I am glad to see pushback from the autistic community about the new Austroads Australian driver standards, which for the first time recently added autism to the list of health conditions which can preclude someone from holding a drivers license. The ABC reported yesterday that “Autistic drivers could find their licences in legal limbo depending on where they live after new standards introduced by Austroads Assessing Fitness to Drive (AFTD)“. The change means autistic drivers, who may have been driving for decades incident-free, may now need to pay for a specialised “fitness to drive” test if they wish to retain their license. Which of course is not just an extra practical or financial hurdle (although it is both those things) because this also means that autistic people are at the mercy of the assessing specialist (who may hold their own stigma and ignorance around autism and neurodivergence) and who now holds the power to deem that the person is not fit to drive, resulting in significant bad outcomes such as loss of mobility, and potentially loss of access to work and community.

According to Austroads, drivers need good vision, physical ability, and cognitive capacity to undertake the complex task of driving a motor vehicle”. The standards exist to guide health professionals in when to refer patients for a driver assessment or allied health assessment of their fitness to drive. Medical exclusions from driving can occur when conditions like epilepsy, or even a one-off seizure, make you a medical risk to drive. I found this out the hard way after having a post-partum seizure, when I was advised that I couldn’t drive for six months. There was a quantifiable medical risk that, having had one seizure, I might have another one, while driving. These kinds of medical exclusions or conditions on driving are not new, but now, autism has been tucked under the assessment provisions along with “other developmental and intellectual disabilities” (all emphasis is theirs):

A person is not fit to hold an unconditional licence:

  • if the person has a neurological disorder that significantly impairs any of the following: visuospatial perception, insight, judgement, behaviour, attention, comprehension, reaction time, memory, sensation, muscle power, coordination and vision (including visual fields).

conditional licence may be considered by the driver licensing authority subject to periodic review*, taking into account:

  • the nature of the driving task; and
  • information provided by the treating doctor about the likely impact of the neurological impairment on driving ability; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1. Practical driver assessments).

Periodic review may not be necessary if the condition is static.

I note that the criteria the driver is being assessed against is quite subjective: “significant impairment” – significant by what standard? There is no guidance provided around this. And the caveat at the bottom “Periodic review may not be necessary if the condition is static” is tricky as it perpetuates the outdated idea that autistic people are each fixed in a static point on a spectrum. If you’re familiar with the “Level 1, Level 2” classification of autism for the purposes of demonstrating level of need in NDIS applications, you know how inaccurate and unhelpful these fixed labels are. We know that functioning and coping can be variable not just across the lifespan but due to a range of other factors. I’d hate it if my permission to drive was being judged (as is eligibility for financial support from the NDIS) on how I function on my worst day. And, is it really appropriate to do that, anyway? I think most people wouldn’t want to be judged that way. So again, autistic people may actually be subject to regular reviews of their fitness to drive at the whim of the assessor they get allocated on the day. More barriers, more expense.

Maddeningly, the new driver standards actually acknowledge that the addition of autism to the list of conditions which can warrant testing and potentially exclusion from driving is not based on an evidence base of people having traffic accidents because they are so busy flapping their hands or taking their hands off the wheel in a sensory rage to take off their unbearably itchy jumpers. There’s no spate of autism-fuelled traffic accidents here, no insurance premiums being spiked because autistic drivers are a menace behind the wheel. The document actually acknowledges ” evidence from driving studies are limited…” but still proceeds with the the neurotype defense: “Drivers with ASD may (emphasis mine, citation needed) drive differently from people without ASD. May. It doesn’t provide any citations from this limited evidence base, but does claim that “shortcomings in tactical driving skills have been observed, while rule-following aspects of driving are improved”. So autism may make you a worse driver in some ways, and better in others.

Side note: I bet you if they started cross-referencing actuarial tables looking at road accidents, they would probably be able to make a better case against precluding ADHDers from driving. We would likely be overrepresented in accidents caused by speeding, or by substance or alcohol misuse, as ADHD brains, especially those who are undiagnosed, unmedicated and unsupported, because ADHD brains are more prone to impulsive behaviour and addiction. So yeah, we with ADHD need to be paying close attention to the targetting of autistic drivers and speaking up.

Bless Ro Bersten for pointing out in her interview with the ABC, that autistic drivers have already proven their fitness to drive through the drivers test.

“To pass a driver’s test, there are practical items that are checked off, and you’ve either done them or you haven’t. So it shouldn’t matter what the neurotype of the tester or the participant is — because you either have passed the test or you haven’t passed the test.”

I am disappointed in the medical professionals or bodies on the consultation body which had input into this change to the Austroads standards. As the health professionals in the conversation, they were probably the closest thing to advocates that autistic people had in the room. The outcome – a blanket classification of all autistic people as needing to prove their fitness to drive, was made despite the lack of evidence supporting this move. Our understanding of, and advocacy for, neurodivergent people is yet again being dictated by the medical profession as though having a different neurotype is a medical illness, where there are always deficits assumed, unless we can pass an extra hurdle to prove our fitness to drive.

This is part of a larger problem than just access to driving. This blanket discrimination-by-neurotype is all too common across the Australian workforce, and in a country where ADHD can be used to deny employment in police services, armed forces and civil aviation, we in the ADHD community need to be speaking out against creating classes of people by neurotype, which is what is happening here. If merely being autistic is enough to make you need to pass an extra test to prove your fitness to drive, we ADHDers need to speak up, as ADHD could very easily be the next neurotype to be targeted this way.

When I wrote my Making Sense of Adult ADHD program, I did a dive into how neurodivergence is treated in the workforce, and the discriminatory practices baked into the Australian workforce, which means that people need to consider the potential negative effects of obtaining a formal diagnosis, or of disclosing their ADHD to an employer. Discrimination happens, both unlawful and with legal sanction.

In August this year, The Guardian reported on the different approaches to ADHD taken by police across the nation, highlighting that an ADHD diagnosis can disqualify an applicant from joining the police in some states. If you follow the links above to the articles about discrimination against ADHD in police services, armed forces and civil aviation, you’ll see just why treating neurodivergent neurotypes like autism or ADHD as though they are mental health conditions which can and should be ‘recovered from’ is problematic, both from a human rights perspective, but also from a health and safety perspective. They treat ADHD like a disease or mental health crisis that you can recover from, or leave behind in childhood, or ” get remission” from. Quite often, their employment criteria may exclude people with an ADHD unless the person is “in remission” which they define as symptom free and not medicated. For some employers, such as the Queensland Police, ADHD job applicants must not have been on ADHD medication, or receiving treatment such as counselling, and have been symptom-free for two years. This is an outdated way to conceptualise neurodivergence and it is dangerous. It used to be believed that some adults “grow out of” ADHD, but evidence increasingly shows that the architecture of our brains and nervous systems doesn’t change. An adult who through developing coping or masking skills doesn’t “show” symptoms still has an ADHD brain. But perhaps the pertinent thing to point out here is: ADHDers are healthier and safer when we are diagnosed, and receive appropriate support and medication. If I go off my ADHD meds and stop accessing counselling, I doubt I will have the level of mental health and wellbeing that I have right now as a properly supported ADHDer. Granted, the armed forces enact the same discrimination against people with chronic health conditions such as diabetes, who require medication ongoing – it is not operationally safe to send people into a warzone who might get cut off from their meds, the argument goes. Sadly the trend to disqualify people from jobs due to their ADHD incentives them to avoid diagnosis, lie or choose not to disclose their ADHD, or eschew treatment and medication, for fear of losing access to these jobs. It is not safe to create an environment where people have an incentive to hide their neurotype and not receive the appropriate treatment or support.

Discrimination and othering by neurotype is historically what the medical profession and the DSM have done (The DSM is the Psychiatrist-authored Diagnostic and Statistical Manual, which creates the labels and criteria for diagnosis for mental illnesses and conditions including autism and ADHD). Science always boils down to the best explanation we have at the time, and its the intended purpose of evidence-based science and medicine that we update our knowledge as it is proven to be outdated. But scientific and medical literature including the DSM is not immune to human foibles. It’s always been a product of, and produced in, the social knowledge, ignorance and biases of its day. I mean, homosexuality appeared in the DSM as a disorder until 1973. Sadly the DSM, which is intended to be a technical document outlining diagnostic criteria, has had an overly powerful role in creating our society’s understanding of autistic and ADHD people, and because of its diagnostic background, has built our society’s understanding of our neurodivergence as deficit.

Neurotype-discrimination against drivers has happened before – I refer you to the 2019 Change.org petition to the UK Government to “remove neurodevelopmental conditions from the list of DVLA (Drive and Vehicle Licensing Authority) compulsory notifiable conditions” on the grounds that ” “being singled out for compulsory notification, without any evidence that we are collectively less safe than other road users, is an act of disability discrimination”. The community backlash worked, leading the DVLA to announce:

“We have amended the advice on GOV.UK for both drivers and medical professionals which make it clear that a driver who has an autism spectrum disorder only need tell us if their condition could affect their driving.”

Can we hope for a similar outcome here?