Until recently, it was a little-known fact that autism is listed as one of the conditions likely to affect someone’s ability to drive safely.
GPs – especially those in Queensland – can expect to receive an uptick in patients with autism inquiring about fitness-to-drive certificates, after mainstream media reports have shone a light on an obscure legal requirement.
The ABC has published two in-depth articles over the last week looking at the latest update to the Assessing Fitness to Drive standards, which followed a review of the existing evidence in early 2022.
Despite the review finding very little evidence linking an autism diagnosis to poor driving, the updated standards listed it as a condition that should be assessed individually.
It falls under the “medical standards for licensing – neurological conditions, other neurological conditions” section of the guidelines, which can be found on page 177.
What does the law say?
The standards state that a person is not fit to hold an unconditional licence if they have a neurological disorder that significantly impairs visuospatial perception, insight, judgement, behaviour, attention, comprehension, reaction time, memory, sensation, muscle power, coordination or vision.
A conditional licence may be considered after input from the treating doctor about the likely impact of the person’s neurological impairment on their driving ability, which is where GPs come in.
The standards apply nationally, meaning that GPs across all states and territories could feasibly see an increase in inquiries or interest from patients with autism left unsure about whether they’re required to notify the state transport authority about their condition.
Specific wording differs, but across most states and territories, drivers are legally required to report any long-term health condition or disability that has or may have an impact on their driving.
Queensland does it differently (as usual)
The state where GPs are most likely to be hearing from patients, though, is Queensland, where there’s an extra law – known as Jet’s Law – which imposes a fine of up to $9288 on drivers who don’t report medical or physical incapacities to the Department of Transport and Main Roads.
Under Jet’s Law, people with a health condition that may make it unsafe to drive are automatically disqualified from getting a driver’s licence.
Unless, that is, they get a medical certificate stating that they either do not have a mental or physical incapacity likely to affect their ability to drive safely or that provides enough information about the person’s mental or physical incapacity that the department feels comfortable enough to grant them a conditional licence.
According to the ABC, the department added autism to the list of reportable health conditions for Jet’s Law back in 2012.
The Medical Republic could not independently verify this claim, finding no mention of autism as a reportable condition on either the Transport and Main Roads medical fitness to drive information page or the Private and Commercial Vehicle Driver’s Health Assessment form.
The department did not answer TMR’s direct question on where to find this information.
Transport and Main Roads general manager Joanna Robinson said that everyone driving in Queensland has a legal obligation to notify the department about permanent or long-term medical conditions that are likely to impact their ability to drive safely.
She skirted around definitively stating whether people with autism are risking the $9288 fine if they don’t notify the department about their diagnosis.
“While autism may impact the ability of a person to drive safely, only long term or permanent medical conditions which are likely to adversely affect a person’s ability to drive safely must be reported to [Transport and Main Roads] and require a medical certificate to confirm they are fit to drive,” she said.
“If a person is unsure about whether their medical condition is likely to adversely affect their ability to drive safely, they are encouraged to seek medical advice about their specific condition.
“Relevant medical conditions are listed in the national Assessing Fitness to Drive publication.
“It is the treating doctor’s responsibility to assess medical fitness in accordance with the medical standards, principles and guidelines provided in [these guidelines].”
The department also said that there “is no specific legislation that states that autistic people cannot drive”.
What’s the actual evidence
One of the more intriguing aspects of this saga is that the review of fitness-to-drive medical standards found relatively little evidence to suggest that drivers with autism are any more or less unsafe than neurotypical drivers.
“A targeted literature review identified studies that suggest drivers with [autism spectrum disorder] drive differently from their neurotypical counterparts, noting shortcomings in tactical driving skills,” the review said.
“However, the extent to which this affected their own safety or the safety of other road users is unclear and there was not enough information to evaluate any [motor vehicle crash] or other road safety risk.
“Specialist advice noted that the variability of [autism spectrum disorder] characteristics and the degree of severity were too diverse for a specific standard.”
To be clear, the review team were unable to identify any systematic reviews that investigated the relationship between autism and motor vehicle crash risk, and only two studies that investigated the relationship between autism and self-reported crash risk.
One found no significant difference between autistic and neurotypical drivers in terms of self-reported collisions and the other found drivers with autism were slightly safer drivers.
A large review of 28 studies, however, identified that drivers with autism had more difficulty performing complex driving functions, more difficulty driving in heavy traffic and had decreased manoeuvring ability.
While the review itself concluded that there was not enough evidence to determine the crash risk associated with autism, the updated guidelines noted that people with autism can have “differences in social communication and interaction, with restricted and repetitive patterns of behaviour, interest and activities”.
“There is considerable difference in the range and severity of [autism spectrum disorder] symptoms, so assessment should focus on these and the significance of likely functional effects, rather than an [autism] diagnosis,” the guidelines read.
The specific issues that they might experience in relation to driving, according to the guidelines, range from managing attention and distraction to difficulty adapting to unexpected change and emotional regulation.