ADHD may be more common among elite athletes

By Carolyn Crist

(Reuters Health) - ADHD (attention-deficit/hyperactivity disorder) may be more common in elite athletes, a new research review suggests.

In fact, ADHD likely plays a role in some athletes' career choices and achievements, and proper management of the condition is important for safety and performance, the review authors note in the British Journal of Sports Medicine.

Often, however, "elite athletes can't get proper treatment and care due to lack of knowledge and stigma," said study author Dr. Doug Hyun Han of Chung Ang University Hospital in Seoul, South Korea.

ADHD is a common brain condition that affects an estimated 3% to 7% of people worldwide, and roughly 7% to 8% of elite athletes, the review team notes. The condition can include problems with attention and impulsivity that cause difficulties in academic, work and personal relationships.

"The focus of management should be on medications and psychosocial treatment to optimize long-term outcomes for elite athletes in sport and life," Han told Reuters Health by email.

Han, with coauthors from the U.S. National Collegiate Athletic Association, the University of Maryland and University of Wisconsin-Madison, searched medical databases for research involving ADHD, sports participation and elite athletes at professional, Olympic or collegiate levels.

Han and colleagues couldn't find many official reports or previous research about ADHD in elite athletes, but the few existing reports seem to indicate that rates are higher than in the general population. In a 2018 systematic review of 17 studies, about 4% to 8% of 15- to 19-year-old athletes had ADHD. In another study, 7% of college athletes were taking stimulant medication for ADHD.

The review authors also looked at ADHD medication use documented under Major League Baseball's Therapeutic Use Exemption, which allows athletes to request permission to take a medication on the World Anti-Doping Agency Prohibited List. During the 2017-2018 off-season until the end of the 2018 season, 101 players, or 8.4%, were granted exemptions.

The authors note that other conditions might explain ADHD-like symptoms or exist alongside the disorder, such as mood disorders, anxiety disorders, intellectual and learning disorders, autism spectrum disorder and substance use disorders. Concussion, for example, is frequently reported in athletes alongside ADHD, and ADHD is associated with prolonged recovery after a concussion. Such associated conditions could impair sports performance, the reviewers note.

Still, studies have shown that elite players, especially in baseball and basketball, may benefit from being impulsive, the authors write. A study of Korean professional baseball players found they had higher than average novelty-seeking traits, which are linked with hyperactivity, exhilaration and excitement with new stimuli. Sports participation itself could be a physical outlet for intense emotion and stress, reducing ADHD symptoms, the reviewers add.

"ADHD might actually have positive effects on sports performance, and we need to study that more," said Dr. George Pujalte, a sports medicine specialist at the Mayo Clinic in Jacksonville, Florida, who wasn't involved in the review.

Sports that require reactive decision-making and quick movements could benefit, he said. The phenomenon of "hyperfocusing" may allow athletes to block out distractions, for instance. At the same time, stimulants can be misused for performance enhancement, so mental health professionals, nutritionists and sports physicians should work together to help elite athletes manage their ADHD.

"Researchers are just scratching the surface on understanding the unique effects of ADHD on athletes," Pujalte told Reuters Health by email. "We need to keep an open and inquisitive mind whenever we hear about high-level athletes with the condition or who are taking stimulants."

SOURCE: British Journal of Sports Medicine, online May 16, 2019.