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What Do Athletes with ADHD Need to Know About TUEs?

In recent years across the U.S., there’s been a consistent increase in the number of children and adults diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). As such, there is an increasing trend in the number of athletes with ADHD participating in sanctioned sporting events with anti-doping rules.

Athletes with ADHD can continue using necessary prohibited stimulant medications while competing in sanctioned sports as long as they receive a Therapeutic Use Exemption (TUE), which requires them to demonstrate that they can satisfy strict criteria for TUE approval.

Here is more on what you need to know about complying with anti-doping rules if you have ADHD:


Why is a TUE needed?

Stimulant medications used as the first line treatment for ADHD are listed on the World Anti-Doping Agency (WADA) Prohibited List. In virtually every sport or activity, improved attention or focus has the potential to increase an individual’s performance. With that in mind, the use of stimulant medication for a lack of attention or focus after an ADHD diagnosis requires an extremely high level of scrutiny in accordance with best clinical practice to avoid abuse in sport.


Where do I start?

Before applying for a TUE, explore our TUE Resources and review the TUE Pre-Check Form. These tools will help determine what steps should be taken in the TUE application process.

If a TUE for ADHD medication is necessary, an athlete and their physician will need to demonstrate that the medication is needed to treat a diagnosed condition supported by medical documentation, and that the treatment will only return the athlete to a normal, baseline level of health. The medical documentation should also show the prohibited medication is necessary because there are no other reasonable treatment alternatives.

Evaluation and diagnosis of ADHD must be made by a pediatrician, psychiatrist, or other physician who specializes in the treatment of ADHD. The diagnosis must be made in accordance with DSM-5 criteria for ADHD.

If you are competing internationally, a diagnosis from anything less than a psychiatrist (MD), or in some cases a pediatrician, will not be adequate. It also never hurts to get a second opinion from a licensed and qualified medical practitioner.


Why is an ADHD diagnosis necessary?

It is sometimes difficult, but not impossible, to isolate and confirm a diagnosis of ADHD because other medical and psychological conditions can have similar symptoms. Therefore, it’s very important that other causes of symptoms be ruled out through objective medical evidence before confirming an ADHD diagnosis.


What documentation is needed to support a diagnosis?

In many cases, ADHD TUE applications lack sufficient supporting medical documentation. Athletes and their medical support personnel must provide objective medical information showing developmental history, level of impairment, and even observations that justify a DSM-5 diagnosis of ADHD. Without this information, one cannot justify a meaningful diagnosis and subsequent treatment with stimulants. ADHD cannot be diagnosed accurately just from brief office observations or by talking to the person.

Objective medical documentation, such as structured questionnaires that specifically identify symptoms, as well as objective observations from licensed providers, help justify a diagnosis of ADHD. Anything that is self-reported, including symptoms and surveys, can help to add perspective to the file, but are not considered objective nor definitive in establishing a diagnosis.

The most credible TUE applications show a diagnosis based on information from multiple sources, which can include ADHD symptom checklists, standardized behavior rating scales, a detailed history of past and current functioning and development and evolving impairment, information obtained from family members or significant others who know the person well, and changing treatment efforts.


Need more help?

For more assistance, contact USADA’s Drug Reference Team at 719-785-2000 x2 or at drugreference@usada.org.

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