyperactivity disorder. It may be wise to require that this teen take his ADHD medication before driving, or have additional rules about friends and phones to minimize distractions; creating more structure and rules around this privilege can make a lifesaving difference for the impulsive teenager. During extensive practice sessions, there will be clear evidence of ADHD behaviors and how they impact driving, and these are teachable moments to build the adolescent’s self-awareness.

Driving safely is hard enough, and special efforts are necessary concerning the highest-risk behaviors. Parents are both regulators and role models on driving – with speed, courtesy, seat belts, cellphones, alcohol use, etc. It is hard to stay credible when parental behavior and teaching are not consistent.

Cell phones deserve a special discussion from parents, whether or not their children are highly distractible. Adolescents tend to be more frequently on the phone, texting, or updating their Facebook status. Having a phone available while alone in the car is a great safety plan, in case there is an accident or problem with the car. But parents need to have an explicit conversation about good car habits. It may be helpful for parents to ask that their children text once before driving and then when the car is off, or to keep the phone in the glove compartment in order to resist the urge to answer or return a call or text. There should be very strict consequences for texting while driving, in addition to any legal ones, ideally losing the privilege for a long enough time to be memorable. It is not overly dramatic for parents to have a conversation with their child about the likelihood of dying or killing someone as a result of something as simple as sending a text, and to use local reports of accidents to reinforce this standard.

The conversation about good driving habits also should focus on drugs and alcohol. Parents need to be able to tell their children about the serious dangers and legal consequences of driving drunk. But they also should be clear that any drug could impair their driving skills; marijuana is no safer to use before driving than alcohol. They should have a clear plan in place that will either rigidly follow the rule concerning the "designated driver" or facilitate their child calling them or a cab if they ever have used alcohol or drugs when out driving, without fear of significant repercussions. It is critical to establish that safety always comes first, and that it will always be helpful to be honest with parents when managing difficult situations.

Parents should consider whether driving privileges should require some financial contribution from their new driver to the car, gas, or insurance payments. This is a good time to step back and consider the parents’ values concerning money, the direction of the teenager’s attitudes, and how the costs of gas, insurance, or even an additional car fit into the values and priorities of the family. Contributing to the costs of a car can be very motivating to a teenager who might otherwise not be enthusiastic about working. For a busy and productive adolescent (and where the family can afford the costs), there may be less need to use car costs as leverage. Certainly, contributing money or service to the family is all part of new adult responsibilities that come with a license. Driving is an adult responsibility, and presents an ideal opportunity to teach adolescents about the balance between privileges and responsibilities, and about the family’s values about money.

Like other milestones in adolescence, driving can be an opportunity to add to the warmth and trust of an increasingly adult relationship between parent and teenager. Alternatively, driving can become a bitter struggle between parental control and the developmental push to autonomy. There will be errors and mistakes with both the technical and judgment aspects of this new territory.

Parents’ job is to protect teens from mistakes that are irreparable, while facilitating their expanding independence. In setting rules and expectations, parents can emphasize their confidence in their adolescent’s capacity to handle all the requirements of driving, while also impressing upon their teen the seriousness of this new privilege.

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also chief clinical officer at Partners HealthCare, also in Boston. E-mail Dr. Swick and Dr. Jellinek at [email protected].

Adolescence is characterized by milestone after milestone on a route that starts with early puberty and progresses to virtually complete autonomy by young adulthood. Obtaining a driver’s license is among the most meaningful steps along this path in terms of independence, responsibility, and risk. Learning to drive is a pragmatic, almost unique opportunity, as it often brings together a highly motivated teenager and concerned parents working together on a task over considerable time.

Teaching a teenager to drive encompasses teaching a skill, demonstrating an attitude, and communicating values concerning safety, peer relationships, paying for added expenses, and "adult" responsibility with rewards and consequences in the real world where not even parents can fix potential harms.

Driving is a major issue in pediatric primary care, as automobile accidents are the leading cause of morbidity and mortality in children under 18 years. Pediatricians can offer parents critical guidance about helping their children master this skill, appreciate the level of risk involved, add to their growing sense of the value of money, and balance new privileges with added expectations.

Pediatricians should be aware of their state’s laws regulating when adolescents may get a driver’s permit, what they have to do to get their driver’s license, and even additional regulations around when adolescents can drive unaccompanied or with friends. One guideline to optimize safety is for the "learner" to get as many miles of practice as possible under parental supervision. The first year or two of driving carries the highest risk of accident; extensive practice may mitigate that risk. Many adolescents take "drivers ed," but these limited hours may be more effective after many informal driving lessons with a parent or other trusted relative.

All parents have vivid memories of how they were taught to drive. Pediatricians might ask parents what learning to drive was like and what it meant to them. Do the parents want to repeat or modify their own experience when they have a "second" chance with their teenager? Parents bring unique knowledge of their child’s strengths and vulnerabilities as well as their own adolescent experiences to help guide any additional rules they may wish to put in place.

Some adolescents, because of their anxiety, will be in no hurry to get their driver’s license. If your family lives where public transportation is good, there may be no need to push him faster than he can comfortably handle. But it can be helpful for parents to wonder with these adolescents what could be helpful about driving, such as whether it might be useful for building peer relationships, commuting to a summer job, or college. And the parent can be curious about what his teenager’s greatest anxiety about driving is. It may be easily addressed ("What if I run out of gas?"), or more profound. In either case, giving an anxious adolescent a chance to articulate what he is concerned about and to consider when the advantages of driving will outweigh the risks, can help him to feel he is actively choosing when to drive, not just passively waiting to feel less scared. This is an important distinction that can have resonance with later choices that may be intimidating, but necessary to normal development.

Then there are the parents in your practice who wish their adolescent were a bit more anxious. Their child is the eager, confident, leap-before-you-look type, which poses a different set of challenges with driving. This adolescent would benefit from a more methodical, structured approach to getting her driver’s license. Extensive driving practice should help to provide enough concerning moments to temper her bravado. Stricter rules (and consequences for breaking those rules) around practicing and driving will help the intrepid adolescent develop self-control as she expands her skills gradually.

Among the most worrisome teenagers are those who are very impulsive, including those with attention-deficit/hyperactivity disorder. It may be wise to require that this teen take his ADHD medication before driving, or have additional rules about friends and phones to minimize distractions; creating more structure and rules around this privilege can make a lifesaving difference for the impulsive teenager. During extensive practice sessions, there will be clear evidence of ADHD behaviors and how they impact driving, and these are teachable moments to build the adolescent’s self-awareness.

Driving safely is hard enough, and special efforts are necessary concerning the highest-risk behaviors. Parents are both regulators and role models on driving – with speed, courtesy, seat belts, cellphones, alcohol use, etc. It is hard to stay credible when parental behavior and teaching are not consistent.

Cell phones deserve a special discussion from parents, whether or not their children are highly distractible. Adolescents tend to be more frequently on the phone, texting, or updating their Facebook status. Having a phone available while alone in the car is a great safety plan, in case there is an accident or problem with the car. But parents need to have an explicit conversation about good car habits. It may be helpful for parents to ask that their children text once before driving and then when the car is off, or to keep the phone in the glove compartment in order to resist the urge to answer or return a call or text. There should be very strict consequences for texting while driving, in addition to any legal ones, ideally losing the privilege for a long enough time to be memorable. It is not overly dramatic for parents to have a conversation with their child about the likelihood of dying or killing someone as a result of something as simple as sending a text, and to use local reports of accidents to reinforce this standard.

The conversation about good driving habits also should focus on drugs and alcohol. Parents need to be able to tell their children about the serious dangers and legal consequences of driving drunk. But they also should be clear that any drug could impair their driving skills; marijuana is no safer to use before driving than alcohol. They should have a clear plan in place that will either rigidly follow the rule concerning the "designated driver" or facilitate their child calling them or a cab if they ever have used alcohol or drugs when out driving, without fear of significant repercussions. It is critical to establish that safety always comes first, and that it will always be helpful to be honest with parents when managing difficult situations.

Parents should consider whether driving privileges should require some financial contribution from their new driver to the car, gas, or insurance payments. This is a good time to step back and consider the parents’ values concerning money, the direction of the teenager’s attitudes, and how the costs of gas, insurance, or even an additional car fit into the values and priorities of the family. Contributing to the costs of a car can be very motivating to a teenager who might otherwise not be enthusiastic about working. For a busy and productive adolescent (and where the family can afford the costs), there may be less need to use car costs as leverage. Certainly, contributing money or service to the family is all part of new adult responsibilities that come with a license. Driving is an adult responsibility, and presents an ideal opportunity to teach adolescents about the balance between privileges and responsibilities, and about the family’s values about money.

Like other milestones in adolescence, driving can be an opportunity to add to the warmth and trust of an increasingly adult relationship between parent and teenager. Alternatively, driving can become a bitter struggle between parental control and the developmental push to autonomy. There will be errors and mistakes with both the technical and judgment aspects of this new territory.

Parents’ job is to protect teens from mistakes that are irreparable, while facilitating their expanding independence. In setting rules and expectations, parents can emphasize their confidence in their adolescent’s capacity to handle all the requirements of driving, while also impressing upon their teen the seriousness of this new privilege.

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also chief clinical officer at Partners HealthCare, also in Boston. E-mail Dr. Swick and Dr. Jellinek at [email protected].