Every October, ADHD Awareness Month provides an opportunity to spark important conversations about understanding, inclusion and support for those living with Attention Deficit Hyperactivity Disorder (ADHD).
In the sporting world, that conversation takes on an additional layer of responsibility – particularly when it comes to the use of stimulant medications prescribed to manage the symptoms of ADHD.
For athletes, maintaining focus, energy, and mental clarity can be the difference between success and setback. Many with ADHD rely on medications such as methylphenidate (Ritalin, Concerta) or amphetamine-based treatments (Adderall, Vyvanse) to support their health and wellbeing.
|
Our latest news, resources, podcasts, courses and webinars:
|
However, what creates an added layer of complexity for athletes with ADHD, is that these substances are also listed on the World Anti-Doping Agency’s Prohibited List (S6 Stimulants) due to their potential performance-enhancing effects.
Sport Integrity Australia’s Medical Adviser, Dr Ian Murphy explained what ADHD is and how stimulant medications are used to treat the condition.
“ADHD is thought to occur due to problems with synaptic transmission (connections between individual neural cells allowing for transmission of signals) in the Central Nervous System – specifically the brain. The neurotransmitters (NTs) involved in these connections are dopamine and norepinephrine,” Dr Murphy said.
Stimulant medications work to increase the levels of dopamine and norepinephrine in the brain, helping to ease symptoms of the disorder such as impulsivity, hyperactivity, lack of focus, and motivation.
These treatments afford individuals greater control over their actions and may reduce the impulsivity that might otherwise be detrimental to their functioning.
— Dr Ian Murphy, Sport Integrity Australia’s Medical Adviser
Dr Murphy said that while having ADHD should never be a barrier to participation or performance, it is critical for sport participants and their support networks to understand their obligations and responsibilities of fair competition.
This includes understanding how Therapeutic Use Exemptions (TUEs) work, what substances require approval, and how to manage medications responsibly; this can help protect athletes from unintentional Anti-Doping Rule Violations, while ensuring they prioritise their own health and wellbeing.
A TUE permits an athlete to use a substance or method that is otherwise prohibited, strictly for legitimate medical treatment. In Australia, TUEs are managed and approved by the Australian Sports Drug Medical Advisory Committee (ASDMAC).
“Depending on the level an athlete is competing at, they may need to apply for a TUE in advance of competing,” Dr Murphy explained.
“In this regard, they should use the TUE checker on the SIA app and website, or seek advice from SIA regarding their status for needing to obtain a TUE.”
The Australian Institute of Health and Welfare (2024) reported the steady climb in the prescription of stimulants for the treatment of conditions such as ADHD since 2012.
Dr Murphy confirmed that the increased understanding and awareness of ADHD in recent years has seen a rise in the number of diagnoses and stimulant treatments of the neurodevelopmental disorder, particularly in adults.
This means there is an increased need for athletes to understand the TUE process and know their options.
“There is no one size that fits all advice here. Some athletes will require a TUE in advance based on the level they are competing at,” Dr Murphy warned.
“However, for others, the option of a retroactive TUE exists. An athlete that is in the situation of being on medication for ADHD should seek advice as soon as possible.”
Sydney-based sport psychiatrist and member of the Australian Sports Commission’s Mental Health Referral network, Dr Adam Martin, works alongside athletes and team physicians across the country, in the treatment of mood disorders like anxiety and depression and neurodivergent conditions such as ADHD.
He explains that the first safeguard is that athlete psychiatrists and treating physicians be judicious in their assessment, diagnosis and prescription of stimulant medications for the treatment of ADHD.
The first thing is knowing that stimulant medications are banned substances in sport, and that your patient will likely need to get a Therapeutic Use Exemption
— Dr Adam Martin, Sport Psychiatrist
“I think it’s important to look at the treatment of these conditions holistically, where alongside medications we also support with psychosocial strategies and coping skills.
“This can include basic life skills like organisation, emotional regulation, anxiety management and diet.”
He also encourages athlete support networks, particularly those of children and young athletes, to be aware of medication dosage and routines, to protect against sleep and appetite disturbances.
These factors are particularly important for athletes, ensuring they are getting the appropriate calories and rest needed to fuel their bodies.
Dr Martin also advised athletes or their parent/carer to seek education and be informed about the rules on stimulant medications in sport and the TUE application process, to avoid the adverse effects of medication withdrawals.
In the short term, it could be dysregulating if a person has been on medication for a long time and then stops it for the purpose of a competition
— Dr Adam Martin
“You might see sleep disturbance for instance, or problems around organisation and concentration – you would expect them to worsen.
“It's never a good idea to jump off psychiatric medications cold turkey. The risk is that you're then not treating a condition which you should be treating.”
He also provided reassurance to the sporting community on the impacts of these stimulant drugs where they are correctly and appropriately prescribed to those with ADHD.
“On the assumption that the condition is diagnosed correctly, the appropriate prescribing of stimulants works to treat a disorder and is bringing someone up to baseline rather than giving them an extra edge.”
Dr Martin explains that while stimulant drugs can enhance athletic performance by increasing heart rate, muscle contractility, and reducing perceptions of fatigue, athletic ability involves more than these factors – and stimulants may actually hinder performance in individuals with ADHD.
“There is the possibility that by regulating themselves with medication – say a footballer who relies on natural aggression and is channelling some of that effectively into their performance – could theoretically be made less aggressive or competitive on the sports field now.”
Sport Integrity Australia continues to work closely with sporting organisations, medical professionals, and athletes to develop and provide a range of educational courses and resources to ensure all athletes can continue to train and compete safely, fairly, and within the rules.
As ADHD Awareness Month continues, Sport Integrity Australia is encouraging all sport participants – from grassroots to elite – to take the time to understand their obligations in sport and expand their awareness through education, to protect the integrity of sport together.