When I worked at the FAA, I used to say that Attention Deficit Hyperactivity Disorder (ADHD) was one of the conditions of the new millennium because we saw many cases. I suspect many of these mainly younger airmen were surprised when they received a letter from the FAA.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines ADHD as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by” the following symptoms:
Inattention: Six (or more) of the following symptoms [that] have persisted for...6 months ... that negatively impacts directly on social and academic/occupational activities:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or other activities...;
- Often has difficulty [remaining focused] in tasks or play activities...;
- ...Mind seems elsewhere, even in the absence of any obvious distraction...;
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties [at work]...;
- Often has difficulty [in] organizing tasks and activities...;
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort...;
- Often loses things necessary for tasks or activities...;
- Is often easily distracted by extraneous stimuli...;
- Is often forgetful in daily activities....
Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that. .. negatively impacts directly on social and academic/occupational activities:
- Often fidgets with or taps hands or feet or squirms in seat...;
- Often leaves seat in situations when remaining seated is expected...;
- Often runs about or climbs in situations where it is inappropriate...;
- Often unable to play or engage in leisure activities quietly...;
- Is often “on the go,” acting as if “driven by a motor”...;
- Often [talking] excessively;
- ...Completes people’s sentences [or] cannot wait for turn in conversation...;
- Often has difficulty [in] waiting his or her turn...;
- Often interrupts or intrudes on others....
We heard these stories all the time: “My son’s teacher said he couldn’t sit still in class and was disruptive, so they sent me to our physician who placed him on a medication”; “I was started on such and such medication at the insistence of my parents, who thought I had this condition.” There are many student pilots out there who are taking the stimulant or stimulant-type medications and find out only when they go to the aviation medical examiner that both the medication and the condition are unacceptable for medical certification and receive a denial.
The FAA requires any airman who either has received the diagnosis or is taking one of the medications used to treat this condition to be off the medication for at least 90 days and undergo a neuropsychological evaluation with a clinical psychologist. This type of testing is very familiar to the aerospace medicine specialist as it is used extensively to evaluate neurocognitive functioning. The evaluation is a battery of different tests that measure different aspects of brain function. It is very comprehensive and generally takes six or more hours to perform. The complement of tests provides an objective way for the clinical psychologist to test for ADHD and any other underlying pathology that affects one’s memory, ability to multitask, understand instructions, and many other executive tasks. The psychologist can compare one’s scores to “normal” functioning individuals. Many young folks are placed on these medications without being tested. They are given them based solely on a history. In many cases they do not even have the condition, which is one reason why the FAA requires the testing.
Some of the medications that individuals take for ADHD are Adderall, Concerta, Ritalin, Strattera, Vyvanse, and Dexedrine. Take note: These medications are either amphetamine-based or methylphenidate-based stimulants. The FAA does not accept the use of any of these medications.
So potential airmen who have received this diagnosis or are taking one of the medications need to demonstrate whether they have the condition; if they do, then they will be denied medical certification.