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Attention deficit hyperactivity disorder (ADHD) is an important issue for the physician taking care of athletes since ADHD is common in the athletic population, and comorbid issues affect athletes of all ages. The health care provider taking care of athletes should be familiar with making the diagnosis of ADHD, the management of ADHD, and how treatment medications impact exercise and performance. In this statement, the term "Team Physician" is used in reference to all healthcare providers that take care of athletes. These providers should understand the side effects of medications, regulatory issues regarding stimulant medications, and indications for additional testing. This position statement is not intended to be a comprehensive review of ADHD, but rather a directed review of the core issues related to the athlete with ADHD.

Context:Attention deficit hyperactivity disorder (ADHD) is common in the general population, and many individuals with this condition participate in sports activity at all competition levels.Evidence Acquisition:Related studies were selected through literature searches of PubMed, MEDLINE, and Cochrane databases for the years 1991 to 2011. Key search terms were ADD, ADHD, sports, athletes, athletics, guidelines, NCAA, WADA, IOC, college, concussion, diagnosis, management, treatment, evaluation, return-to-play, pharmacotherapy, adult, adolescent, student, screening, injury, risk, neuropsychiatry, TBI, traumatic brain injury, and epidemiology.Study Design:Literature review.Level of Evidence:Level 4.Results:ADHD usually has an early onset, with delayed diagnosis in some patients due to heterogeneous presentations. Suspected cases can be evaluated with available diagnostic tools and confirmed clinically. Athletes with ADHD may participate at all competition levels.Conclusion:Athletes with ADHD are able to participate at all competition levels by following published guidelines and requirements. Exercise benefits many athletes with ADHD. The relationship between ADHD and concussion syndromes is currently under investigation.

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Diabetes mellitus is the most common group of metabolic diseases and is characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Most patients with diabetes are type 2 (90%); the remaining patients have type 1 disease. Athletes with diabetes range from the athlete participating in various youth sports to the competitive Olympic athlete and present a significant challenge to themselves and the medical staff who care for them on a daily basis. Each sport and the type of exercise have their own effects on diabetes management with numerous factors that significantly affect glucose levels, including stress, level of hydration, the rate of glycogenolysis and gluconeogenesis, and the secretion of counter-regulatory hormones. This article provides a general overview of diabetes mellitus, the effects of exercise on glucose levels, and a detailed review of the potential complications encountered in the management of diabetes in the athlete.

Patients with T2DM who are empowered with knowledge about their disease and treatment can take an active role in their diabetes care, and therefore, are more likely to achieve blood glucose and A1C goals, which can slow progression of their disease and the onset of complications. Although concentrating solely on medical information and physiological facts does not guarantee patient empowerment and self-management, educational strategies such as interactive teaching, problem solving and individualized education can have a positive impact. Insulin titration algorithms can empower patients to manage their therapy, and such algorithms are simple to use for patients treated with insulin analogs. As patients with T2DM become empowered by knowledge and gain more control of their disease, their physicians must then serve as their advisors rather than as their directors or prescribers.

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