Taking the wheel: Driving with disabilities

For many, obtaining a driver's license is a right of passage to independence.  Learn how to successfully navigate this passage and determine the rules of the roadway in the world of special needs.

by Holly Olmsted-Hickey, One Place for Special Needs


Do I Really Need a Specialist to Learn to Drive?iStock photo Driver training
If you have special needs, a driver rehabilitation program may be a necessary intervention when learning to drive a vehicle.  Drivers are often referred to a driver rehabilitation program by physicians, eye doctors, occupational therapists, driving schools, parents, high schools and state-sponsored vocational programs.  Referrals are usually made due to a significant break in the driving routine; a need of further evaluation due to injury or illness; or a need for additional training before acquiring a license. 

When a medical condition limits visual, physical, sensory, and/or cognitive function as it relates to the task of driving, having the instruction of a Certified Driver Rehabilitation Specialist (CDRS) provides the optimal outcomes to create a successful, independent driver.

What a CDRS offers over regular driving instruction is specific training, experience and understanding when it comes to both physical and “invisible” special needs (such as learning disabilities, dyslexia, and high-functioning autism). To receive a CDRS credential, the requirements include:

A. An undergraduate degree or higher in a health related area of study with 1- year full-time experience in degree area of study and an additional 1-year full- time experience in the field of Driver Rehabilitation.
B. A four-year undergraduate degree or higher with a major or minor in Traffic Safety and/or a Driver and Traffic Safety Endorsement with 1-year full-time experience in Traffic Safety and an additional 2 years of full-time experience in the field of Driver Rehabilitation.
C. Two-year degree in a health-related area of study with 1 year experience in degree area of study and an additional 3 years full-time experience in the field of Driver Rehabilitation.
D. Five years of full-time work experience in the field of Driver Rehabilitation.

With this credential, there is no doubt you are working with a qualified professional in the area of driver rehabilitation, training and instruction. After taking your driving and personal history, a CDRS will evaluate your physical skills and behind-the-wheel abilities including vision, perception, thinking, motor function and reaction time.   After this initial evaluation, the CDRS then evaluates your behind-the-wheel driving skills, including maneuvering skills, residential and highway driving and driving in moderate to high traffic. Based on these assessments, your driver rehabilitation specialist may recommend one of the following:

  • New driver behind-the-wheel training, with or without adaptive equipment.
  • Behind-the-wheel training with adaptive equipment for experienced drivers.
  • Reviewing and re-establishing driving skills for experienced drivers.
  • Alternative transportation options to discuss with you and your family.

While instruction may follow a certain course of action, individuals are treated with the one-to-one attention necessary to achieve success as a licensed driver.  Typical appointments last anywhere from 45 minutes to up to two hours, allowing ample time for drivers to get comfortable with their surroundings and driving behind the wheel of the vehicle.

To Drive or Not to Drive: That is the Question
How does a parent know if their child is ready to drive? This is an important question whether the individual is typically developing or has special needs.  Some teenagers with physical disabilities who, with adaptive equipment, may have the skills, readiness and maturity that their typical peers may not.  That said, there are prerequisite questions before a driver ever gets behind the wheel of a vehicle, says CDRS and Occupational Therapist Anne Hegberg of Marianjoy’s Driver Rehabilitation Program in Wheaton, Illinois.

Questions such as:
Do you know how to ride a bicycle?
Can you be at home alone?
How interested are you in learning to drive?
How determined are you to learn to drive?
How are your attention skills?
How are your processing skills?

For those who pass initial evaluations and screenings and are able to learn to drive, the timing of the day a driver’s license is issued still varies from individual to individual.  “There are some students who are former drivers who have been affected with a traumatic brain injury that can reacquire the essentials of driving relatively quickly,” says CDRS and President of the Northeast Chapter of the Association of Driver Rehabilitation Specialists Matthew Meltzer. “There are also teenagers who are first time drivers that pick up just as quickly while some may need more time to process certain aspects of the roadway.” 

Meltzer is also the owner of Meltzer's Driver Training Center in New York.  It is a deeply-rooted, family-owned and run business with almost 90 years of professional driving instruction including a renowned specialty in driver rehabilitation.  With almost forty years of professional driving instruction experience, he has taught thousands of learning-disabled students (or students with learning differences) and physically disabled students (or “differently-abled” as he likes to put it), to drive. Meltzer notes that it is not unusual for people with learning differences to take a long time to learn to drive. For some it may be 30 or 40 hours and others, 100 or more hours.  It is very individualized to the needs of the person driving.

What accommodations are made for special needs drivers? 
Accommodations can range from adaptive devices for the physically challenged to the gift of more time to get settled and comfortable for those with driving anxieties or “invisible disabilities,” such as high functioning autism or a nonverbal learning disorder.  There are a variety of adaptive modifications that can be added to a vehicle to make it drivable for someone with a physical disability.  Not only are there the commonly used wheelchair lifts, but there are hand controls, extension levers, raised floors, repositioned gas or brake pedals and even higher technology such as joysticks for gas, brakes and steering.  What once was a barrier for those with physical disabilities is newfound independence with the use of some of the following adaptive devices for vehicles:

Hand controls: Used with a hand when one cannot use either leg

Steering wheel spinner - Can be used with either hand when only one hand available.

Directional cross-over level - For the right hand, when the left directional has awkward access.

Left hand gear shift - For left hand use, when regular gearshift access is awkward.

Gear shift extension - Makes the gear shift more accessible.

Parking brake extension level - Makes the parking brake more accessible.

Left foot accelerator pedal with an original manufacturer equipment (OEM) Gas Pedal Block - This sits to the left of the brake pedal.  When right foot is out of service, the OEM Pedal block prevents inadvertent use of OEM accelerator.

Transfer board - Helps driver move from wheelchair to front seat of vehicle.

Torso support positioning belt - This does not replace a seatbelt, but does help the body retain position without moving side to side.

2" to 15" pedal extensions - Help for those who require brake or gas pedal extensions due to shorter leg length.

2" raised floor - Allow smaller feet to rest on floor.

Specially made add on side view mirrors - Allow for better visual capability of vehicle surroundings for those with head turning issues.

Air bag disconnect switch - When one must sit too close to the vehicle air bag for safety.
Seat cushions - (2" to 8") To increase height of driver to see three inches above the steering wheel.

Ignition key extender - For those with limited strength.

It is important to note that it is strongly advised to have the appropriate evaluation and training with any piece of adaptive equipment.  It should not be purchased used or ordered through the Internet.

When an individual can't drive
Both Hegberg and Meltzer agree, getting their students out on the road as independent, skilled, licensed drivers is the most satisfying part of their jobs.  But when should a person not be allowed behind the wheel of a car? Unfortunately, there are some things that cannot be changed when it comes to determining whether a driver can hold a license or not.  Sometimes there is a particular disabling condition that does not permit a driver to drive a vehicle. Some examples of significant issues that can be determining factors in getting licensed to drive:

  • An exaggerated startle reflex, often seen in those with cerebral palsy patients, might make it impossible to drive or even to keep one's hands on the wheel
  • Visual perceptual problems detecting where the center is in space makes it difficult to determine the car’s positioning in the roadway
  • Rule-boundaries of an Asperger’s client or an inability to read the faces or emotions of other drivers – surprised by a person in a hurry passing them
  • Emotionally not ready to drive (too angry, too nervous, too anxious)
  • General lack of maturity

According to Hegberg, even after 20 years as a specialist, one of the hardest things about being a CDRS is telling someone they cannot drive.  “Driver Rehabilitation Specialists often need to act as an impartial third party for drivers with questionable skills,” says Hegberg.  “Taking away that source of independence can be crushing.” 

When obtaining a driver’s license or driving a vehicle isn’t an option, public transportation provides a necessary source of independence.  Hegberg encourages public transportation whether able or unable to drive noting that the ability to navigate your surroundings is a key to independence.

Some resources to help when driving is not possible:
City or county public transportation
Family support
Neighborhood taxi service
Local Department of Health and Rehabilitative Services.

Work on driving skills now
If you have a child that either isn’t of driving age or needs to work on certain skills before learning to drive, what can be done?  Here are some ideas:

Have the child participate in the driving activity as an “active passenger” by looking around and knowing where you are. While sitting in the passenger seat, point out surroundings, note the weather and give driving instructions including when to accelerate, turn and stop. 

Talk to your passenger when you are in the driver’s seat.  Create a better understanding and awareness of your surroundings from the road conditions (rain, snow or even the emerging winter and spring potholes) to noticing pedestrians on the street corners.

Riding a bike is often a good prerequisite to driving as far as understanding the rules of the road.

An excellent exercise is to give detailed directions of how you are going to get from one place to another by car without even turning the ignition.  Recite your car trip by naming streets, buildings and landmarks along the mental route while noting turn directions and stop signs.  This can be done from both a driver and passenger perspective.

Those with physical and invisible challenges understand the meaning of “Never say never.”  Being an independent and skilled driver with a disability is often possible.  Knowing yourself, understanding and respecting your goals and limitations are the keys to creating the independent driver with disabilities.

More reading

The Great Big Guide to Disability Driving Resources

Association for Driver Rehabilitation Specialists

Find your state's Department of Motor Vehicles

Holly Olmsted-HickeyAbout the writer

Holly Olmsted-Hickey is the married mom of two boys, an autistic spectrum teenager and a typically developing six-year-old, each with their own gifts and challenges.  She is the Development Manager for One Place for Special Needs and, in her spare time, the leader of The Windy City Chicagoland Apraxia Network and blogger/writer at waitingroomtherapy.wordpress.com.  She drinks a lot of coffee, plays softball to relieve stress and enjoys an occasional nap. Reprint permission granted if you include: Reprinted with permission from One Place for Special Needs http://www.oneplaceforspecialneeds.com