Considerations in the Care of Athletes With Attention Deficit Hyperactivity Disorder

Abstract

Athletes' performance and quality of life can be negatively affected by ADHD. Risks exist for those who take ADHD medications. More research is needed on the implications ADHD may have in specific sports, and on possible advantages of medication use. Potential deleterious effects of these medications should be addressed.

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. Like classic stimulants, the psychostimulant modafinil reportedly may mask symptoms of fatigue 331.…”

“…Athletes taking stimulants may be able to exercise to higher core body temperatures without perceived thermal stress,212 thereby raising concerns about both performance enhancement and safety 212. Stimulants may cause several side effects, including insomnia, anxiety, increased heart rate and blood pressure, and an undesired decrease in appetite, all of which can negatively impact performance and threaten athlete safety 211 306 309 322 324 325…”

“…Bupropion, an antidepressant with some stimulant properties, is sometimes used off label for ADHD,306 322 335 especially for individuals with comorbid depression. Clonidine and guanfacine in extended release formulations are approved in some countries for use in children under the age of 18 years with ADHD (which could include elite athletes) 325 336. These latter two medications have not been studied in elite athletes, but sedation and cardiac side effects such as hypotension, bradycardia and QTc prolongation are possible side effects 336 337.…”

“…These latter two medications have not been studied in elite athletes, but sedation and cardiac side effects such as hypotension, bradycardia and QTc prolongation are possible side effects 336 337. Tricyclic antidepressants may also be used off label for ADHD,325 but side effects such as sedation, weight gain, cardiac arrhythmias and dry mouth may preclude their use in elite athletes 305…”