Vehicle crashes are a leading cause of death among teens. Teens with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or both (ADHD–ASD) may have a greater crash risk. We examined the between-groups demographic, clinical, and predriving performance differences of 22 teens with ADHD–ASD (mean age = 15.05, standard deviation [SD] = 0.95) and 22 healthy control (HC) teens (mean age = 14.32, SD = 0.72). Compared with HC teens, the teens with ADHD–ASD performed more poorly on right-eye visual acuity, selective attention, visual–motor integration, cognition, and motor performance and made more errors on the driving simulator pertaining to visual scanning, speed regulation, lane maintenance, adjustment to stimuli, and total number of driving errors. Teens with ADHD–ASD, compared with HC teens, may have more predriving deficits and as such require the skills of a certified driving rehabilitation specialist to assess readiness to drive.