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 Four 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:
- Does the FAA prohibit pilots diagnosed with ADHD from taking medication?
- 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:
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
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.