adhd IN sPORT

Information based on my new book – ADHD in Sport: Strategies for Success.

References from the book

Introduction

Media coverage on athletes with ADHD:

Diagnosis: ADHD diagnosis in NICE: Overview | Attention deficit hyperactivity disorder: diagnosis and management | Guidance | NICE

Child prevalence rates: The 2015 study which suggests 11% of children in the US have ADHD: Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., … & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34-46.

Child prevalence figures: ADHD being up to 8% of under 18s: Salari, N., Ghasemi, H., Abdoli, N., Rahmani, A., Shiri, M. H., Hashemian, A. H., … & Mohammadi, M. (2023). The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis. Italian journal of pediatrics, 49(1), 48.

Teen and adult prevalence: Between 65% – 85% of those diagnosed as children still meeting the diagnostic criteria in their teens: Biederman, J., Monuteaux, M. C., Mick, E., Spencer, T., Wilens, T. E., Silva, J. M., … & Faraone, S. V. (2006). Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychological medicine, 36(2), 167-179.

Adult prevalence: The meta-analysis of ADHD studies following those diagnosed into adulthood that found 15% of all cases persist fully but up to 75% will continue to have significant ADHD related impairments as an adult: Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of abnormal psychology, 111(2), 279.

Athletes and ADHD: The 2010 USA university study which found 7.1% of elite athletes had a TUE: Parr, J. W. (2011). Attention-deficit hyperactivity disorder and the athlete: new advances and understanding. Clinics in sports medicine, 30(3), 591-610.

TUE levels in ADHD: The USA Major League Baseball (MLB) 2018 report on 8.4% of athletes being granted a TUE: Baseball, M. L. (2018). Major League Baseball’s joint drug prevention and treatment program. New York: Major League Baseball.

  

Chapter 1: Understanding the sporting brain

Decision making: We each make around 35,000 micro decisions a day (Sahakian, B. & LaBuzetta, N. (2013) Bad moves : how decision making goes wrong, and the ethics of smart drugs. Oxford University Press).

The Twisties: Simone Biles pulling out of the beam competition in the 2021 Tokyo Olympics citing The Twisties: https://www.bbc.com/news/world-us-canada-57986166

Test Anxiety: The Psychological Science paper of 309 German students showing anxiety about taking a test makes it harder to absorb the information. (Theobald, M., Breitwieser, J., & Brod, G. (2022). Test anxiety does not predict exam performance when knowledge is controlled for: Strong evidence against the interference hypothesis of test anxiety. Psychological Science, 33(12), 2073-2083)

ADHD is highly heritable (estimated to be over 70% genetic): Faraone, S. V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular psychiatry, 24(4), 562-575.

 

Chapter 2: The impact of sport on your ADHD 

The specific cognitive improvements that research finds exercise can support:

Type of exercise: The benefits seem to be strongest when it is cardio exercise and specific types that demand cognitive engagement – Den Heijer, A. E., Groen, Y., Tucha, L., Fuermaier, A. B., Koerts, J., Lange, K. W., … & Tucha, O. (2017). Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD: a systematic literature review. Journal of Neural Transmission, 124, 3-26.

Catecholamine hypothesis: Prince, J. (2008). Catecholamine dysfunction in attention-deficit/hyperactivity disorder: an update. Journal of clinical psychopharmacology, 28(3), S39-S45.

BDNF impact: Knaepen, K., Goekint, M., Heyman, E. M., & Meeusen, R. (2010). Neuroplasticity—exercise-induced response of peripheral brain-derived neurotrophic factor: a systematic review of experimental studies in human subjects. Sports medicine, 40, 765-801.

Increased blood flow theory: Lambourne, K., & Tomporowski, P. (2010). The effect of exercise-induced arousal on cognitive task performance: a meta-regression analysis. Brain research, 1341, 12-24.

Benefits for behaviour: The study that found after exercise attention span and impulse control improved and the number of times they disrupted the classroom reduced. Ruhland, S., & Lange, K. W. (2021). Effect of classroom-based physical activity interventions on attention and on-task behavior in schoolchildren: A systematic review. Sports medicine and health science, 3(3), 125-133.

Locomotor skills: The study that found over 10 weeks, 45 minutes of moderate-to-vigorous exercise three times per week found improved locomotor skills. Verret, C., Guay, M. C., Berthiaume, C., Gardiner, P., & Béliveau, L. (2012). A physical activity program improves behavior and cognitive functions in children with ADHD: an exploratory study. Journal of attention disorders, 16(1), 71-80.

Dexterity: In a study of boys with ADHD, exercise appears to improve manual dexterity. Meßler, C. F., Holmberg, H. C., & Sperlich, B. (2018). Multimodal therapy involving high-intensity interval training improves the physical fitness, motor skills, social behavior, and quality of life of boys with ADHD: a randomized controlled study. Journal of attention disorders, 22(8), 806-812.

Motor skills: Researchers who set boys with ADHD 9 x 30 minute HIIT sessions over a three week period found that, as well as physical fitness, motor skills (including dexterity and ball skills) and scores focused on self-esteem and friends. Meßler, C. F., Holmberg, H. C., & Sperlich, B. (2018). Multimodal therapy involving high-intensity interval training improves the physical fitness, motor skills, social behavior, and quality of life of boys with ADHD: a randomized controlled study. Journal of attention disorders, 22(8), 806-812.

Stress: The study that reported improved anxiety and conduct as well as less hyperactivity, inappropriate emotions and daydreaming in children with ADHD following tai chi sessions. Hernandez-Reif, M., Field, T. M., & Thimas, E. (2001). Attention deficit hyperactivity disorder: Benefits from Tai Chi. Journal of Bodywork and Movement Therapies, 5(2), 120-123.

Anxiety and Depression: The study looking at those with and without ADHD found children with ADHD who regularly participated in sports that showed fewer anxiety-related symptoms compared to those participating less. Kiluk, B. D., Weden, S., & Culotta, V. P. (2009). Sport participation and anxiety in children with ADHD. Journal of attention disorders, 12(6), 499-506.

Somatic anxiety: Exercise has been found to reduce these somatic anxiety symptoms. Lufi, D., & Parish-Plass, J. (2011). Sport-based group therapy program for boys with ADHD or with other behavioral disorders. Child & Family Behavior Therapy, 33(3), 217-230.

Mood: The study looking at ADHD adults using exercise found that almost all of them proactively used exercise to lift their mood. They reported being physically active increased mental clarity and attention and that two thirds said when they were less physically active their mood dropped and they felt their mental health suffered. Ogrodnik, M., Karsan, S., Cirone, V., & Heisz, J. J. (2023). Exploring the relationship between cardiorespiratory fitness and executive functioning in adults with ADHD. Brain Sciences, 13(4), 673.

Confidence: The study on the value of exercise which found a third of ADHD participants reported that seeing progress at the gym helped them feel they had increased their competence, confidence, and self-esteem. Ogrodnik, M., Karsan, S., Cirone, V., & Heisz, J. J. (2023). Exploring the relationship between cardiorespiratory fitness and executive functioning in adults with ADHD. Brain Sciences, 13(4), 673.

Motivation: The 20-minute cycling activity in adult men with ADHD symptoms who found their motivation and energy increased and their feelings of confusion, depression, and fatigue decreased.  Fritz, K. M., & O’Connor, P. J. (2016). Acute exercise improves mood and motivation in young men with ADHD symptoms. Medicine and science in sports and exercise, 48(6), 1153-1160.

 

Chapter 3: How ADHD influences sporting performance 

Brain fog and headaches:  The pre-season cognitive testing study of over 39,000 college athletes that found those with ADHD reported more concussion like symptoms in their baseline testing than those without it.

Concussion: The study where it was found that ADHD was associated with 1.2 times greater risk of a concussion and those using medication were at 1.5 times greater risk of a concussion. The study found that those with ADHD had more severe concussion symptoms, took longer to recover (on average three days longer) and had worsened ADHD symptoms after concussions. Gunn, B. S., McAllister, T. W., McCrea, M. A., Broglio, S. P., Moore, R. D., & CARE Consortium Investigators. (2022). Neurodevelopmental disorders and risk of concussion: findings from the National collegiate athletic Association Department of defense grand alliance concussion assessment, research, and education (NCAA-DOD CARE) consortium (2014–2017). Journal of neurotrauma, 39(5-6), 379-389.

Hyperactivity: Hyperactivity symptoms are thought to show up in around 70% of children’s cases and to reduce within adult ADHD.

Injury: The study in Japan that found that adults with ADHD visited the emergency room and were hospitalised more than non-ADHD adults. Naya, N., Tsuji, T., Nishigaki, N., Sakai, C., Chen, Y., Jung, S., & Kosaka, H. (2021). The burden of undiagnosed adults with attention-deficit/hyperactivity disorder symptoms in Japan: a cross-sectional study. Cureus, 13(11).

Injury: The study in Denmark that found that those with ADHD had a lower life expectancy and double the risk of death compared with non-ADHD adults. Dalsgaard, S., Østergaard, S. D., Leckman, J. F., Mortensen, P. B., & Pedersen, M. G. (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. The Lancet, 385(9983), 2190-2196.

Memory: The study suggesting that up to 85% of those with ADHD are thought to have working memory issues and the worse the severity of the ADHD issues the worse the working memory issues.  Al-Saad, M. S. H., Al-Jabri, B., & Almarzouki, A. F. (2021). A review of working memory training in the management of attention deficit hyperactivity disorder. Frontiers in behavioral neuroscience, 15, 686873.

Motor skills: The study of 28 adults looking at graphomotor skills finding that those without ADHD and those on ADHD medication were able to improve their fluency of writing the more they practiced.  Duda, T. A., Casey, J. E., & McNevin, N. (2015). Development of graphomotor fluency in adults with ADHD: Evidence of attenuated procedural learning. Human movement science, 44, 1-10.

Motor skills: Study finding individuals with ADHD can exhibit motor deficits which might influence their abilities for control over balance, dexterity and coordination. Ziereis, S., & Jansen, P. (2015). Effects of physical activity on executive function and motor performance in children with ADHD. Research in developmental disabilities, 38, 181-191.

Pain regulation: A study discussing ADHD and chronic pain levels. Kerekes, N., Sanchéz-Pérez, A. M., & Landry, M. (2021). Neuroinflammation as a possible link between attention-deficit/hyperactivity disorder (ADHD) and pain. Medical Hypotheses, 157, 110717.

Quality of life: The systematic review of 23 studies finding students with ADHD had lower grade point averages, reported more academic problems and would be less likely to graduate. Weyandt, L. L., & DuPaul, G. (2006). ADHD in college students. Journal of attention disorders, 10(1), 9-19.

Reaction time: Discussion of the speed–accuracy trade-off in children with ADHD so that their reaction time might be super-fast but that may be to the detriment of accuracy. Karalunas, S. L., Huang-Pollock, C. L., & Nigg, J. T. (2012). Decomposing attention-deficit/hyperactivity disorder (ADHD)-related effects in response speed and variability. Neuropsychology, 26(6), 684

 

Chapter 4: Wellbeing

B vitamins: The 2016 study in the Journal of the Royal College of Psychiatrists found that concentrations of vitamins B2, B6 and B9 were associated with ADHD, and that low levels of B2 and B6 impacted symptom severity. Landaas, E. T., Aarsland, T. I. M., Ulvik, A., Halmøy, A., Ueland, P. M., & Haavik, J. (2016). Vitamin levels in adults with ADHD. BJPsych Open, 2(6), 377-384.

Zinc: The 2010 study in Child Psychiatry & Human Development Journal found Zinc levels to be lower in children with ADHD and that supplements could reduce hyperactivity and impulsivity. Oner, O., Oner, P., Bozkurt, O. H., Odabas, E., Keser, N., Karadag, H., & Kızılgün, M. (2010). Effects of zinc and ferritin levels on parent and teacher reported symptom scores in attention deficit hyperactivity disorder. Child Psychiatry & Human Development, 41, 441-447.

Iron: The study that found 84% of children with ADHD were low in Ferritin levels, compared to 18% of children without ADHD. Konofal, E., Lecendreux, M., Arnulf, I., & Mouren, M. C. (2004). Iron deficiency in children with attention-deficit/hyperactivity disorder. Archives of pediatrics & adolescent medicine, 158(12), 1113-1115.

Magnesium: Study discussing magnesium in those with ADHD. Huang, Y. H., Zeng, B. Y., Li, D. J., Cheng, Y. S., Chen, T. Y., Liang, H. Y., … & Lin, C. H. (2019). Significantly lower serum and hair magnesium levels in children with attention deficit hyperactivity disorder than controls: A systematic review and meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 90, 134-141.

Omega-3: The meta-analysis of Omega-3 Fatty Acid Supplementation suggesting that omega-3 fatty acids can improve symptoms of ADHD. Bloch, M. H., & Qawasmi, A. (2011). Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 50(10), 991-1000.

Caffeine – A study looking at caffeine blocking the action of adenosine. Sohail, A. A., Ortiz, F., Varghese, T., Fabara, S. P., Batth, A. S., Sandesara, D. P., … & Patel, U. K. (2021). The cognitive-enhancing outcomes of caffeine and L-theanine: a systematic review. Cureus, 13(12).

Eating Disorders: Systematic review and meta-analysis on the findings that adults with ADHD are more likely to have been diagnosed with an eating disorder. Nazar, B. P., Bernardes, C., Peachey, G., Sergeant, J., Mattos, P., & Treasure, J. (2016). The risk of eating disorders comorbid with attention‐deficit/hyperactivity disorder: A systematic review and meta‐analysis. International Journal of Eating Disorders, 49(12), 1045-1057.

Eating Disorders: The UK Sport guidance on Eating Disorders in Sport suggesting that about 13.5% of all athletes have some kind of eating disorder and in sports like distance running that was higher at 16%. Report

Sleep: The studies estimating that up to 80% of adults with ADHD have one or more sleep problems. Yoon, S. Y. R., Jain, U., & Shapiro, C. (2012). Sleep in attention-deficit/hyperactivity disorder in children and adults: past, present, and future. Sleep medicine reviews, 16(4), 371-388.

Sleep: The analysis of 16 studies finding children with ADHD were more likely to have difficulty with sleep initiation (i.e. trouble falling asleep) fragmented sleep, poor sleep efficiency, sleep disordered breathing and excessive daytime sleepiness. Cortese, S., Faraone, S. V., Konofal, E., & Lecendreux, M. (2009). Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. Journal of the American Academy of Child & Adolescent Psychiatry, 48(9), 894-908.

Light sensitivity: The findings that 69% of those with ADHD say that light sensitivity is issue for them.  Kooij, J. S., & Bijlenga, D. (2014). High prevalence of self-reported photophobia in adult ADHD. Frontiers in neurology, 5, 256.

 

Chapter 5: Training strategies

Remove training distractions: The 2019 study of college students with ADHD reporting that staying focused is their number one challenge living with ADHD. Kreider, C. M., Medina, S., & Slamka, M. R. (2019). Strategies for coping with time-related and productivity challenges of young people with learning disabilities and attention-deficit/hyperactivity disorder. Children, 6(2), 28.

Habit development: The research on habits from University College London that suggests on average it takes 66 days to develop a new habit. Lally, P., Van Jaarsveld, C. H., Potts, H. W., & Wardle, J. (2010). How are habits formed: Modelling habit formation in the real world. European journal of social psychology, 40(6), 998-1009.

Behavioural skills training: The study looking at using psychosocial interventions like behavioural skills training in ADHD to improve specific sports skills, game knowledge, sportsmanship, and gross motor proficiency. O’connor, B. C., Fabiano, G. A., Waschbusch, D. A., Belin, P. J., Gnagy, E. M., Pelham, W. E., … & Roemmich, J. N. (2014). Effects of a summer treatment program on functional sports outcomes in young children with ADHD. Journal of abnormal child psychology, 42, 1005-1017.

                                                                                             

Chapter 6: Competition strategies for ADHD athletes

Thought labelling: The neuroimaging study finding that the process of thought labelling diminished the response of the amygdala. Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words. Psychological science, 18(5), 421-428.

Preparing for the worst: Michael Phelps in his book, No Limits. Phelps, M., & Abrahamson, A. (2008). No limits: The will to succeed. Simon and Schuster.

 

Chapter 7: Common ADHD co-occurring conditions

Co-occurring condition probability: The study among primary school children that found 62.5% of those with ADHD had other conditions too. Mohammadi, M. R., Zarafshan, H., Khaleghi, A., Ahmadi, N., Hooshyari, Z., Mostafavi, S. A., … & Salmanian, M. (2021). Prevalence of ADHD and its comorbidities in a population-based sample. Journal of attention disorders, 25(8), 1058-1067. 

ASD prevalence in ADHD: The Swedish study newly diagnosed with ADHD finding the most common co-occurring condition found was autism. Giacobini, M., Ahnemark, E., Medin, E., Freilich, J., Andersson, M., Ma, Y., & Ginsberg, Y. (2023). Epidemiology, treatment patterns, comorbidities, and concomitant medication in patients with ADHD in Sweden: A registry-based study (2018–2021). Journal of Attention Disorders, 27(12), 1309-1321.

ASD prevalence in ADHD: Studies suggesting 30-65% of children with ADHD also have clinically significant symptoms of ASD. Leitner, Y. (2014). The co-occurrence of autism and attention deficit hyperactivity disorder in children–what do we know?. Frontiers in human neuroscience, 8, 268.

Dyspraxia: Study suggesting an estimated 50% of those with ADHD also have dyspraxia.  Blank, R., Barnett, A. L., Cairney, J., Green, D., Kirby, A., Polatajko, H., … & Vinçon, S. (2019). International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Developmental Medicine & Child Neurology, 61(3), 242-285.

Dyslexia prevalence in ADHD: Study suggesting about 25-40% of those who have ADHD also have dyslexia. McGrath, L. M., & Stoodley, C. J. (2019). Are there shared neural correlates between dyslexia and ADHD? A meta-analysis of voxel-based morphometry studies. Journal of Neurodevelopmental Disorders, 11, 1-20.

Alexithymia prevalence in ADHD: Paper suggesting 22% of those with ADHD also have Alexithymia. Edel, M. A., Rudel, A., Hubert, C., Scheele, D., Brüne, M., Juckel, G., & Assion, H. J. (2010). Alexithymia, emotion processing and social anxiety in adults with ADHD. European journal of medical research, 15, 403-409.

Hypermobility prevalence in ADHD: The 2022 study at the University of Sussex looked at 109 adults with neurodiversity (diagnosed autism, ADHD or Tourettes and found 51% had signs of hypermobility, compared to 20% of those who are neurotypical. Csecs, J. L., Iodice, V., Rae, C. L., Brooke, A., Simmons, R., Quadt, L., … & Eccles, J. A. (2022). Joint hypermobility links neurodivergence to dysautonomia and pain. Frontiers in psychiatry, 12, 786916.

Hypermobility: The 2012 study of those with hypermobility where it was found the volume of the amygdala was significantly larger in the hypermobile group. Eccles, J. A., Beacher, F. D., Gray, M. A., Jones, C. L., Minati, L., Harrison, N. A., & Critchley, H. D. (2012). Brain structure and joint hypermobility: relevance to the expression of psychiatric symptoms. The British Journal of Psychiatry, 200(6), 508-509.

ODD (Oppositional Defiance Disorder) prevalence in ADHD: The study suggesting that around 50% of children with ADHD also have ODD. Eskander, N. (2020). The psychosocial outcome of conduct and oppositional defiant disorder in children with attention deficit hyperactivity disorder. Cureus, 12(8).

ODD (Oppositional Defiance Disorder) prevalence in ADHD: Study suggesting the numbers of adults with substance use disorder have been found to as high as 58%. Sizoo, B., van den Brink, W., Koeter, M., van Eenige, M. G., van Wijngaarden-Cremers, P., & van der Gaag, R. J. (2010). Treatment seeking adults with autism or ADHD and co-morbid substance use disorder: prevalence, risk factors and functional disability. Drug and alcohol dependence, 107(1), 44-50.

Anxiety prevalence in ADHD: Study suggesting up to 47% of those with ADHD also have an anxiety disorder.  Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., … & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of psychiatry, 163(4), 716-723.

Depression prevalence in ADHD: Studies suggesting the depression in those with ADHD it has been estimated at between 8 and 55%. Riglin, L., Leppert, B., Dardani, C., Thapar, A. K., Rice, F., O’Donovan, M. C., … & Thapar, A. (2021). ADHD and depression: investigating a causal explanation. Psychological medicine, 51(11), 1890-1897.

Depression prevalence in ADHD: The Danish study looking at 2.9 million people aged over 10 found a five-fold higher rate of suicide attempts and three-fold higher rate of death in individuals with ADHD compared to those without. Fitzgerald, C., Dalsgaard, S., Nordentoft, M., & Erlangsen, A. (2019). Suicidal behaviour among persons with attention-deficit hyperactivity disorder. The British Journal of Psychiatry, 215(4), 615-620.

Bipolar prevalence in ADHD: Bipolar is another area where we see higher than average levels in those with ADHD. A review of ten studies found the worldwide prevalence rate of bipolar disorder is estimated as 1–3% but the prevalence in the ADHD group was greater than 3% in every study. Schiweck, C., Arteaga-Henriquez, G., Aichholzer, M., Thanarajah, S. E., Vargas-Cáceres, S., Matura, S., … & Reif, A. (2021). Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 124, 100-123.

SAD prevalence in ADHD: The study of patients with ADHD where 27% reported symptoms of SAD. Amons, P. J. T., Kooij, J. J. S., Haffmans, P. M. J., Hoffman, T. O., & Hoencamp, E. (2006). Seasonality of mood disorders in adults with lifetime attention-deficit/hyperactivity disorder (ADHD). Journal of affective disorders, 91(2-3), 251-255.

Burnout prevalence in ADHD: The study suggesting that burnout is much higher in those with ADHD than in the general population. Higuchi, Y., Inagaki, M., Koyama, T., Kitamura, Y., Sendo, T., Fujimori, M., … & Yamada, N. (2016). A cross-sectional study of psychological distress, burnout, and the associated risk factors in hospital pharmacists in Japan. BMC public health, 16, 1-8.

Accidents, Injuries and Illness in ADHD: The study of a large Danish clinical register found an increased mortality rate in children, adolescents and adults with ADHD. Dalsgaard, S., Østergaard, S. D., Leckman, J. F., Mortensen, P. B., & Pedersen, M. G. (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. The Lancet, 385(9983), 2190-2196.

Accidents, injuries and Illness in ADHD: The study showing children under four with an ADHD diagnosis were 70% more likely to be admitted to a hospital than those without one. Silva, D., Colvin, L., Hagemann, E., Stanley, F., & Bower, C. (2014). Children diagnosed with attention deficit disorder and their hospitalisations: population data linkage study. European child & adolescent psychiatry, 23, 1043-1050.

Accidents, injuries and Illness in ADHD: The study finding that once medication has been started injuries and accident and emergency visits in children with ADHD significantly reduce.  NEED OU TO FIND

Cardiovascular issues in ADHD: The study suggesting 43% of those with ADHD have cardiovascular issues. Li, L., Chang, Z., Sun, J., Garcia‐Argibay, M., Du Rietz, E., Dobrosavljevic, M., … & Larsson, H. (2022). Attention‐deficit/hyperactivity disorder as a risk factor for cardiovascular diseases: A nationwide population‐based cohort study. World Psychiatry, 21(3), 452-459.

Gastro-intestinal issues in ADHD: The study finding they are about twice as common in those with ADHD (33%) than the general population (19%): Attention deficit hyperactivity disorder and gastrointestinal morbidity in a large cohort of young adults – PMC (nih.gov)

Immune system issues in ADHD: Study finding that are about twice as common in those with ADHD (7%) than the general population. Cortese, S., Sun, S., Zhang, J., Sharma, E., Chang, Z., Kuja-Halkola, R., … & Faraone, S. V. (2018). Association between attention deficit hyperactivity disorder and asthma: a systematic review and meta-analysis and a Swedish population-based study. The Lancet Psychiatry, 5(9), 717-726.

GP visits in ADHD: The 2024 study based on data from 136 GP practices in Scotland finding that those with ADHD are between 60 and 90% more likely to miss GP appointments. McQueenie, R., Ellis, D. A., Williamson, A., & Wilson, P. (2024). Attention-Deficit/Hyperactivity Disorder and serial missed appointments in general practice. PLOS Mental Health, 1(2),

Central Nervous System conditions and ADHD: The Neurodevelopmental Genomics Cohort Study finding that children with central nervous system conditions were significantly more likely to have ADHD. Merikangas, K. R., Calkins, M. E., Burstein, M., He, J. P., Chiavacci, R., Lateef, T., … & Gur, R. E. (2015). Comorbidity of physical and mental disorders in the neurodevelopmental genomics cohort study. Pediatrics, 135(4), e927-e938.

Adenotonsillectomy in ADHD: The study finding that 27.8% of children with ADHD have had the surgical procedure to remove tonsils and adenoids compared to fewer than 10% of children in the general population. Dillon, J. E., Blunden, S., Ruzicka, D. L., Guire, K. E., Champine, D., Weatherly, R. A., … & Chervin, R. D. (2007). DSM-IV diagnoses and obstructive sleep apnea in children before and 1 year after adenotonsillectomy. Journal of the American Academy of Child & Adolescent Psychiatry, 46(11), 1425-1436.

 

Chapter 8: Medication

Medication: The 2020 study in the British Journal of Psychology stating 62 per cent of children in the UK with an ADHD diagnosis were receiving medication. Price, A., Ford, T., Janssens, A., Williams, A. J., & Newlove-Delgado, T. (2020). Regional analysis of UK primary care prescribing and adult service referrals for young people with attention-deficit hyperactivity disorder. BJPsych Open, 6(1), e7.

Medication effectiveness: The study suggesting medication is effective in between 65-75% of cases and for these people their symptoms have been found to improve by up to 90%. Halperin, J. M., Berwid, O. G., & O’Neill, S. (2014). Healthy body, healthy mind?: the effectiveness of physical activity to treat ADHD in children. Child and Adolescent Psychiatric Clinics, 23(4), 899-936. / Smith, B., Barkley, R., & Shapiro, C. (2006). Combined child therapies. Attention-deficit hyperactivity disorder, 3, 678-691. 

Stimulant medication: The study saying that over 50% of individuals with ADHD are prescribed a stimulant medication. Wilens, T. E., Faraone, S. V., & Biederman, J. (2004). Attention-deficit/hyperactivity disorder in adults. Jama, 292(5), 619-623.

Reduced appetite: Study suggesting that those taking the most common stimulant for ADHD (methylphenidate) were more likely to have a decreased appetite than those not taking it. Karabekiroglu, K., Yazgan, Y. M., & Dedeoglu, C. (2008). Can we predict short-term side effects of methylphenidate immediate-release?. International Journal of Psychiatry in Clinical Practice, 12(1), 48-54.

Weight loss: The study on ADHD stimulant medication where 91% of those taking it lost weight and the average weight loss was 3.6kg. Santosh, P. J., Sattar, S., & Canagaratnam, M. (2011). Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults. CNS drugs, 25(9), 737-763.

Weight / height loss: The study using longitudinal data suggesting that children using stimulant medication generally have a reduction in height of 1cm per year and weight gain of 3kg lower than predicted over a three year period. Feldman, H., Crumrine, P., Handen, B. L., Alvin, R., & Teodori, J. (1989). Methylphenidate in children with seizures and attention-deficit disorder. American journal of diseases of children, 143(9), 1081-1086. / Faraone, S. V., & Giefer, E. E. (2007). Long-term effects of methylphenidate transdermal delivery system treatment of ADHD on growth. Journal of the American Academy of Child & Adolescent Psychiatry, 46(9), 1138-1147.

Overheating: A study suggesting  that stimulants used to treat ADHD symptoms can increase the body’s core temperature. Piper, B. J., Fraiman, J. B., & Meyer, J. S. (2005). Repeated MDMA (“ecstasy”) exposure in adolescent male rats alters temperature regulation, spontaneous motor activity, attention, and serotonin transporter binding. Developmental Psychobiology: The Journal of the International Society for Developmental Psychobiology, 47(2), 145-157.

Blood pressure: A study finding that stimulant medication can cause an elevation in blood pressure. Wernicke, J. F., Faries, D., Girod, D., Brown, J. W., Gao, H., Kelsey, D., … & Heiligenstein, J. (2003). Cardiovascular effects of atomoxetine in children, adolescents, and adults. Drug safety, 26, 729-740.

Heart rate: Study finding ADHD medications have been found to cause a small increase in heart rate averaging 1–4.8 beats per minute (at both rest and active). Santosh, P. J., Sattar, S., & Canagaratnam, M. (2011). Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults. CNS drugs, 25(9), 737-763.

WADA rules: TUE Physician Guidelines – ADHD | World Anti Doping Agency (wada-ama.org)

Controlled drug: A study showing in the USA, ADHD medications are the second most common form of illicit drug use in university students (after marijuana). Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2017). Demographic subgroup trends among adolescents in the use of various licit and illicit drugs, 1975-2016 (Monitoring the Future Occasional Paper No. 88).

Controlled drug: The study finding that 54% of students legitimately prescribed ADHD stimulants were approached by peers to share their medication. McCabe, S. E., Knight, J. R., Teter, C. J., & Wechsler, H. (2005). Non‐medical use of prescription stimulants among US college students: Prevalence and correlates from a national survey. Addiction, 100(1), 96-106.

Controlled drug: The study where 29% admitted they had given or sold their medication to others. Upadhyaya, H. P., Rose, K., Wang, W., O’Rourke, K., Sullivan, B., Deas, D., & Brady, K. T. (2005). Attention-deficit/hyperactivity disorder, medication treatment, and substance use patterns among adolescents and young adults. Journal of Child & Adolescent Psychopharmacology, 15(5), 799-809.

 

Chapter 10: Parenting an athlete with ADHD

Long term success: 1992 research saying that how children with ADHD do as adults is not predicted by the levels of their symptoms but by the quality of their relationships with their parents, their ability to do well at school and their social skills. Hinshaw, S. P. (1992). Externalizing behavior problems and academic underachievement in childhood and adolescence: causal relationships and underlying mechanisms. Psychological bulletin, 111(1), 127.

Parenting: The study suggesting that parenting a child with ADHD increases your risk of depression, self-blame and isolation. Glatz, T., Stattin, H., & Kerr, M. (2011). Parents’ reactions to youths’ hyperactivity, impulsivity, and attention problems. Journal of abnormal child psychology, 39, 1125-1135.

Parent training: The NICE guidelines recommending parent training for the families of children with ADHD before they become teenagers. Recommendations | Attention deficit hyperactivity disorder: diagnosis and management | Guidance | NICE

Excellent paper to highlight the development of ADHD understanding and where it now sits: Attention-Deficit/Hyperactivity Disorder: A Historical Neuropsychological Perspective – PMC (nih.gov)

Tips for coaching athletes with ADHD

Adapted from ADHD in Sport: Strategies for Success

ADHD is considered to be present when someone has persistent patterns of inattention, hyperactivity or impulsivity (or a combination) which causes significant dysfunction and challenges in their lives. It can cause some deficits in some cognitive functions (the ways we monitor and regulate our goal-directed behaviours) impacting our behaviours, emotions, performance, relationships and motivation.

Studies suggest the elite athlete population may present with ADHD at greater rates than that seen in the general population and that at least 10% of athletes have ADHD.

Benefits of ADHD on athletes

In ADHD there can be a deficit in explicit memory. Those with ADHD who have not been able to work around explicit memory difficulties in academic environments can find themselves being far more successful and thriving in environments which require implicit memory (like sport) and so it becomes a safer, more enjoyable place to be and a popular career choice.

Parents of children with hyperactive ADHD may well encourage them into lots of sports to ‘tire them out’ and use up excess energy. If they find a sport they love then their ability to hyperfocus can mean they have both the energy required and the intense engagement to work hard and improve quickly. Alongside the hyperfocus, the ability to react quickly to changing stimuli can be valuable in many sports.

Another element of ADHD which can be used really effectively in sport is novelty seeking. This helps the athlete to be really creative about doing things differently, less predictably or taking more risks in order to feed that craving, setting themselves up for success.

Finally, the demands of competitive sport (such as structure, routine, dedication and effort levels) could have a protective role for those with ADHD as it gives a safe energy outlet and fulfils the need for routine, hyperfocus and high energy. When you feel safe in an environment you achieve better results and flourish.

Communicating better with athletes who have ADHD

  • Ask them what already works well for them – they will be the biggest expert in themselves.
  • Try to understand the ADHD brain – Read chapter one of ADHD in Sport: Strategies for Success to understand the high-performance brain and chapter three to see where the elements of ADHD can disrupt high performance by creating a highly sensitive threat system. 
  • Check the athlete has the right message from a briefing
  • Be clear in briefings on what information applies to who
  • Give as much certainty and clarity as you can – Asking an athlete with ADHD ‘for a chat’ without giving any context may see them catastrophize. Explain up front why you want to talk and what you will cover.
  • Deliver information simply: Long streams of instructions with lots of distractions around won’t give an athlete the clarity they need to do the task being set.
  • Give clear instructions using specific language.

Some of the issues you might notice… and how you can reduce their impact on sporting performance and provide more psychological safety

 

Issue

Response

Disorganisation

·       Avoid public criticism.

·       Communicate clear timelines of deadlines.

·       Keep requests simple – ask only one question at a time.

·       Help athletes create checklists of kit and equipment required.

·       Highlight consequences, not punishments.

 

Emotional dysregulation

 

·       Get to know the signs of ADHD dysregulation so you can spot quickly when support needed.

·       Have a code word they can use to highlight that are struggling.

·       Anticipate hard moments like transitions or changes in rules.

·       Help to create an environment where all athletes have a more stable, less fragile threat system.

·       Offer immediate praise of any effective and restrained behaviours.

 

Forgetfulness

 

·       Break down instructions into small chunks giving just one at a time.

·       Ask the athlete to repeat the instruction back to you to ensure it has been understood.

·       Streamline feedback and just give the most important piece.

·       Offer visual cues. This reduces stigma, frustration and keeps the athlete reminded and away from distractions.

·       Reduce gaps between asking for something to be done and when it should be done.

 

Hyperactivity

·       Create a consistent schedule and structure with clear expectations of conduct.

·       Consider how changes may cause stress and forewarn.

·       Give responsibility for any logistical tasks like putting equipment out or away or running to office to pick up something.

·       Don’t leave ‘empty space,’ instead offer suggestions of movements or activities to do when others might be asking for downtime.

·       Give out fidget toys to play with during any thinking type sessions.

Hyperfocus

 

·       Teach them how to use imagery and how to practice skills this way (it gives additional skills development away from physical environment and without risk of an overtraining injury.

·       Help them see their value and identity in other areas of life too so they don’t struggle so much if their form dips or they get injured.

·       Talk to them about how their focus can be their super-strength.

·       Emphasise the importance of recovery to become a better athlete.

 

Impulsivity

 

·       Lots of praise for good attitudes and efforts to ‘wait’.

·       Intentionally creating opportunities for impulsivity in training sessions.

·       Use praise, tokens and delayed rewards to improve this behaviour.

Inattention

 

·       Reduce opportunities for distraction during a session so plan your transitions, have equipment ready, move quickly between activities.

·       Break down tasks into smaller chunks.

·       Keep messages and feedback short and clear.

·       Be very precise with language: instead of ‘focus’ say ‘keep looking at the ball and follow where it goes with your eyes’.

·       Create individual and small group activities as well as large group ones to keep engagement and activity levels high.

·       If you have the space, give ADHD athletes a low stimulus environment for recovery or meetings.

 

Lack of perseverance

 

·       Offer positive reinforcement when perseverance occurs, openly and intentionally rewarding the effort.

·       Focus your goal setting with the athlete on process goals.

·       Offer reward activities for seeing an activity through to the end.

 

Low self-esteem

 

·       Helping the athlete identify and play to their strengths.

·       Offer positive reinforcement of activities completed well.

·       Offer constructive feedback rather than critique.

·       Help the athlete identify their super strength and find their niche role in the team or event.

·       Reward effort and praise process rather than outcomes.

 

Processing difficulties

 

·       Offer really tangible feedback.

·       Offer regular updates on their progress.

·       Instead of criticising speed of action, praise ability to reflect.

·       Reduce external interference when giving instructions or feedback.

·       Explain equipment usage or new movements step by step.

 

Procrastination

 

·       Positive reinforcement when things are done in time.

·       Regular reminders of what is required by when.

·       Breaking down any ‘big’ activities into more manageable chunks.

 

Rejecting routine and structure

 

·       Bring in something novel or exciting at the end of each practice. This can often be athlete led or co-created.

·       Rather than rejecting their new ‘shiny’ ideas out of hand suggest they research them. 

·       Challenge yourself to set interesting sessions. This will excite the ADHD athlete’s interest-based motivation system.

 

Sensation seeking

 

·       Move them away from any dangerous equipment in rests during training sessions.

·       Ask them to take on a chore during any info giving that will fulfil their sensation seeking and ask a peer to give them the info after.

·       Suggest sensation soothing tools for matches or competitions; velvet sown into the inside of a glove, fabric tape on the inside of the wrist, elastic band or hairband around the wrist.

 

Unhelpful training behaviours

 

·       Set a predictable practice schedule and structure which has clear conduct expectations. Make the rules visual and within eyesight.

·       Focus on ‘positives before negatives’ offering lots of positive, specific feedback to help self-reflection.

·       Offer ‘noisy time’ breaks for talking, playing/off task and clowning around.

·       Unless there is a safety aspect, do not cancel free time or movement time as punishment. The dopamine will be needed and likely calm the behaviours.

·       Ask the athlete with ADHD to demonstrate exercises.

 

 

If you would like more information you can find it in: ADHD in Sport: Strategies for Success by Dr Josephine Perry

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