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ADHD Institute Register

23 May 2019

Pujalte GGA et al. Clin J Sport Med 2019; 29: 245-256

ADHD is associated with academic underachievement and impairment in behavioural, social and motor functioning, such that the symptoms of ADHD may affect individuals’ eligibility to participate in athletic activities, and potentially impact their athletic performance. This systematic literature review aimed to examine the impact of ADHD on athletes, and explore the effects of sport participation on ADHD symptoms. A deeper understanding of the link between ADHD and sport would facilitate improved management of ADHD, as well as appropriate diagnosis and treatment of ADHD in athletes. Literature searches were run in MEDLINE, Embase, PsycINFO and Cochrane Database, using search terms including: sports, athletes, attention deficit, conduct disorder and various pharmacological or drug therapy terms, on 19 August 2016.

The findings of the study were as follows:

Impact of ADHD on athletes

  • The prevalence of ADHD among athletes is unknown, although, as reported by Kaufman et al. (2011), ADHD prevalence may be higher among collegiate and professional athletes compared with the general population. The authors suggest that this may be due to the beneficial effects upon ADHD symptoms of physical exercise and positive reinforcement associated with team-based sports. However, the sample size used in the 2011 study was small (n = 7), and further investigation is required.
  • ADHD symptoms are often first identified by parents and teachers. In some cases, disruptive behaviour and poor academic performance may be excused if the student is a high-performing athlete, resulting in late diagnosis of ADHD. Physicians treating collegiate athletes should be aware of ADHD symptoms, as symptoms are often unmasked in later educational settings by higher academic demands and a greater requirement for independent functioning.
  • ADHD negatively impacted strength, agility and coordination in children (Cho et al. 2014), which may in turn have an impact on social functioning and participation in sports; however, the effects of pharmacological treatment on motor functioning in children with ADHD are understudied.

Impact of ADHD on risk of sports-related injury

  • Athletes with ADHD exhibit increased risk-taking behaviour, and this is hypothesised to lead to an increased risk of sports injury.
  • Symptoms of a concussion, such as difficulty focussing and impaired memory, may be masked or compounded by ADHD symptoms (White et al. 2014), and may worsen in athletes with ADHD compared with those without.
  • Computerised testing used to determine if an athlete can return to sport after injury may be ill-suited to athletes with ADHD, due to its repetitive nature. Prolonged exclusion from sport due to failing to return to baseline test scores following injury may be detrimental to children/adolescents with ADHD.

Treatment of ADHD in athletes

  • Behavioural therapy can be used as an alternative to or in combination with stimulants to manage ADHD, and the authors note that a combination of different modalities are generally used to manage ADHD symptoms in athletes.
  • Stimulant medications remain the first-line treatment for managing ADHD symptoms, although their use in athletes with ADHD is controversial owing to their performance-enhancing capabilities and potentially harmful side effects. For example, the thermogenic effects of stimulant medications may be elevated during physical activity, such that athletes prescribed stimulants may be at risk of heat injury or cardiac arrhythmia. However, some stimulants are permitted at elite-level sport, if the athlete has diagnosed ADHD and has obtained therapeutic use exemption documentation.
  • Several studies have demonstrated a link between aerobic exercise and improved cognitive and behavioural function (Berwid, Halperin 2012), and the authors suggest that a structured programme of physical activity should be considered as a non-pharmacological treatment option for ADHD.

The impact of ADHD on athletes and the effects of participation in athletic activities upon ADHD symptoms share a complex relationship. Participation in sport demands attentiveness, organisational skills and conforming to a structure, but many parents/coaches have reported positive effects of sport participation on ADHD symptoms. Additionally, potential side effects of stimulants used to treat ADHD may be exacerbated by exercise and/or high-stress environments. The authors concluded that athletes with ADHD should be monitored by knowledgeable practitioners with an awareness of the side effects of prescribed medications and their relevance to physical activity, as well as knowledge of the regulatory guidelines of an athlete’s chosen sport.

Read more about the impact of ADHD on athletes and sport participation here

Berwid OG, Halperin JM. Emerging support for a role of exercise in attention-deficit/hyperactivity disorder intervention planning. Curr Psychiatry Rep 2012; 14: 543-551.

Cho H, Ji S, Ching S, et al. Motor function in school-aged children with attention-deficit/hyperactivity disorder in Korea. Psychiatry Investig 2014; 11: 223-227.

Kaufman KR, Bajaj A, Schiltz JF. Attention deficit/hyperactivity disorder (ADHD) in gymnastics: preliminary findings. Apunts Medicina de l’Esport 2011; 46: 89-85.

Pujalte GGA, Maynard JR, Thurston MJ, et al. Considerations in the care of athletes with attention deficit hyperactivity disorder. Clin J Sport Med 2019; 29: 245-256.

White RD, Harris GD, Gibson ME. Attention deficit hyperactivity disorder and athletes. Sports Health 2014; 6: 149-156.

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