FAA Guidelines: No Rx for Commercial Airline Pilots with ADHD?

FAA Guidelines on ADHD

If you have an ADHD diagnosis, will that interfere with your dream of becoming a commercial pilot?  As with all things ADHD’ish, it depends.  This post explores FAA policy and ADHD, especially regarding medication.

It’s common lore that folks with ADHD gravitate to flying planes. Whether or not that is true, I do field many questions about ADHD-related restrictions on becoming a pilot.

For example, one question came from the spouse of a commercial airline pilot. Her husband has been diagnosed with ADHD (and, from her report, displays strong symptoms at home). But, she claimed that FAA guidelines prohibit him from taking medication for it. Could this be true? Yes, it is true.

Another example: A young man I know diagnosed with ADHD at age 23  finds this prohibition completely unfair. Becoming a pilot is his lifelong dream; seeing the disappointment on his face is heartbreaking.

Yet, I also saw how impaired he was before beginning stimulant medication. He repeatedly asked the same questions of the support group, always arrived very late to the meeting, and reporting struggled with his schoolwork. With medication, he became sharper, more alert, and with much improved working memory. The difference truly was night and day.

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.

Let’s remember: ADHD is a highly variable syndrome. Moreover, it affects individuals. There are no cookie-cutter descriptions, answers, or strategies.

He was diagnosed 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.

Bottom Line

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

  • ADHD itself is not a disqualifying condition.
  • Yet, 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 Strattera).
  • A 90-day period of taking no medication is required before evaluation.
  • The FAA requires its own extensive evaluation for ADHD.

Current FAA Guidelines: Summary

Here is the December 2018 information from the 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 and consists of a battery of different tests that measure various areas of neurocognitive functioning. The evaluation is quite comprehensive and 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 about attentiveness 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 is a neuropsychological evaluation required?

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 testing is required?

There are two test batteries:

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

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

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).

 

If you have any experience or accurate on this topic, please share. Are there any workarounds to this prohibition?

 

49 thoughts on “FAA Guidelines: No Rx for Commercial Airline Pilots with ADHD?”

  1. 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

  2. Having been in the aviation industry for over 40 yrs, I’m convinced at least 20% of professional pilots would qualify as having an undiagnosed attention or hyperactivity “disorder.” I would be one of those. Flying airplanes seems to be an attraction, probably because of the intense and varied stimuli it provides.

    Yes, for many years the FAA would disqualify any medical applicant that reported past diagnosis or treatment for ADD/ADHD. Many applicants were able to get around this by claiming a misdiagnosis or a diagnosis was made by a non-medical person. When the school nurse recommended little Johnny go on Ritalin, it could have a lifetime of consequences. To get such a diagnosis reversed is an expensive and time consuming process. Now it seems the FAA has softened a bit on that hard line but a previous diagnosis of ADD/ADHD will still put a number of obstacles in a professional pilot’s career path.

    For a non-professional pilot, ADD/ADHD should not be an issue as long as one applies only for a basic medical certificate called ‘BasicMed’ or elects to exercise only Sport Pilot privileges which require no formal FAA medical screening process.

    Interestingly (and conversely), it seems having ADD/ADHD is an asset in airline management. David Neelman, founder of JetBlue airlines has often spoken and written books about having ADD/ADHD and how it has helped him in his airline successes.

    One day this will be undoubtedly be recognized as an overreach/overreaction by the FAA. Perhaps a severe form of ADD/ADHD would be grounds for medical denial but milder forms of this “disorder” seems to make the best pilots and no I’m not referring to the ability to “hyperfocus.” The other symptoms, failed personal relationships, messiness or poor organizational skills, anxiety, boredom, depression, alcohol (and substance) abuse are all readily apparent.

  3. Sports light pilot certificstion is a possible work around. The way I read it disqualifying meds do not apply to sport light and there is no medical.

  4. My son has had adhd since he was small. He is in college now and still dreams of flying. We researched and made many phone calls to discover he must be off meds and take the battery of testing before applying for the PPL. He hasn’t taken meds for 3 years and his grades suffer but he had side effects on the meds so I am not sure what is worse. He wants to take the testing next month over spring break but it’s over $2k! We live in SC. Do you think there’s hope for him or are we just wasting money?

    1. Hi Jill,

      It seems your son has a very important decision to make:

      1. Pursue ADHD treatment, with medication if he needs it: Side effects can be managed; someone will need to be more pro-active about treatment. Most prescribers are doing a poor job of it.

      2. Risk having his untreated ADHD symptoms affect his would-be flying career.

      Of course I cannot tell you. I don’t know your son, his aptitude for a career as a pilot, whether his poor grades are the result of his lack of interest or ADHD-related cognitive problems, and all the rest.

      But it’s something to consider very carefully. Sometimes the “reward” can be very enticing to folks with ADHD, most especially when it seems out of reach. That can provide a drive that might diminish after the reward is achieved.

      Good luck to you both.

      Gina

    2. There’s hope! I have a similar story. I dealt with ADHD throughout my childhood, finally being diagnosed when I was 13. I stayed on medication for 6 years. I stopped taking medication about 6 months before taking the battery of tests, and I passed. My grades and performance in college suffered some, but I’m now a commercial pilot. Totally worth it! (I drank coffee throughout the testing, and that helped a lot)

  5. Just to clarify my comment, if you have taken medication for add or ADHD within the past 5 years you have to wait 5 years since you took the medication to apply for a class 4 or higher medical and then go through 28 different tests which have to be done by an AME and are not insured by most insurance companies and then wait a year and go through all the tests again before you can actually get the medical

    1. Oh, thanks for the details, Zachary. Do you have a source that I can link to, for readers?

      thanks!
      g

    2. Is this true for a first time PPL? My son has been off meds for 3 yrs. and wants to do the testing next month. Are we wasting money? I had not heard 5 years waiting.

  6. In Canada and in the United States by January 15 2017 having ADD or ADHD is an immediate denial of flight privileges

    1. Hi Zachary,

      Wow, thanks for the update.

      Canada contemplated a similar law, but for driver’s licenses. They abandoned it, based on the assumption that such a law would just discourage people from seeking a diagnosis and treatment.

      tx
      g

  7. Hello,

    I have been diagnosed with ADD since I was 12 and I was prescribed to Adderall ( 25mg) by my doctor. I’m 16 and take the Adderall daily, I have a GPA 0f 3.8 unweighted and take all advanced and AP classes. Unlike lot’s of people with ADD I don’t struggle in the least bit in school and have a high aptitude for learning. When I’m off of medicine there’s definitely a difference in me (No academic performance is lost though), I become a little less impatient and tend to be a little “Amped Up.” But I have started to learn to cope with it on the days that I’m without it.

    To get to the point, I have aspirations to become a pilot in the Air Force and eventually move onto commercial as both of my parents are commercial cargo pilots and certified flight instructors. But in order to achieve my goals I have to get off of the Adderall. I’m still young but I wanted to know if I should start to get off of it now to make the transition easier when I’m older, or wait to get off of the Adderall right before I start flight school like “Katie” said earlier in this chat.

    Thanks

    Loren

    1. Hi Loren,

      I can only offer you my opinion, as I don’t know how the military views such situations. (All branches are difference, of course, and who knows what the criteria will be by the time you’re of age for it to matter.)

      So, here are my thoughts:

      1. Continue ADHD medical treatment. Your grades might not suffer (at least for now) when you don’t take the medication. But it sounds like your mood and temper do. That can affect your relationships, including relationships with teachers. I would imagine that having “good conduct reports” throughout your education are important when seeking to be an Air Force pilot. Moreover, as coursework gets more complex, you might not be able to perform at the level you desire without medication.

      2. Optimize other strategies. ADHD is highly variable. Some people can adopt environmental strategies to offset symptoms, thus eliminating the need for medication.

      These strategies might include organizational systems, if that’s where one’s symptoms primarily cause problems.

      But such strategies can also include getting regular aerobic exercise (in the morning is best, apparently), getting sufficient sleep, and eating a healthy diet. The latter also might include experimenting with excluding certain foods that might cause adverse effects, cognition-wise. For example, many people with ADHD are sensitive to gluten and dairy; others do best with a diet that maintains steady insulin instead of one that creates spikes from simple carbs.

      Of course you can and should do all this while still taking the medication. But the more you optimize healthy habits, the less medication you might need.

      I hope this helps.

      Best of luck to you in reaching your goal!

      g

  8. Hey there,

    I was diagnosed with ADHD when I was 13 and was prescribed Ritalin. I was on Ritalin until I was 19, which is when I began my flight training. Since I had the full childhood diagnosis, I had to wait 90 days off medication, then take the battery of cognitive tests. As an aside, the FAA was not at all forthcoming about what I needed to do to obtain a medical certificate. I really had to wrench it out of them.
    Fortunately I passed the evaluations, and I obtained a 1st class medical, and I’m now working on getting all of my certificates to fly commercially. However, I’m not allowed to take stimulants again if I want to keep my certification. I’m doing my flight training at Embry-Riddle Aeronautical University, and I have several peers who definitely have some form of ADHD. The unfortunate thing about the way the FAA deals with this is that is doesn’t actually prevent people with ADHD from flying, it just prevents them from getting help.

    1. Hi Katie,

      Thank you so much for relating your experience with getting your flight certificate while disclosing ADHD.

      You are so right….there are MANY untreated folks with ADHD in our skies, and it raises the risk for both them and others.

      Congratulations on becoming certified!

      g

  9. Pingback: Treat Pilots for "Depression" But Not ADHD: A Dangerous Practice? - ADHD Roller Coaster with Gina Pera

  10. Hello!

    I have been diagnosed with ADHD. Well, sort of; my doctor just kind of prescribed me Vyvanse but I havent seen any official documentation, and I managed to get my Cat. 1 in Canada.

    I am currently pursuing my CPL after recently just getting my PPL through school. However, I don’t normally take medication when i fly, only when I study. I find that my “condition” actually benefits me in the sky…I’m really good at thinking of more than one thing at a time, which allows me to attend to proper instruments for certain situations (ex. Climbing and monitoring the fuel pressure, ASI, and heading while primarily looking at attitude/outside). My anxiousness has me thoroughly checking my systems to make sure all is running well.

    Perhaps I’m misdiagnosed (could be a minor case of GAD), but the key for me is exercise. When I’m in the sky after a run, it helps me focus on attending to the right things in the environment, and avoids a “racey” mind. I tend to be more worried and stressed than the people around me, but working out tends to help bring me to the optimal arousal for performance, and really allows me to get the job done.

    When Im not on meds, I’m not thinking about random things. Rather, it’s me constantly worrying about if Im doing the right things at the right time, and worried about all the things I need to do at once to a point where I tend to be avoidant of organizing myself because it scares me.

    I dont know! I notice other people with ADHD around me are somewhat different, in a sense that they dont really care about what they have to do. With me, I tend to care a little too much about the little things and tend to miss the bigger picture.

    Moral of the story = I find that when using natural remedies (exercise) for calming my thoughts, I tend to perform in-flight the way I should, but I still never feel satisfied with how I do afterward haha.

    Next stop: Mindfulness

    1. Hi James,

      From what you describe, there are more clues to anxiety than ADHD. But there could well be both.

      Sometimes the people with ADHD who have co-existing anxiety are higher performing, because they worry themselves constantly over what they might be forgetting. This worry, however, takes its toll.

      I encourage you to keep reading about ADHD and see if the diagnosis resonates for you in other ways.

      Good luck!
      g

  11. Ron, Charlene, and any others,

    I know that my response is late but better late than never. The clinic was Psych Recovery Inc. in St. Paul, MN. I think that my follow up appointment ended up around $250 / $300 too so it cost around $1200 by the time it was all said and done.

    I successfully completed my PPL training in February 2014 so there is hope.

    1. Hey Justin, Do you know which provider you used at Psych Recovery. I am needing to do the testing but I too was quoted over $2000. I’ve been told to be careful about who I use as the FAA is very specific about how they want the tests completed and presented to them. Obviously the person you met knew exactly how to process the materials and submit to the FAA?

      Thanks

      Simon

  12. I was diagnosed with ADD in 2006. I am now a commercial pilot and not being able to take my meds has made life extremely difficult. Any idea why this regulation exists???

    1. Hi Jacob,

      I don’t know, but it’s probably the same as in the military. They want to be sure pilots can function without medication, if it came to that. Or so that’s how it’s been explained to me.

      g

  13. Gina–I loved your book. I listened to it on the CDs. My husband finally saw a doctor yesterday. however, he is a commercial pilot so i see no immediate help –and I am exhausted. Do you know of any support groups in Maryland? Thanks

  14. This all sounds pretty discouraging. I’m a Marine veteran and just got out in 2010. I was aiming for veterinary school and have slowly been decreasing that goal since then. I’ve always love flight and have just decided to start pursuing it. It’s the only thing left that I can see myself doing for the rest of my life. Once I got into school again, I also got the Dx for ADD, not ADHD and my prescription to the dextroamphetamine is pretty small compared to many other people. Most of it comes from having trouble tuning people out that are around me and having a need-to-know of people coming in and out of the lecture halls. That I can surely thank my military service for, but it adds to the minor case of ADD I have. I wonder how many pilots out there have been able to pull this off. I function just fine without the medication but it helps a ton when I am in situations like that and can’t shut off my trained instincts. It’s heightened situation awareness, basically. Does it sound like I have a good chance of gaining waivers? I was going to try to get into an aviation major starting this fall and was considering becoming a UAV pilot for the National Guard. It’s frustrating to see that this could keep me grounded! I thought I finally settled on that career that will make me happy.

    “Love what you do and you won’t work a single day in your life.” Or something like that. I would love to hear some more advice and/or thoughts on this topic. I’m nervous about the battery of tests, though. Thanks!

    1. I wish I had some answers for you, Justin. The most useful advice I can think of is to maximize all the non-Rx strategies you can.

      First, I’d recommend reading Dr. Parker’s book:

      http://www.amazon.com/New-ADHD-Medication-Rules-Science/dp/1938467221/ref=sr_1_2?ie=UTF8&qid=1361122659&sr=8-2&keywords=paying+attention+to+the+meds+for+paying+attention

      Then, I would suggest looking into

      –amino-acid supplements (such as tyrosine in the am, on an empty stomach)
      –optimizing your diet (protein in the morning, eliminating simple sugars and carbs, etc.)
      –incorporating brain-boosting exercise (aerobic in am with “coordinated” exercise, meaning not just running or some other “rote” activity but one that requires coordination and varied movements)
      –making sure you’re getting good sleep

      I hope this helps.
      Gina

  15. I would like to comment and say that I have been going through the problem of being denied my 3rd class medical because I was on Adderall.

    I was diagnosed as an adult and had been on the medication for 2 years when I started work on my private pilot license in January. The first step was being denied my medical. The second step was a letter from the FAA stating that I could not fly with ADHD and while taking Adderall, but if I was off the medication for 90 days and could pass a battery of tests (including a UA) I could obtain my medical. September 6th marked my 90th day off Adderall and next Monday I am taking the day off work to complete the testing. I hope that I can pass. This has been a very difficult path to take as I find that my symptoms are worse now than when I started taking the medication. I would encourage shopping around for testing resources as my initial contacts quoted around $2,000 but I was able to find a doctor to do the tests for $750.

    1. Hi Justin,

      That’s a lot of dedication on your part!

      There are many things you can do to improve your brain function in the meantime — get exercise in the morning, get enough sleep (not always easy for some people with ADHD, I know!), eat a protein breakfast in the morning.

      I wonder if it’s just Adderall (and any other amphetamine stimulant) or if the methylphenidate class is prohibited as well. Same for Strattera, which is not a stimulant (but in my experience is not entirely effective as a standalone treatment for ADHD).

      I can see the reasoning. Many people with ADHD don’t take their medication consistently. Or it’s not the most effective medication at the best dosage. So, the testing makes sure that you can function well without your medication (in case you don’t take it!).

      Still, it does seem to penalize people who are responsible about being diagnosed and taking medication responsibly.

      Good luck!
      g

    2. Justin,

      I was wondering if you could give me the name of the Dr. that you were able to see for the ADHD testing for the $750? What state are you in? I am in Colorado and I got quoted $4000 for all the required tests so definitely want to find someone that can do it for cheaper. How did all your testing go?

      Thanks,

      Ron

    1. Yes, Marni. I also wrote a book that covers many of the questions you ask: Is It You, Me, or Adult A.D.D.?

      It’s available as a paperback, a Kindle and Nook book, and as an audiobook.

  16. Thanks for your response!

    I requested this book from the library, thanks for the recommendation.

    This is something I am interested because of my significant other. Reading the comments on your Meetup page made me curious about common experiences with ADD in relationships. The comments seemed to be more focused on functionality in the world and coping with things like depression.

    One question, for example, is how can ADD affect relationships and how can it be worked with. Mood seems to be a huge factor but my inquiry is more about issues like not being able to contain troughs and set internal boundaries with a significant other. The closer someone is emotionally, the more issues there are of course. I’m sure there are many other factors, so the inquiry is endless.

    But you gave me a resource to look into and I appreciated it!

  17. I mis-read this as “Meditation and ADD”. Took me a while to figure out it was NOT about that. I was so hopeful that there was some info about how meditation can ever be done by someone with ADD. (significant other) Oh well 🙂

    1. Hi Marni,

      Actually, I just hosted a lecture here in Palo Alto with Dr. Lidia Zylowska, author of “The Mindfulness Prescription for Adult ADHD.” Look for the book on Amazon. There is a CD in the back with guided meditations.

      It’s true, though, that some people with ADHD will have a hard time with any meditation practice until they take medication. The two together can be quite powerful. Some people with ADHD, depending on severity of symptoms and life situations, will be able to practice the techniques in the book without medication. It just depends on the person.

      On the blog I write for CHADD, you can read a guest post by another physician who teachers Mindfulness Meditation for the ADHD community, Dr. Mark Bertin: http://adultadhdrelationships.blogspot.com/2012/06/communicating-mindfully.html

  18. The Air Force regularly dispenses “Go Pills” (dexedrine) to its pilots in combat. Military pilots in 2003 were regularly exceeding their dosages in Iraq yet my Vyvanse which is not as easily abused would disqualify me???

    http://www.msnbc.msn.com/id/3071789/ns/us_news-only_on_msnbc_com/t/go-pills-war-drugs/#.T9izpL9jjQo

    I was undiagnosed for 14 years as a police officer, detective and FBI certified computer forensics examiner. It wasn’t until I gave up the adrenaline that certain difficulties emerged. So I can carry a gun, take on great responsibility that affect peoples liberties but can’t pursue a hobby that just may allow me to be just as effective off medication and that much more effective on medication given the Air Force’s reasoning. That’s just not right.

    1. Crazy isn’t it? There’s a good chance that a large majority of enlisted men/women have ADHD, did poorly in school because of it, and therefore enlisted in the military because college was not a viable option. Yet these military personnel get to fly jets and carry guns. My son was diagnosed at 12 with ADHD and has been successful due to the fact that he takes medication. He recently graduated from a prestigious university with an engineering degree and would love to become a pilot, but cannot due to his ADHD. His comment about it related to how insane it is to think that an ADHD pilot without medication would be a safer pilot. Not!

    2. Yes, crazy. That’s what it is, Jane.

      This kind of “don’t ask, don’t tell” policy does nothing for public safety and penalizes those responsible folks with ADHD who know when they need medication — and take it.

      Congrats on your son’s graduation!
      g

  19. I was diagnosed with ADHD as a teenager. I outgrew/manage the condition well as an adult. Recently I attempted to get a pilot’s license. I can tell you for certain that any use of stimulant meds is a categorical disqualifier for your medical (required for a pilot’s license). Any pilot that takes them and reports it will lose their license. The Catch-22 is that if you are diagnosed with ADHD, you are disqualified because of the condition, and if you take medication to manage the condition, you are disqualified for taking a prohibited drug. The only way I have found to get/keep your license with an ADHD diagnosis is to (1) be off meds for more than a year, and (2) pass a huge battery of outdated psychological tests (such as WAIS-R, and MMPI-2, costing north of $2k) to prove you are not impaired by your condition when off meds, including a drug test for any stimulants — no easy task. You are then never allowed to go back on any stimulant medication.

    1. Thanks for sharing that info. The policy sounds similar to that of the military, where it causes many problems.

      I hope that some day we find ways to make it possible for people with ADHD to both be pilots and serve in the military while still benefiting from medical treatment.

      best,
      g

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