ADHD AND THE FAA

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:

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or other activities...;
2. Often has difficulty [remaining focused] in tasks or play activities...;
3. ...Mind seems elsewhere, even in the absence of any obvious distraction...;
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or work-related duties...;
5. Often has difficulty [in] organizing tasks and activities...;
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort...;
7. Often loses things necessary for tasks or activities...;
8. Is often easily distracted by extraneous stimuli...;
9. 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:

1. Often fidgets with or taps hands or feet or squirms in seat...;
2. Often leaves seat in situations when remaining seated is expected...;
3. Often runs about or climbs in situations where it is inappropriate...;
4. Often unable to play or engage in leisure activities quietly...;
5. Is often 'on the go,' acting as if 'driven by a motor' ...;
6. Often [talking] excessively;
7. ...Completes people’s sentences [or] cannot wait for turn in conversation...;
8. Often has difficulty [in] waiting his or her turn...;
9. Often interrupts or intrudes on others...."

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.