Patient Presentation
A 15-year-old male came to clinic for a sports physical. During the interview he said that he was really excited because he had just gotten his driving learner’s permit.
His mother expressed ambivalence because she thought that he would be able to get his full license too soon, yet she was looking forward to having him help by driving his younger sister to various activities.
The social history revealed a teenager who was an A-B student, active in music and art, and with a stable circle of friends that his parents liked.
The pertinent physical exam showed a healthy teenager with growth parameters in the 50-90%. He had mild comedomal acne on his face.
The diagnosis of healthy teenager was made. The physician discussed with the teenager and parent some of the risk factors for increased crashes and injuries such as teenage passengers in the car, nighttime driving, speeding, not using seat belts and having distractions in the car such as music, eating, or cellular telephone use.
The family was well-aware of the state’s graduated driver licensing laws, but the physician also noted that the parents could decide on their own “family laws” which could be more restrictive. She also printed a sample teen driver contract for the family from the Academy of Pediatrics’ website for the family to consider when talking about the rights and responsibilities of driving.
Discussion
Motor vehicle accidents are the leading case of death for 16-20 years olds in the United States, resulting in ~5500 fatalities yearly. Teenage drivers are only 6% of drivers but account for 14% of the fatal crashes.
The younger the driver, the higher the crash rates. Males have higher crash rates and fatalities than females.
There are many reasons for these higher rates including:
- Driving inexperience – driving is a complex activity that the teen has not yet learned
- Increased risk taking – as a part of normal adoelscent behavior
- Nighttime driving – it is more difficult to drive at night
- Drug, alcohol and medication use – impairs judgement
- Distractions – using a cellular telephone, eating, etc. Teenage passengers are especially a problematic distraction.
- Unlicensed drivers
- Safety belt use – teenagers use seatbelts less often than adults
- Attention deficit hyperactivity disorder
- Vehicles driven – teens tend to drive smaller, older model cars which tend to have less safety features, sporty vehicles may also encourage speeding
Learning Point
Graduated driver licensing (GDL) was first put into effect in Florida in 1996. In 2007, 44 states have some type of GDL law.
GDL laws phase in on-road driving that allows inexperienced drivers to gain experience under lower risk situations and gradually introduces then to more complex situations as they gain experience.
There are 3 general stages:
- Learner’s licensing stage – where driving is permitted under direct supervision
- Intermediate licensing stage – where driving is not directly supervised but allowed only in less risky situations (i.e. daytime driving or limited nighttime driving, no passengers or limited passengers)
- Full licensing stage – when the driver has shown proficiency at the first two stages
The GDL laws vary by state with substantial variations in the exact policies for the stages and the time period for each stage. A comprehensive listing of current state laws can be found in the “To Learn More” section below.
Studies support the efficacy of GDL laws.
One study showed GDL laws decreased injuries and fatalities for 16 year old drivers by 38-40%.
According to the Insurance Institute for Highway Safety “In an optimal system, the minimum age for a learner’s permit is 16; the learner stage lasts at least 6 months, during which parents must certify at
least 30-50 hours of supervised driving; and the intermediate stage lasts until at least age 18 and includes both a night driving restriction starting at
9 or 10 p.m. and a strict teenage passenger restriction allowing no teenage passengers, or no more than one teenage passenger.”
A sample teen driving contracts between parents and the teenage driver which outlines the privileges and responsibilities of driving are available in the “To Learn More” section below.
Questions for Further Discussion
1. What are the driving laws for teenagers who work in agriculture?
2. What are the driving laws restrictions for people with different medical conditions such as seizures?
Related Cases
- Disease
- Symptom/Presentation
- Age
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Information prescriptions for patients can be found at MedlinePlus for this topic: Motor Vehicle Safety.
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Insurance Institute for Highway Safety and Traffic Injury Research Foundation. Graduated Licensing:
A Blueprint for North America.
Available from the Internet at http://www.iihs.org/laws/state_laws/pdf/blueprint.pdf (rev. August 2004, cited 7/19/2007).
National Highway and Transportation Safety Administration. Graduated Driver Licensing.
Available from the Internet at http://www.nhtsa.dot.gov/people/injury/NewDriver/GraduatedDriverLicense/index.htm (rev. September 2006, cited 7/19/2007).
American Academy of Pediatrics Policy Statement. The Teen Driver. Pediatrics 2006:18;2570-2571. Available from the Internet at: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;118/6/2570.pdf (rev. December 2006, cited 7/19/2007).
Barker SP, Chen L, Li G. Nationwide Review of Graduated Driver Licensing. AAA Foundation for Traffic Safety.
Available from the Internet at http://www.aaafoundation.org/pdf/NationwideReviewOfGDLSummary.pdf (rev. February 2007, cited 7/19/2007).
Insurance Institute for Highway Safety. U.S. Licensing Systems for Young Drivers.
Available from the Internet at http://www.iihs.org/laws/state_laws/pdf/us_licensing_systems.pdf (rev. May 2007, cited 7/19/2007).
Allstate Insurance Company. Parent-Teen Driving Contract. U.S. Licensing Systems for Young Drivers.
Available from the Internet at http://www.allstateteendriver.com/files/parent-teen-contract.pdf (rev. 2007, cited 7/25/2007).
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
5. Patients and their families are counseled and educated.
6. Information technology to support patient care decisions and patient education is used.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
14. Knowledge of study designs and statistical methods to appraisal clinical studies and other information on diagnostic and therapeutic effectiveness is applied.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, Children’s Hospital of Iowa
Date
September 10, 2007
Pediatric Education 