Preventing seat belt unbuckling in an individual with autism and ADHD: a case study

Vehicular accidents are a leading cause of mortality among adolescents and young adults. The American Academy of Paediatrics (AAP) advocates for seatbelt use to reduce injuries and fatalities. Individuals with special needs, including attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and developmental disabilities, present unique transportation safety challenges like frequent unbuckling. Despite increasing availability and use of aftermarket products designed to prevent unbuckling, their real-world effectiveness remains understudied.

This proof-of-concept single-case observational study describes the use of a customizable, malleable seatbelt cover in a 19-year-old female with ADHD and ASD who faced challenges with safe vehicular transport.

Data were collected in April 2025 across three conditions, where the subject was secured in the backseat with a seatbelt. She either: (i) rode with the parent driver (control), (ii) rode alongside a 1:1 behaviour therapist with the parent driver, or (iii) rode with the parent driver andseatbelt cover in place. Primary outcomes measured included unbuckling frequency over the approximately 25-minute car ride. In total, 8 rides occurred per condition.

Results revealed elimination of unbuckling events while the modifiable seatbelt cover was in place. The control condition yielded frequent unbuckling (mean: 5 events per ride), while the presence of a 1:1 therapist reduced these behaviors (mean: 0.75 events per ride). These exploratory findings show that utilizing the seatbelt cover and behavioral strategies together may reduce harmful unbuckling behaviours in individuals with ASD.

Further research assessing the generalizability of these interventions and risks/benefits of such aftermarket products is needed to prevent injury and death.