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ADHD often persists into adolescence when motor vehicle crash risk peaks. Small studies suggest that adolescents with ADHD have increased crash risk, but had substantial methodologic limitations and were conducted before Graduated Driver Licensing polices were implemented.We conducted the first longitudinal study to estimate crash rates over the early years of licensure among adolescent drivers with ADHD identified in a community setting.We identified residents in the US state of New Jersey (NJ) born 1987–1997 who were patients of the Children’s Hospital of Philadelphia’s primary care practices. Electronic health records were linked to NJ’s licensing and crash databases from 2004–2014. Subjects with an ICD-9-CM diagnostic code of ‘314.x’ were classified as having ADHD. We compared crash, citation, and license suspension rates for 1769 licensed drivers with ADHD and 13 167 without ADHD via Poisson regression, and compared crash circumstances for crash-involved subjects.Over the first four years of licensure, rates for all outcomes were consistently higher for drivers with ADHD including: crashes (adjRR: 1.36, 95% CI: 1.26, 1.48); moving violation citations (1.47 [1.36, 1.58]); and license suspensions (1.32 [1.08, 1.61]). Drivers with ADHD who crashed within 2 years of licensure were responsible in 77% of crashes compared with 70% of drivers without ADHD (p<0.001). The most common crash-contributing driver action was inattention (45% vs 41% of drivers with and without ADHD, respectively, p=0.05). Crash types were not significantly different for responsible drivers with and without ADHD.Adolescent drivers with ADHD had higher crash, citation, and license suspension rates than drivers without ADHD over the first four years of licensure. However, the manner by which adolescents crash is not substantially different by ADHD status.Tailored interventions for adolescents with ADHD are needed; driver training programs should include a focus on attention while driving.