Attention Deficit Hyperactivity Disorder (ADHD), formerly referred to as Attention Deficit Disorder (ADD) is considered by some to be a condition of the new millennium because of the numbers of individuals affected, including many adolescents and teens who are being treated for symptoms often associated with the condition. Unfortunately, these young people being treated are applying for medical certification and receiving an unhappy surprise when the FAA determines that they are not qualified for certification because of the diagnosis and/or use of disqualifying medications.
ADHD is a complex disorder to diagnose. 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:
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:
The condition presents with a common scenario seen by health care providers and by the FAA Aerospace Medical Certification Division: “My son’s teacher said he couldn’t sit still in class and was disruptive, so they sent us to our physician who placed him on medication”; “I was started on medication at the insistence of my parents who thought I have ADD.” 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 an extensive evaluation if an applicant for medical certification has been diagnosed with (an important point to keep in mind!) or is currently taking one of the medications used to treat this condition. If medications are being taken, they must be discontinued for at least 90 days and you will be asked to undergo a neuropsychological evaluation with a clinical psychologist or neuropsychologist. The testing is very familiar to the psychology world and consists of a battery of different tests that measure various areas of neurocognitive functioning. The evaluation is quite comprehensive and generally takes six or more exhausting 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 short and long-term memory, ability to multitask, and to understand and comply with instructions, and many other “executive” tasks. The psychologist can compare one’s scores to “normal” functioning individuals, rather than against the applicants’ own baseline scores since there is no baseline testing to compare to! This is one of the objections that opponents have for this type of evaluation process.
Many young folks are placed on these medications without ever being tested. They are prescribed the meds based on parental or personal concerns about attentiveness to tasks such as job or school performance or other demonstrated history. In many cases, people who are treated for apparent symptoms don’t really have ADHD, but in order to rule it out, a formal clinical evaluation should be done.
Some of the commonly-prescribed medications that individuals take for ADHD are Adderall, Concerta, Ritalin, Strattera, Vyvanse, and Dexedrine. All these medications are disqualifying for medical certification purposes!
If an applicant for a medical certificate has the diagnosis of ADHD and/or is taking medication for symptoms, the FAA requires a comprehensive evaluation to determine if the diagnosis exists. If someone really does have ADHD as reflected in the evaluation, the FAA will not be able to grant any class of medical certification.