Few studies have reported on the prevalence, symptoms and treatment of ADHD in elite athletes. The purpose of this narrative review was to summarise literature on symptoms, comorbidities, effects of ADHD on performance and management options for elite athletes with ADHD.
Key databases, such as PubMed, SPORTDiscus, PsycINFO, Scopus and Cochrane, were searched in November 2018 using combined search terms related to ADHD, sports participation and the elite nature of participation. The authors reviewed only articles published in English. When there were gaps in athlete-specific literature, other literature was reviewed to provide guidance on diagnosis, prevalence, functional impairment and management. Elite athletes were defined as those who competed at professional, Olympic or collegiate/university levels.
Prevalence and comorbidity of ADHD in elite athletes
- In a systematic review of 17 studies of ADHD, the prevalence of ADHD in athletes (aged 15–19 years) was between 4.2–8.1% (Poysophon and Rao 2018).
- Common and normative sport-related hyperactivity observed in athletes may be difficult to distinguish from ADHD.
Effects of ADHD for elite athletes
- Lack of focus and concentration, oppositional behaviour, argumentative attitude, frustration, lowered self-esteem and labile mood associated with ADHD could impair athletic performance (White et al. 2014; WebMD 2017).
- Depression, anxiety and substance-use disorders in ADHD may impair sports performance (White et al. 2014; WebMD 2017).
- High stress, depressive mood and anxiety in elite athletes could be a result of undiagnosed and untreated ADHD (Alexander, Harrison 2013).
- Some athletes with ADHD naturally excel in baseball and basketball, as these sports involve quick movements and reactive decision-making that could be linked to the athlete’s impulsivity (Parr 2011).
- The authors stated that the ‘hyperfocus’ traits of ADHD in elite athletes may enable them to block out distractions during practice and competition; however, these effects have not been systematically studied.
- Physical activity and sports may improve symptoms of ADHD, as children with ADHD who participated in ≥3 sports activities were reported to have fewer symptoms of anxiety and depression compared with those who participated in ≤2 sports activities (Kiluk et al. 2012).
Management of ADHD in elite athletes
- Child athletes with ADHD treated with stimulants have reported better outcomes in attention-to-task, balance and acceleration compared with athletes with ADHD who were treated with non-stimulants (Pelham et al. 1990).
- Compared with individuals in the general population with ADHD, adult athletes with ADHD may have a different side-effect profile following administration of stimulants.
- If stimulants are to be prescribed for elite athletes, prescribers must be aware of the safety and tolerability issues as well as anti-doping rules relevant to these individuals with ADHD.
ADHD and its symptoms may play a role in an athlete’s choice of a sports career. Sports activity may reduce the symptom frequency of ADHD as well as the severity of ADHD in elite athletes. Management of ADHD could have an effect on the safety and performance of elite athletes and should aim to focus on long-term outcomes relevant to elite athletes’ sport and life.
Read more about the impact of ADHD for elite athletes here