Toward Scalable Driver Readiness Screenings for Autistic Teens: Clinical Measures Correlated With Real-World Evaluations

Importance There are no standardized pathways to guide autistic adolescents through the learning-to-drive process, beginning with deciding whether they are ready to pursue driving. Objective To examine whether commonly used clinical assessments correlate with driver readiness determinations. Design Cross-sectional, nonexperimental study using a single in-person visit comprised of a clinical assessment and on-road passenger activities. Setting A primary care clinic in an urban city. Participants Twenty-one autistic adolescents aged 15–19 years without a learner's permit were recruited via email outreach. Inclusion criteria required English fluency and ability to complete an in-person 4-h visit. Outcomes and Measures Participants completed a clinical battery and on-road passenger activities. Readiness determinations were dichotomized into “Not Ready” or “Ready” for a formal driver evaluation. We conducted descriptive statistics, correlations, and positive predictive and negative predictive value tests to assess differences by clinical measures scores and readiness determinations. Results Seven participants were categorized as “Not Ready” and 14 as “Ready.” Strongest correlations with readiness were observed for Bruininks–Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) Short Form scores and Beery Visual–Motor Integration (VMI) scores. Potential cut points between groups included <22 on the Beery VMI raw score, >65 on the BOT-2 Total Point Score, >36 on the BOT-2 Standard Score, and ≥5 on the BOT-2 Transferring Pennies score. NIH Toolbox working memory and cognitive flexibility tasks showed moderate associations. Conclusions and Relevance Commonly used clinical assessments show preliminary associations with driver readiness outcomes. Findings support future development of a standardized screening battery to guide referral decisions and predriving skill development.