Attention Deficit Hyperactivity Disorder or Not?

I know you’ll find this hard to believe but diseases sometimes can be fads. In other words some disorders catch the public fancy and all of a sudden “everyone’s got it”. Entities such as Chronic Fatigue Syndrome, fibromyalgia, Lyme’s Disease all are documented illnesses and can be very serious but a lot of people decide they have them because they don’t have any better explanation for their problems. Sad to say, sometimes a health care provider erroneously tags someone with one of these labels. From what we see here in an AME’s office, that seems to apply to Attention Deficit Hyperactivity Disorder (ADHD). Don’t get me wrong. ADHD is a common and serious mental health problem. If you do indeed have it it’s important that it be diagnosed and treated. However, we see a number of potential airmen who come in and report that sometime in their childhood or adolescence they were said to have ADHD. They were put on medicine for a while and then tapered off for whatever reason. They feel fine and they look fine today. However, they have the label and the FAA is not about to issue a medical certificate until they know whether or not the diagnosis way back when was correct or not.

What does ADHD look like? As you might guess, it is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. An ADHD patient wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized. These problems are not due to defiance or lack of comprehension. A person with ADHD seems to move about constantly, or excessively fidgets, taps, or talks. Adults may exhibit extreme restlessness or wearing others out with constant activity. A person with ADHD may take hasty actions without first thinking about them. That may have high potential for harm. He may have a desire for immediate rewards or inability to delay gratification. He may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences. Put all of these behaviors into a cockpit and disaster is just around the next cloud! I’m sure you can see why the FAA takes a really close look at an airman with possible ADHD.

The problem is, some kids are just naturally full of life and a little rambunctious. That’s not ADHD. However, if they are not at the top of their class parents sometimes get upset. If an otherwise normal kid is a little too disruptive in class teachers get upset. They want an answer. They want a solution. So the kid gets a pill for ADHD. Its been repeatedly shown that if you give a sugar pill to folks, no matter what’s wrong with them, about a third of people will feel a bit better. The rambunctious kid gets a little more attention from his parents, his teacher, his doctor. He feels somewhat better. He’s labeled with ADHD. However, the diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind normal development for his or her age. The doctor should also make sure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children who truly have ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.

Poorly controlled ADHD or some of the medications used to treat it may be incompatible with safe operation of an aircraft. To get your medical you will have to work with your AME to obtain any necessary evaluations and other past medical records for a neuropsychologist and the FAA to review. They will want to determine the validity of the diagnosis. If you have it they will want to determine if it is well-controlled. To do this you will have to undergo a neuropsychological evaluation by an FAA approved examiner. There are two in Minneapolis and one in Rochester. If you find you do OK off ADHD medications and have stopped them you must wait 90 days before testing and evaluation. You want to make sure that the neuropsychologist’s office can perform a urine drug screen for ADHD medications. You will have to pass a specimen at the time of the exam or within 24 hours. You will also have to send all you medical records as well as academic records to the neuropsychologist for her review before testing. Once all that is done, trot over to your AME and get a flight physical. He will defer issuing a certificate and send it into the FAA. They will mull over all of that stuff and if testing is favorable and there’s nothing else wrong, you’ll get your medical certificate!