Attention Deficit Hyperactivity Disorder: Unique Considerations in Athletes

Abstract

Context:Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition in the general population, with evidence suggesting that it may be more common among athletes.Evidence Acquisition:Literature searches were performed on PubMed, MEDLINE, and Cochrane databases for the years 2000 to 2016 utilizing the following key search terms: ADHD, ADD, guidelines, diagnosis, athlete, sports, treatment, pharmacotherapy, stimulants, risk, cardiovascular effects, concussion, and traumatic brain injury (TBI).Study Design:Clinical review.Level of Evidence:Level 4.Results:ADHD exists among athletes at all levels of play, and symptomatology overlaps significantly with that of concussion. Treatment with stimulants has cardiovascular effects and may not be permitted by the athlete’s governing body. An athlete’s level of competition and individual cardiovascular risk factors may therefore affect medication choices.Conclusion:ADHD diagnosis and treatment are paramount to optimal quality of life and functioning in affected individuals. Pharmacologic treatment options should not specifically be avoided in athletes; however, stimulant use is an independent risk factor for heat illness. Concussion, a common athletic injury, may have an altered course in those affected by ADHD, specifically with regard to neurocognitive testing and recovery.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

“…In managing ADHD in elite athletes, psychosocial interventions should be used;57 these interventions may be as effective as—and should be considered an alternative to—stimulant medication in athletes with mild functional impairment 306 309 320–325. Depending on the age of the elite athlete, treatment may include: behaviour therapy or CBT; individual education plans; parent teaching/training and caregiver support; and education for athletes, families and coaches 308 321 326…”

“…Stimulants are a primary pharmacological treatment for ADHD 62 211 306 309 321 322 324 325 327. Such medications, including those in the methylphenidate and mixed amphetamine salts classes, may be ergogenic,328 329 and are misused because of the perception of performance enhancement 306 322 324 325 327 330.…”

Cognitive Disorders Among Incoming College Football Athletes: Legal and Medical Implications of Undisclosed Inclusion in Concussion Research

“…This is of particular concern when athletes practice or compete in the heat. Stewman et al 135 also note that stimulant use is an independent risk factor for heat illness. Recently, the independent investigation into the death of University of Maryland student and football athlete Jordan McNair found that McNair was on a prescription of Vyvanse (50mg dose).…”

Interaction between Age, Sex, and Mental Health Status as Precipitating Factors for Symptom Presentation in Concussed Individuals

“…Children with neurodevelopmental disorders such as ADHD have been found to have a greater lifetime history of concussion [19,20] but this is not a consistent finding [15].…”

“…Age also plays a significant role in concussion symptom presentation with peaks occurring in young adulthood (15)(16)(17)(18)(19) years old) and those over 65 years old [12]. Among individuals older than 65, falls are responsible for more than 50% of concussions, while in young adults, motor vehicle accidents and sports-related concussions are most common [12].…”