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The blog of a travelling psychiatrist and football lover. Who happens to be a halfway decent photographer. Takes a cynical view of the world

Archive for the tag “adhd football”

ADHD and Sport.The Russians Hack into medical records. How many athletes have ADHD and should they receive treatments?


So the result of an almighty hack into the medical records of USA competitors in the Rio Olympics tells us not unsurprisingly that  a few use Oxycodone for pain,  a few use steroids or derivates and Simone Biles the world’s leading gymnast uses Methylphenidate ( which sadly most of the world including The Times, think is synonymous with Ritalin , when a little education would tell folks that there are multiple formulations ).  All these drugs were evaluated by independent doctors and judged to be fit for purpose. Nothing here is new.  In fact Olympic-level athletes must submit a therapeutic use exemption (TUE) form to the Therapeutic Use Exemption Committees detailing the symptoms, diagnosis, and testing criteria utilized in forming the diagnosis of ADHD. So spurious diagnoses are unlikely and uncommon. img_1553

ADHD is likely rife in sport and now that adult ADHD is more often recognised and treated prevalence rates will likely increase. Adult ADHD has a prevalence rate of at least 3-4% of the population.  In fact any football fan will complain weekly about “adhd traits” in their team, without recognising what they are referring to. The key ADHD traits in adults relate to impulsivity and inattention. And often occur together in fact.

Many athletes are already recognised as having ADHD. Louis Smith the UK gymnast and Michael Phelps are two current examples. It is well known that some Premiership footballers are undergoing treatment. Some will decline medication ( regardless of any ruling about medicinal use) , preferring the non-drug treatments ( and yes there are quite a few). Some will also choose to only take medication sporadically for their own reasons.

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Should they be allowed to? Categorically yes. The lack of focus that comes with ADHD is not a good feature in sports where focus is critical. Gymnastics being one such example.

So how many athletes have ADHD? Firstly maybe it needs definition of what exactly is an athlete?  Reported figures suggest that around 8-10% of professional sportsmen have ADHD. It is worth also citing that whereas in childhood forms of ADHD the male-female ratio is around 5-1, in adults the ratio becomes almost 1-1. Some of the more inattentive cases of ADHD in females not getting diagnosed as early as the more over hyperactive males.

Some estimates of ADHD prevalence are even higher. Recent statistics put out by Major League Baseball show the incidence of ADHD  is twice as high as in the general adult population, at about 9 percent versus 4.4 percent in the 14-44 age range (National Institute of Mental Health study, 2006. ). Many also remain undiagnosed and some fear to have a diagnosis made, so prevalence estimates could well be as high as 15%.

I can find no clinical research on prevalence rates in these populations however watching any football game there is usually a few players who are more impulsive and have more inattention than others. Impulsivity may lead to yellow and red cards and unwise passing. Most fans can point to a couple of their players that meet these criteria.

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ADHD paradoxically can also potentially be an advantage in athletes where periods of focus for racing or playing are often short, some times less than 10 seconds. In some cases treatment may have negative effects and not the potentially ” improved” effects that some might believe from usage of stimulants or non-stimulant medications.

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Some of these strengths linked to ADHD which, managed properly , can lead to success in multiple areas of life, and  include: an ability to multitask, deal with chaos, creativity, non-linear thinking, an adventurous spirit, resilience, high energy, risk taking, calm under pressure, and the capacity for hyper focus . Talking to many ADHD experts they report that in many adult ADHD cases hyper focus is prevalent and in certain situations ADHD patients can focus better than the general population.

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Should ADHD be treated then in athletes? Generally it should as most athletes have lives outside of their sport and other facets of their lives including relationships may suffer.

ADHD can manifest in many ways, including lack of focus and concentration, oppositional behavior in team sports, argumentative attitude, frustration, poor self-esteem, and mood lability. In addition, anxiety, depression, substance abuse, each of which directly affects team sports and participant interaction. For these reasons, athletes with ADHD often perform better with medical treatment in life and in their sport.

Some disagree with this and a few papers discuss the ethics of using stimulants based on performance enhancement. My view is different. The medication elevates underperformance where this is found, not in all cases,  and brings it to normal levels. Athletes also deserve a life and relationships and employment. Medication has an important role to play.

 

 

Should All Sportsmen Be Screened for Adult ADHD?


As someone who has watched football and other sports closely for 50 years and often photographed games, it is clear that in many games there is evidence of both hyperactivity, inattention and impulsivity, the diagnostic components of ADHD. Emotional lability is also a major feature of ADHD though is yet to feature in the formal list of diagnostic terms. Adults with ADHD can have all of these or simply one component. The diagnosis will still be ADHD if the many other criteria for this diagnosis are met. And thats the real point. Simple acts of impulsivity or inattention do not determine a diagnosis of ADHD, it is far more complicated than that.  In this modern era though where medical screening is routine and obligatory to detect cardiac problems such as various forms of cardiomyopathies ( which have huge arrhythmogenic potential), should it not be useful at a minimum to screen for ADHD? ADHD can be managed and treated by a variety of techniques and medications. IMG_2210

Each week the news is full of sportsmen who have behaved in a manner that is often described as ” reckless”, but it might equally be regarded as ” impulsive” or ” emotional labile” responses.  Joe Marler the England and Harlequins prop forward, was recently determined to have called Samson Lee a ” gypsy boy” in an international rugby game. On his return from a 2 match suspension he last night April 22nd 2016, is cited for ” kicking an opponent in the head”. Seemingly reading comments attributed to Conor O’Shea ,  the Harlequins director of rugby, Marler needs to “learn to control his emotion”. In the same week James Vardy reacted in an emotional and possibly verbally aggressive way to a referee after being sent off. Football often refers to flashpoint tempers, but of course not all players react this way. There is no way of knowing who has ADHD without formal testing and most players with these facets will not have ADHD.

00002399There are of course well recognised sportsmen who have been successful in their careers and also diagnosed with ADHD, but a key facet is that often this diagnosis has come either after their career or later on in it.   A good example is Cammi Granato. An Olympian athlete and history maker, Cammi Granato  has ADHD. As a member of the U.S. women’s hockey team that won gold  in the 1998 Olympics, she  scored more goals than any other U.S. women’s hockey player. But she told Psychology Today in 2011 that her personal life felt out of control until she was officially diagnosed with ADHD in 2003 and started learning how to take control. This is a single case history or vignette but is unlikely to be unique. The key issue for sportsmen is how to learn how to take control and more importantly prevent issues emerging, such as red cards and maybe as a defender inattentive issues.

Clearly I am hypothesising greatly here but do believe that screening all sportsmen in professional sports would be beneficial both to themselves and their sports. An awareness of the potential outcomes of an impulsive act might just reduce incidence of future ones.

A retired Scottish footballer, Roddy Grant, was diagnosed at age 47 which in this era is far from uncommon.

“Football helped me mask the condition because it would burn up so much energy.

“But I was always high as a kite after games, win, lose or draw. Colleagues in the dressing room would say I was hyper and it was a massive issue for me”

http://www.dailyrecord.co.uk/news/scottish-news/st-johnstone-legend-roddy-grant-2934855#kSW5gWRlpVL4G2Ws.99

Other than effects on the individual there are likely effects on the team. Would a clinical research study for example show that players with ADHD have worse disciplinary records? Would strikers with ADHD be more effective as their impulsivity would be positive and creative? Would defenders with inattentive forms of ADHD concede more goals through errors?

There is though a far bigger picture here, and this was well reported in The Guardian last year.

A few years back, a Premier League club found themselves in a moral dilemma because one of their academy players was creating problems behind the scenes. The boy was talented enough to have a chance of a successful career. But his behaviour was erratic and showed no sign of improvement. It went on long enough for psychiatric reports to be ordered and the prognosis was that he had a disorder – possibly ADHD – that needed medication.

The problem for the club was that some of the drugs were prohibited, meaning that if he took them he could not continue as a footballer and would have to be cut free. That left the club with two choices: go with the medical opinion or try to find another way and, in effect, ignore the professional advice.

So screening is not without its problems, however management of ADHD does not mandate the obligatory usage of medications. Screening can also be a fairly simple task, to screen for the possible presence of ADHD, those with positive screens can then be fully evaluated, a far more complex procedure.

There is certainly a case to consider in modern top level sport that sportsmen should be screened for the presence of all disorders that may affect their careers. Possibly ADHD is one of those.

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