The Use of Stimulant Medication to Treat Attention-Deficit/Hyperactivity Disorder in Elite Athletes: A Performance and Health Perspective

Abstract

The use of stimulants as a treatment for attention-deficit/hyperactivity disorder (ADHD) among elite athletes is a controversial area with some arguing that stimulant use should not be permitted because it offers an advantage to athletes (fair play perspective). Guided by an integrated model of athletic performance, we address common concerns raised about stimulant use in sports from our perspective, which we coined the "performance and health perspective," highlighting relevant research and pointing to gaps in empirical research that should be addressed before bans on use of stimulants for athletes with ADHD are considered. The current article posits that a stimulant ban for athletes with ADHD does not necessarily facilitate fair play, ensure safety, or align with existing policies of large governing bodies. Instead, we recommend that stimulant medication be allowed in high-level sport, following proper diagnosis by a trained professional and a cardiac assessment to confirm no underlying heart conditions. Athletes with ADHD approved to use stimulant medication should be monitored by a health care professional, physically reevaluated and reassessed for ADHD as clinically appropriate and as indicated by relevant sports governing bodies. This performance and health perspective is consistent with that of multiple sport governing bodies who offer therapeutic use.

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

“…Although there are athlete specific considerations within each category of psychiatric medications, there is a paucity of applicable research on the topic 56 60. Available studies have methodological flaws, including small sample sizes; medications are not used in real world dosages or time frames; populations studied are not representative of elite athletes; few female athletes are studied; performance measures used to determine if a medication has a negative impact on athletic performance may not represent actual performance impact; and study subjects often lack the mental health disorder that the medication is intended to treat 60–62. We acknowledge these limitations.…”

“…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.…”

Outcomes of Adverse Analytical Findings in Individual and Team Sports

“…The current system of TUEs allows athletes with clinical conditions to use some banned substances while competing in official events but there has been some argument against it [18]. The high number of TUEs conceded in particular sports, the high proportion of Olympic athletes that suffer from asthma [5], and the use of stimulants to treat athletes with attentiondeficit/hyperactivity disorder has also been questioned [19,20]. These concerns are aggravated in the light of the current data, because gymnastics, triathlon, shooting, aquatics, tennis, ice hockey, skiing, and cycling, with percentages varying from 45 to 12%, presented a higher proportion of exoneration after adverse findings due to medical reasons (Figure 1 and 2).…”

Sport-Specific Use of Doping Substances: Analysis of World Anti-Doping Agency Doping Control Tests between 2014 and 2017

“…Interestingly, stimulants are typically used as treatment for attention-deficit/hyperactivity disorder (ADHD) among elite athletes, which has raised concerns in last years. To this regard, it has been argued that stimulant use may be a reasonable option for school-age athletes with ADHD but no at the professional level (Reardon & Factor, 2016) while others state that banning therapeutic use of stimulants may lead to an unfair playing field for athletes with ADHD (Garner, Hansen, Baxley, & Ross, 2018). Gymnastics have a high proportion of young athletes it might be speculated that the high use of stimulants in this sport might be in part the result of the use of this type of drug as a treatment for ADHD.…”