ADHD and the Athlete

Athletes are not spared from the risk of developmental disorders like learning disabilities and attention deficit hyperactivity disorder (ADHD).  Once an athlete is diagnosed with ADHD, the effect of this disorder and it's treatment on athletic performance becomes important.  

Dr. J. W. Parr recently published a comprehensive review of recent research and understanding of ADHD in the athlete.   The review includes a look at diagnostic issues as well as a summary of the neurobiology of ADHD.  After this general introduction, the review focuses on some key issues in athletes with ADHD.


Although some children with ADHD have motor performance problems the majority do not.  The effect of ADHD on athletic performance is somewhat related to individual sporting activity.  ADHD may be more of a sport performance problem in sports requiring prolonged attention, i.e. fencing and less of a problem in large muscle performance sports such as swimming and track and field.  Indeed, some of the world's most successful athletes have been diagnosed with ADHD.  Parr notes that multiple Olympic gold medal winner Michael Phelps has made it publicly known he has ADHD.


Additionally, Parr notes that ADHD appears to be as common in athletes as in the general population.  Using his unpublished observations of athletes at Texas A & M University, he estimates that 7 to 9% of all athletes are receiving stimulant and nonstimulant medications for ADHD.  Given the estimated community prevalence of ADHD at 4 to 7%, the prevalence of ADHD medication use in the Texas A & M athlete population suggests a prevalence at least as high as the general population.

Parr reviews the risk of substance abuse with stimulant medication.  He notes that the oral stimulant drugs in ADHD typically lack significant euphoric effects found with intravenous stimulant illicit drug use (i.e. cocaine or methamphetamine). 


There is increasing research examining the effect of ADHD stimulant drug use and performance.  Acute administration of methylphenidate or placebo to a group of cyclists (without ADHD) resulted in prolonged peak performance.   Whether chronic administration of stimulants in those with ADHD improves performance in unclear.  However, there is some data that supports a drop in motor performance in athletes with ADHD on days they skip or miss their ADHD medication.

Athletes commonly develop a pattern of dosing their medication in a manner that accommodates their sporting activity and perceived effects of medication on performance.  Parr notes this is somewhat of an individual decision.  He notes some baseball pitchers that always use their ADHD medications on days they are charting pitches but many do not take it before days they actually pitch.


Dr. Parr does not recommend routine EKG testing of athletes taking medication for ADHD.  He feels that there is no data to support an increased risk of cardiac death in athletes with ADHD on stimulant treatment.  However, he does note one area of medical concern with athletes using ADHD medications.  Some stimulants may impair thermoregulation and increase the risk of heat exhaustion or heat stroke.  He notes physicians and trainers should make sure to provide athletes with ADHD adequate hydration and increased surveillance for heat-related illness.

Many college athletes with ADHD are diagnosed at an early age.  Dr. Parr recommends all college level athletes receiving ADHD drugs submit a copy of the prescribing physicians assessment and treatment recommendations.  The NCAA recommends student athlete documentation in ADHD include:

• Comprehensive clinical evaluation
• Observations and results from ADHD rating scales
• Specific diagnosis
• Recommended treatment

Such prior documentation is necessary should an athlete test positive for a stimulant on urine drug testing.  Disclosure of stimulant use for medical reasons at the time of submitting a urine sample and prior documentation will be needed to address any positive urine drug test results.

This review of ADHD in the athlete is well-written and information for physicians, trainers and other medical staff working in a sports medicine setting.

Photo of 2011 Spring Training game between St. Louis Cardinals and Minnesota Twins in Jupiter, Florida courtesy of Yates photography. 

Parr JW (2011). Attention-deficit hyperactivity disorder and the athlete: new advances and understanding. Clinics in sports medicine, 30 (3), 591-610 PMID: 21658550