Athletes With Attention-Deficit/Hyperactivity Disorder: Position Statement of the American Medical Society for Sports Medicine
Pujalte GGA, Narducci DM, Smith MS, King R, Logan K, Callender SS, Liebman CA, Kane SF, Israel MP, Wolf SF, Nuti R, Khodaee M. Clin J Sport Med. 2023 May 1;33(3):195-208. doi: 10.1097/JSM.0000000000001152. PMID: 37185161.
The American Medical Society for Sports Medicine (AMSSM) updated their 2011 position statement on athletes with attention deficit/hyperactivity disorder (ADHD). The authors address the diagnosis and management of ADHD; ADHD mimics and pattern identification for differentiation; issues related to diversity, equity, and inclusivity; the role of exercise in treating ADHD; effects of ADHD on sport participation; effects of ADHD medications on athletic performance; and the relationship between ADHD and concussions. Table 8 offers the key clinical recommendations.
This information is very good to know as an Athletic Trainer. We work with our patients day in and day out. Recognition of similar symptomology when referring can be a game changer as some of the conditions in the listed differential diagnosis (such as autism, iron deficiency, anemia, seizure disorder, cardiac conditions, and sleep disorders) are not initially thought of when assessing a patient in certain contexts and require referral to a different specialist, like with the cardiac conditions. As Athletic Trainers, we are part of the referral process as discussed, however, medicine is not a straight answer and often trial and modifications occur when talking about treatment options/medication. With this review, it gives a reminder of other avenues and better advocacy for our patients.
Additionally, it has been widely known that females have a hx of getting diagnoses at a later age due to differences in presentation and associated disciplinary actions often taken in schools in the male population. Again, this sets a reminder of the importance of health determinants and diversity in health care. As a health care professional, it is our duty to be thorough in our assessments to fully understand the situation as the black community is 2/3rd less likely to be recognized as having ADHD. Since the hypotheses presented in this article highlights the lack of access, inability to afford the health care needed, stigma, and apparent language barriers as some of the reasons ADHD may be missed in the minority populations, the job of an Athletic Trainer can vastly mitigate that by even being hired in our position. We offer services and resources without an additional price tag. We are quickly being employed in a variety of locations and settings that would increase accessibility to a health care professional, and are trained on educating against stigmas related to mental disorders such as ADHD’s classification.
However, the recommendation for athletes with apprehension of pharmacological innervations can seek out exercise as a replacement is something I am struggling to grasp as they are already athletes competing in a sport that is exercise in itself, with additional training and conditioning days, regardless of the level of athlete. I am just confused on the plan for an athlete taking this route as described in the article. Athletes are doing more than 30 minutes of moderate-to-intense aerobic exercise which is also stated in the article as having improved functions. So, if one of my athletes is having ADHD symptoms, is the exercise method even an option?
Some more interesting take aways are the impact of ADHD on concussion potentially increasing length of time before RTP, but taking a stimulant for their ADHD may lessen the prevalence of concussions in those with ADHD. The options for non-pharm treatments like Omega-3 fatty acid and EPA ratio supplements may help; as well as caffeine as an option to investigate, and non-stimulate medication options.
I am a MSAT student at James Madison University and I really liked learning more about ADHD in athletes. ADHD and mental health issues are becoming much more openly talked about and it is important as athletic trainers to properly care for our athletes.
I was already aware that this needed to be documented as many stimulants are banned in the NCAA/sports leagues unless prescribed by a doctor. What I found interesting was that there is actually a higher rate of ADHD in athletes when compared to the general population. I also learned that there are other medical factors that you should be aware of with athletes with ADHD, such as a higher core temperature. This feels very important to me to know, as if you are aware of an athlete having ADHD you can now know they are at a higher risk for heat related illnesses. There are also a lot of side effects to the medications these athletes will take. This also feels important to know as some symptoms that athletes present with may be able to be connected to their medication that they’re on. Also, a common symptom is decreased appetite, so it can be helpful to know that to be able to better monitor your athletes and make sure that they are properly fueled for their sports. I was also simply shocked to find out that there is a higher prevalence of concussions in athletes with ADHD than those without. I would be intrigued to see more research into that.
Hello, my name is Kayla Jackson, and I am a 2nd-year master’s student in an athletic training program. It was interesting to read about athletes with attention-deficit/hyperactivity disorder and something very relevant to my clinical practice. This article taught me a few new things about ADHD, such as the various treatment options for patients, how and what to educate coaches and families on, and the specific behavioral characteristics to be aware of. As a young clinician, mental health diagnoses are something we will come across a lot. We must be educated and aware of how this might impact our athletes as a whole person and not just physically when performing their sport. One thing that stood out to me was that exercise can be a treatment option for ADHD. Young athletes who are skeptical about psychostimulant medications can use exercise as an alternative. Exercise allows individuals to build motor coordination and balance while improving their psychosocial skills. I also thought mentioning a team approach for discussing and choosing the coping strategies and treatment plan for the athlete dealing with ADHD was very helpful. In my program, we are always taught that patient-centered care involves a team-based approach. When everyone works together to successfully treat a patient while keeping their best interest in mind, the outcomes for the patient are more significant and positive.
My name is Skyler Naves and I am currently a second year MSAT student at James Madison University. I found it very interesting reading about attention-deficit/hyperactivity disorder within athletes and how it can relate to the Athletic Training field. ADHD and mental health are becoming common in the athletic population and talking about it more within our profession could help emphasis how important it is to provide adequate quality of care for the athlete involved. I learned many things after reading this article. One thing that I learned while reading this article was that ADHD medication can potentially improve an athlete’s reaction time, alertness, anaerobic, and endurance performance which could eventually improve overall athletic performance. I did not realize that this type of medication could improve the following factors listed above. It’s good to know as an AT so that if an athlete is taking a stimulant medication for their ADHD, that we have the proper documentation and file it within their medical records. While reading the article, I also learned that as athletic trainers, we need to take into account the medical factors that play a role while taking some ADHD medications. The article mentioned that athletes taking certain ADHD medication could have side effects including a higher core temperature than others. This is extremely important to take into account as an AT since heat illness is something that we are taught in clinical practice. Understanding the risk of these medication can be extremely beneficial when preventing a heat illness in athlete’s who are prescribed ADHD medications. Overall, this article was very informative and provides great details of how to properly give the best, patient focused quality of care within athletes who suffer from ADHD.