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Considerations in the Care of Athletes With Attention Deficit Hyperactivity Disorder

Pujalte, George G. A., MD, FACSM*; Maynard, Jennifer R., MD§; Thurston, McKennan J., MD§,†; Taylor, Walter C. III, MD§; Chauhan, Mohit, MBBS

Clinical Journal of Sport Medicine: May 2019 - Volume 29 - Issue 3 - p 245–256
doi: 10.1097/JSM.0000000000000508
General Review

Objectives: Uncover literature pertaining to: (1) attention deficit hyperactivity disorder (ADHD) and how it impacts athletes; (2) ADHD medication effects; (3) regulations regarding ADHD medications; (4) approaches to conditions similar to, and occurring with, ADHD; and (5) use of stimulants.

Data Sources: MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Ovid interface.

Main Results: ADHD can have many effects on athletes and sports participation. Exercise has positive benefits on ADHD behaviors and players' attitudes. Athletes with ADHD can have worsened ADHD symptoms after concussions. Attention deficit hyperactivity disorder is a modifier of return to play; baseline ADHD symptoms should be used to guide management. Management should include medications, behavioral/psychosocial therapy, and academic accommodations. Behavioral therapy combined with medication is superior to behavioral treatment alone. Sustained exercise as ADHD treatment should be considered mainstay in management. Sports can increase thermogenic effects of stimulants, heat injury, and cardiac arrhythmias. Increased aggressiveness, improved pain tolerance, and decreased sense of fatigue are some attributes of stimulants that are presumed to impart some advantage to athletes, but evidence is uncertain. Attention deficit hyperactivity disorder medications may lead to myocardial infarctions, cerebrovascular accidents, paranoid psychoses, seizures, insomnia, tremors, anxiety, hypertension, and death.

Conclusions: Athletes' performance and quality of life can be negatively affected by ADHD. Risks exist for those who take ADHD medications. More research is needed on the implications ADHD may have in specific sports, and on possible advantages of medication use. Potential deleterious effects of these medications should be addressed.

*Sports Medicine, Department of Family Medicine, Mayo Clinic, Jacksonville, Florida;

§Department of Family Medicine, Mayo Clinic, Jacksonville, Florida;

Sports Medicine, Tanner Clinic, Layton, Utah; and

Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida.

Corresponding Author: George G. A. Pujalte, MD, FACSM, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (

G. G. A. Pujalte has received payment for lectures from American Medical Seminars and travel grants from USA Taekwondo outside of the submitted work. W. C. Taylor serves as the medical advisor to the Women's Tennis Association (WTA), for which Mayo Clinic is paid under contract. The WTA pays W. C. Taylor's travel to 2 to 3 tournaments/yr. W. C. Taylor also owns stock in Gilead Sciences, Inc, Pfizer, and Illumina, Inc, outside of the submitted work, but he has not sold them or received any money from them. No funding was received in support of the submitted work. The remaining authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received December 23, 2016

Accepted July 22, 2017

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