The authors of the above article reported errors with respect to stimulant use governed by USADA and WADA in Olympic-level athletes. These errors affected the final paragraph of the text beneath the subheading “Collegiate, National, and International Elite Competition Regulations” (p. 397) under “Considerations,” “The Attention Deficit Hyperactivity Disorder Athlete and Regulatory Issues.” The authors would like to redact the final paragraph in question and replace it with the following text:
- Athletes who are participating in events governed by the United States Anti-Doping Agency (USADA) or WADA can continue their stimulant use out of competition, but must complete a Therapeutic Use Exemption (TUE) in order to use a stimulant in-competition. More specific information regarding stimulant use in ADHD and WADA is provided in a recent online document (http://www.wada-ama.org/Documents/Science_Medicine/Medical_info_to_support_TUECs/WADA_Medical_info_ADHD_2.0_EN.pdf).
- As with the NCAA, WADA requires the appropriate medical history and diagnostic criteria for ADHD (DSM-IV or ICD-10 criteria) to be submitted with the TUE request, and “highly recommends an annual review by a specialist in the management of ADHD” (http://www.wada-ama.org/en/).
- For ADHD that is well documented and longstanding, the TUE for WADA can be granted for up to 4 years at a time. Given that USADA and WADA protocols and criteria for a TUE may change over time, it is important for the treating physician to check the most current requirements at http://www.usantidoping.org/ and http://www.wada-ama.org/en/, respectively.
- Stimulant medications for ADHD are banned by many professional sports organizations, and team physicians should be aware of specific regulations governing their athletes.
Additionally, these same errors affected the final position statement (#11) reported in the “Evidence-based Conclusions/Recommendations” section (p. 398). The authors would like to redact position #11 and replace it with the following text:
- 11. Position: Team Physicians should be aware of and educate the athlete on regulations and requirements with pharmacologic treatment of ADHD. Athletes with ADHD can participate at every level. At the NCAA level, athletes treated for ADHD with stimulant medication must complete an exemption form that includes a comprehensive evaluation using DSM-IV criteria, an Adult ADHD Rating Scale (behavior ratings or observations), an annual evaluation which includes measuring blood pressure and heart rate, and consideration of nonstimulant medications. Both the IOC and WADA ban the use of stimulants in-competition, but a TUE can be submitted and may give the athlete the authorization to take the needed medicine if the supporting documentation is present and treatment is indicated. The World Anti-Doping Agency does not require that nonstimulants have been considered (see http://www.wada-ama.org/en/). Team physicians for professional sports organizations should be aware of whether stimulant medications for ADHD are banned and require a TUE.
These errors have been noted in the online version of the article, which is available at www.cjsportmed.com.
Putukian M, Kreher JB, Coppel DB, Glazer JL, McKeag DB, White RD. Attention deficit hyperactivity disorder and the athlete: an American Medical Society for Sports Medicine position statement Clin J Sport Med. 2011;21:392–400