FAA Guidelines on ADHD — No Rx for Commercial Airline Pilots?

FAA Guidelines ADHD

This post explores FAA policy guidelines on ADHD. Specifically,  being a commercial pilot while having ADHD and taking medications to treat ADHD symptoms.

Originally published in 2012 and updated February 2022,  it’s one of my most perennially popular posts. I try to keep it updated. So if you have new information, please share in a comment. At the end, I’ll share a January 2022 FAA Safety Briefing article.

This Post Covers Five Related Topics:

  • The two common themes in e-mail questions I receive
  • Basic FFA highlights on ADHD and piloting
  • Current FFA Guidelines: Summary
  • FAA Medical Examinations
  • A link to a January 2022 article written by two FAA psychologists on ADHD policy

Two Themes of Common Questions

It’s common lore that folks with ADHD gravitate to flying planes. I’ve seen no scientific research.  But I have fielded enough questions to suspect it!  There are two common themes in these e-mails:

  1. Does the FAA prohibit pilots diagnosed with ADHD from taking medication?
  2. You’re kidding me? This is discriminatory.

Let’s consider an example of each theme.

1. Diagnosis Is Clear, Stimulants Forbidden?

This common question came from the spouse of a commercial airline pilot. Her husband has an ADHD diagnosis. From her report, symptoms manifest strongly at home. This is increasingly true with age. (He’s in his 40s.) She says he forgets tasks, loses track mid-task, and forgets conversations. His temper flares up a lot these days.

Perhaps most disturbingly to her, given poor sleep’s known negative impacts on cognition, his sleep was erratic and typically too short in length. She worries.

She asked, “Do FAA guidelines truly prohibit him from taking medication for it?”  The answer is: Yes, truly.

2. Isn’t This Discriminatory?

Another common example comes from a young man, age 23.  He was diagnosed two years ago.  Becoming a pilot is his lifelong dream.  He rails against this prohibition as absolutely unfair. Seeing the clear disappointment on his face is heartbreaking.

Yet, I also saw how impaired he was before beginning stimulant medication:

  • Repeatedly asked the same questions of the support group
  • Always arrived very late to the meeting and seemed bewildered about how to change that or if he could change that
  • Reporting struggles with schoolwork and getting sufficient sleep

With medication, he became sharper and more alert. His working memory became much-improved. working memory. The difference truly was night and day.  Did he realize how differently he appeared, compared to the somewhat stoned-looking presentation earlier?

If he stopped taking medication, would being in the cockpit somehow “stimulate” him into higher functioning?  I’m unlikely to bet my life—or his—on it. The much-ballyhooed ADHD Hyperfocus? Not all it’s cracked up to be.  Moreover, it’s certainly not reliable. In fact, hyperfocus is a clinical term. It means dysregulated focus.

Let’s remember: ADHD is a highly variable syndrome. Moreover, it affects individuals. Many also have ADHD-related sleep disorders that impair cognition all on their own. There are no cookie-cutter descriptions, answers, or strategies. So, if you think hyperfocus is your superpower, good for you. But please know, people with ADHD are not clones.

This young man received his diagnosis as an adult, after a thorough and professional evaluation. What about potential pilots whose diagnosis as children was more informal?  It might be worth re-visiting.

Basic FAA Highlights on ADHD and Piloting

As best I can make out, this is the bottom line for potential pilots with ADHD:

  • ADHD itself is not a disqualifying condition.
  • The FAA acknowledges that sometimes that the ADHD diagnosis in the past was in error.
  • If you have a formal diagnosis of ADD or ADHD, you may need to undergo additional testing in order to receive a medical certificate.
  • Most medications used to treat ADHD are disqualifying (stimulants and non-stimulant Strattera).
  • Requires a 90-day period of taking no medication before evaluation.
  • The FAA requires its own extensive evaluation for ADHD.

Current FAA Guidelines: Summary

Consider these points from this FAA webpage concerning ADHD (Guide for Aviation Medical Examiners: Decision Considerations Disease Protocols – Attention-Deficit/Hyperactivity Disorder)

  • The FAA requires an extensive evaluation if an applicant for medical certification has been diagnosed with or is currently taking one of the medications used to treat this condition.
  • If medications are being taken, they must be discontinued for at least 90 days and you will be asked to undergo a neuropsychological evaluation with a clinical psychologist or neuropsychologist
  • The testing is very familiar to the psychology world. It consists of a battery of different tests that measure various areas of neurocognitive functioning. The evaluation is quite comprehensive. It generally takes six or more exhausting hours to perform.
  • The complement of tests provides an objective way for the clinical psychologist to test for ADHD and any other underlying pathology that affects one’s short and long-term memory, ability to multitask, and to understand and comply with instructions, and many other “executive” tasks. The psychologist can compare one’s scores to “normal” functioning individuals, rather than against the applicants’ own baseline scores since there is no baseline testing to compare to!  This is one of the objections that opponents have for this type of evaluation process.
  • Many young folks are placed on these medications without ever being tested. They are prescribed the meds based on parental or personal concerns. Perhaps there was perceived inattentiveness to tasks such as job or school performance or other demonstrated history. In many cases, people who are treated for apparent symptoms don’t really have ADHD. But in order to rule it out, a formal clinical evaluation should be done.

FAA Medical Examinations:

From the FAA’s Guide for Aviation Medical Examiners (AME); Decision Considerations Disease Protocols – Attention-Deficit/Hyperactivity Disorder

Q: Why a required neuropsychological evaluation?

Attention-Deficit/Hyperactivity Disorder (ADHD), formerly called Attention Deficit Disorder (ADD), and medications used for treatment may result in cognitive deficits that would make an airman unsafe to perform pilot duties.

Q: What is the required testing?

There are two test batteries:

INITIAL BATTERY – performed on everyone; and
SUPPLEMENTAL BATTERY – performed when the Initial Battery indicates a potential problem.

Q: Why require a CogScreen-Aeromedical Edition (CogScreen-AE)?

CogScreen-AE is a neurocognitive test developed to assist the FAA in the evaluation of the domains of neurocognitive performance most important for safety of flight.

Q: Who may perform a neuropsychological evaluation?

Neuropsychological evaluations should be conducted by a qualified neuropsychologist with additional training in aviation-specific topics. The following link contains a list of neuropsychologists who meet all FAA quality criteria. See FAA Neuropsychologist List (PDF).

January 2022 FAA Safety Briefing on ADHD

A recent Medium article on this topic comes from two psychologists with the FAA Office of Aerospace Medicine, Drs. Chris M. Front and Randy J. Georgemiller

It’s entitled: Pilots With Attention Deficit/Hyperactivity Disorder (ADHD) — FAA Safety Briefing

Excerpts:

Safety experts agree that at least 70% of aviation accidents are attributable to the pilot. NASA scientists report that most accidents result from some failure in the pilot’s cognitive performance, with distractions and errors in aeronautical decision making (ADM) most prominent….

…The likelihood of an accident rooted in distraction or poor ADM is heightened when the pilot has a condition that negatively affects such skills….

NTSB investigations of fatal accidents attributed to ADHD have documented that pilots with ADHD:

        • failed to adequately prepare for flight (e.g., did not check the weather),
        • continued flight when it was ill-advised (e.g., due to deteriorating weather),
        • engaged in hazardous actions (e.g., low-level maneuvering to show off),
        • and became distracted and made critical errors (e.g., failed to maintain airspeed, stalled, and spun while circling a friend’s home at low altitude).

Due to the risks to flight safety posed by ADHD, regulatory authorities worldwide consider ADHD a disqualifying condition for pilots.

“Disclosure” After the Fact

One more excerpt from that article:

Unfortunately, pilots sometimes fail to disclose ADHD to their Aviation Medical Examiner (AME).

The result is that the FAA learns about the condition after a fatal accident when the toxicology results reveal the presence of medication used to treat ADHD. Notably, pharmacological treatments for ADHD are not approved for flying because they can cause harmful effects on perceptual, motor, and cognitive functions and impair the recognition of fatigue.

Additionally, their effectiveness is time-limited, a particular concern if a dose is missed or flight time exceeds the therapeutic impact of the drug.

ADHD and Driving On the Road

One area of research that clearly demonstrates ADHD-related impairments — and the effectiveness of stimulant medication?  Driving.

This post explores that topic: Driving While Distracted: Adult ADHD Hits the Road

If you have personal experience or something else to share on this topic, please leave a comment. 

—Gina Pera

 

67 thoughts on “FAA Guidelines on ADHD — No Rx for Commercial Airline Pilots?”

  1. This seems wildly unfair, but I wanted to comment on one part of this article that was misrepresented.

    The part where you say that there are many people put on meds but not diagnosed, then suggest that they don’t have ADHD. Apparently you are not aware of the fact that stimulants affect individuals with ADHD brains very differently than neurotypical ones. Stimulants do not stimulate us!! They help us focus. Therefore, if a person without an ADHD brain is put on stimulants they will be STIMULATED and act like such. A VAST difference. There’s no way that tons of people are being put on these drugs and thought ADHD that aren’t. They would be acting DRUGGED because it affects their brains VERY differently!!

    I even asked this of the psychologist (with decades of experience focusing on diagnosing and treating ADHD) if this were true and he confirmed it.

    So this idea of all these people being treated with stimulants without actually having ADHD is ridiculous! They would all be bouncing off the walls!!

    1. Hi Tina,

      Please keep in mind: This blog is the very first website on Adult ADHD, established in 2008. Much of what you know to be true about Adult ADHD….was first publicized by me.

      If you read my “about” page, you’ll see that I am an internationally recognized expert on Adult ADHD.

      I’ve been tackling myths such as you point out since 2002!

      So, before you come in attacking someone, it’s really best to know who and what you are attacking.

      For example, you claim that my article said, “Tons of people are being put on these drugs and thought ADHD that aren’t.” Please, where did I say that?

      I encourage you to re-read the article, this time trying to understand my actual point instead of going in for the kill.

      For one thing, I was quoting the FAA page. Believe it or not, ADHD is often misdiagnosed and medication taken, with poor results.

      For another, there just might be some nuances around ADHD that are not yet familiar to you.

      Thanks for your comment.
      Gina

    2. Tina,
      Many ADD drugs are performance enhancing even for “normal” non ADD individuals. Therefore your statements about individuals being treated bouncing off the walls or being drugged up is inaccurate. It is all about the dosage and individuals metabolism as to how the drug affects them. Similar example…. A patient who is not asthmatic is given an asthmatic drug and is able to perform better. The bronchodilator effect of albuterol improves the performance of even an individual who does not have asthma
      Ss

  2. Like many other children of the time, my nephew, Johnny, was advised to take Ritalin in 2nd grade for ADHD; he was off the drug by 6th grade. There was never a formal diagnosis by the primary school — only that they thought he would do better. Does this automatically disqualify him from becoming a pilot? Johnny’s in his 20’s now. Is testing by a FAA neuropsychoanalysist now required or can he just take a regular pilot’s exam?

    1. Hi Gerry,

      I can’t speak for FAA regulations. From what you write, though—that he was never formally diagnosed and he has not taken medication since 6th grade— it seems that’s not a dis-qualifying issue.

      But you should read the guidelines closely.

      good luck,
      g

  3. Someone with ADHD can totally concentrate on a video game for hours on end. If they are given something that is not stimulating they tend to “zone out.” Ritalin, Adderall, and Strattera stimulate the brain to help it to focus better. It would be interesting to see if someone, who had stopped ADHD meds for 90 days, started playing video games the day right before they had the neuro testing, whether there would be a carry over of the higher effect in concentration when taking those tests (and possible passing them).

    1. Interesting idea.

      My hunch tells me they might do worse on the tests, which are more tedious than videogames, than if they hadn’t played the videogames.

      With the various “brain training” software, there might be higher scores within the system — indicating improvement — but they typically don’t carry over into real life. And that’s the problem.

      thanks for your comment,
      g

  4. Hi all, newly winged USAF C-5 pilot here. Like many who have commented, I had ADD/ADHD throughout my childhood.

    My case was severely disruptive academic and social/behavioral side. I was put on Ritalin and adderall as a young kid and transitioned to vyvanse, wellbutrin, and tenex later on.

    After my 8th grade year, a seed was planted that I COULD potentially become a pilot if I wanted to. One of the biggest agents in that planted seed was my mother, (who had no faith in me or my future, but full belief in my diagnosis) genuinely seeing that specific potential in me.

    Gina, you are spot on with the Monofocus comment. I had never been so vehemently driven in my life as I was chasing down this newfound goal. It was personal. Up until 8th grade I had never received a single A or B (with meds). After my catharsis that summer, I finished my freshman year of high school with a 3.35. Almost makes me question the validity of my diagnosis, and the confidence-draining aura that came along with it. This is a discussion for another day. Today, I will say it was imperative that I came off meds freshman year of high school.

    I got my Class 3 medical 2 years later and that was a fight, but it wouldn’t have happened if I had been later on my official medication withdrawal. Got my PPL shortly after before starting college, and never had any academic or behavioral issues since coming off meds in 9th grade. I finished my B.S. in Business Management with a 3.8, AFROTC Scholarship, and packed my bags for Air Force UPT. If you have a son or a daughter with genuine aspirations to fly, my advice is to believe in them and do your best to drop the “but you have a disability” case. That in itself destroys the one thing that can get us there, confidence. If they really want to do it, and you believe in them, the change will occur and you’ll see a vehement drive leading to something great.

    At that point, let them take the wheel. Opinion: get them off the meds summer before high school (clear and defined life transition) and believe in them. Also, the Air Force and FAA doctors took issue with my Wellbutrin usage (normally prescribed as an anti-depressant) make sure they know, and have in writing from the psychiatrist, it was used purely for the treatment of ADHD, not depression. Diagnosed depression is a kill shot for a flying career. There is no getting around that one.

    1. Dear Jack,

      First, congratulations! Wow…flying a C-5. Well done!

      Second, thank you for sharing your insightful story.

      I did not know that about depression. And that’s too bad. Maybe unfair.

      But there’s a highly publicized case of a few years ago, in Germany, I believe (or a German pilot), where he was allegedly diagnosed with/treated for depression….before crashing his plane, apparently intentionally. Perhaps that drives the rule.

      We will never know the truth of that. But I remember reading what I could of his medical story. And I couldn’t help but wonder….bad prescribing strikes again.

      At any rate, I’m glad you persevered in pursuing your dream.

      People with ADHD aren’t clones, unfortunately. It’s a highly variable syndrome, with all the rest of personality to consider.

      Some could follow your path and come out victorious — and some deeply disappointed.

      But your lessons surely ring true for everyone — believe in your dreams, work hard for them, focus on rewards and accomplishment and less on “but you have a disability.”

      Happy flying!
      g

    2. “Diagnosed depression is a kill shot for a flying career. There is no getting around that one.”

      I’m pretty sure that changed since the crash in the Alps. I’d rather have a medicated pilot than one non-medicated…

    3. I’d be interested to know. Maybe I’m remembering a different incident (pilot suicide by crash), but I recall wondering if he had been misdiagnosed with “depression”.

      It’s astounding how many times psychiatrists and other MDs diagnosed based on how a person “looks” or “feels.”

      Depressed. Anxious.

      The risk is misdiagnosing bipolar disorder, ADHD, etc. as “depression” and taking an SSRI.

      I would not be surprised if that pilot was taking an anti-depressant — prescribed or otherwise procured.

      g

    4. Interesting reply.
      I’m diagnosed with adhd and use medication on as needed basis.
      I could certainly be without medication for 90days if there was a need for it.

      I fare far better in flight simulators than synthetic attention tests.
      In Sweden simulators are used to evaluate the ability of a person to drive a car so why couldn’t it also be used as a complement to neuropychological assesments in both Sweden and USA?

      In the EU rules on adhd and flying would be governed by a common eu directive, making the rules for flying and adhd fairly similiar in most europena contirues.

      I’m also diagnosed with aspergergs that for me personally that would not pose a problem when working with people or flying since I’ve among others things worked with teaching.

      Then what prejudices doctors might have on this condition i would mostly certainly be able to work together with a flying instructor to learn fly and being able to communicate clearly with an air traffic controller.

      Acutally Sweidsh Transportation Authorities tried to suspend an engine dirver with Aspergers’s syndrome but the court ruled his Aspergers’ wouldn’t be a problem when communicating with the rail traffic control.

      Regards Richard

    5. Thanks, Rikard.

      It definitely seems there should be a battery of objective tests and simulators.

      People with ADHD and/or ASD aren’t clones. There is infinite variety among individuals.

      g

    6. Thanks for your comment. We are fighting for my 15 year old daughters dream right now. In fact driving to an appointment with the diagnosing doctor At the moment. She has never been on meds so we are hoping she isn’t denied.

  5. Hi Pam,

    You are right: There is no evidence that essential oils are in any way useful in treating ADHD. And I doubt there will be research unless it is by the company selling the oils. Because there is no reasonable hypothesis that these would have any effect on ADHD.

    It seems to me that a high school junior is very young to be making such a decision. Many males with ADHD are particularly drawn to aviation. Granted, it has its obvious appeal. But I think there’s something of a “self-medicating” aspect to flying for many of these young men. It becomes their mono-focus. And sometimes I wonder if it because how they feel in the cockpit: stimulated, clear (due to the stimulation and noise, etc.), and focused (let’s hope so anyway).

    It might be wiser if he were to pursue traditional education now and then see how he feels later. His brain is still so young (generally, what we think of as brain maturity doesn’t happen until around 25 – and even later for many).

    I would worry about a person with ADHD who needs medication to function adequately becoming a pilot who does not/cannot take medication.

    But I am the cautious sort who sees potential consequences very clearly.

    good luck,
    g

    1. Hey so if someone receives a first class medical and then is diagnosed with ADHD/ADD later on several months after the medical is recieved, how would the FAA know? Would the pilot be in legal trouble if he doesn’t know ADHD is disqualifying?

    2. Hi Gary,

      Sorry, I’m not an FAA legal expert!

      I found this paper on the subject, but it’s from 2013: https://scholar.smu.edu/cgi/viewcontent.cgi?article=1317&context=jalc

      You might also check this site: https://pilot-protection-services.aopa.org/news/2018/february/01/adhd-and-the-faa

      My bottom-line understanding is this:

      If you were to be diagnosed after you were certified and you were to take medication, there is the risk of routine drug-testing that would indicate you are taking a stimulant (and maybe even a non-stimulant..I don’t know).

      If you were only diagnosed but did not pursue treatment, that’s a different question, it seems.

      Good luck finding more answers!
      g

Leave a Comment

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Stay in Touch!
Ride the ADHD Roller Coaster
Without Getting Whiplash!
Receive Gina Pera's award-winning blog posts and news of webinars and workshops.
P.S. Your time and privacy—Respected.
No e-mail bombardment—Promised.
No Thanks!
close-link