ADHD and flying. What's the big deal?

Let’s be honest. When you think about the FAA’s requirements regarding ADHD (attention deficit/hyperactivity disorder), you probably say that to yourself, or some variation of it, usually mixed with some degree of contempt, a sneer, and maybe a shake of the head. Why is that? I mean, why does the FAA care about ADHD in the first place, and why do you have that reaction?

On the second question, I think you have that reaction because of a variation on the axiom “familiarity breeds contempt.” I call it “familiarity breeds complacency” or, “the commonplace fallacy.”

ADHD is so incredibly familiar, and you are so exposed to the term endlessly through media, family, friends, etc., that it has ceased to mean anything to you. Because “everybody has it”, it can’t possibly be serious, right? Put another way, you think that, because it is so common, it can’t be bad, as if the frequency of an occurrence determines whether it is serious or not. Drunk driving is very common. Does that mean it is not serious?

 But really, what’s the deal with the FAA and ADHD, and why do they care in the first place?

This is not going to be an exhaustive treatment of the subject. My only goal is to move the needle on how you think about it, and have you understand why this common entity is considered to be of potential aeromedical significance.

A matter of definition.

When the FAA uses the term ADHD, it means the “real” clinical definition as contained in the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)” published by the American Psychiatric Association.

There is a whole menu of particular characteristics which go into making the diagnosis, and I won’t quote them all. The key is that a person with real ADHD manifests:  “Symptoms and/or behaviors that have persisted ≥ 6 months in ≥ 2 settings (e.g., school, home, church). Symptoms have negatively impacted academic, social, and/or occupational functioning.” (emphasis mine)

So, it has to have negatively impacted functioning. This is not just the “busy kid” in school. “Real” ADHD has true negative effects on a person’s functioning.

Think about trying to instruct a new student pilot who:

• Has poor listening skills

• Is distracted or sidetracked by unimportant stimuli (shiny things)

• Lacks ability to complete assignments or follow instructions (taxi instructions with multiple crossings and hold short instructions, or other complicated ATC communications)

• Does poorly with tasks that require concentration (isn’t that pretty much all of flying?)

• Makes mistakes due to inattention or carelessness (ever seen language like that in an NTSB report?)

Would you let your loved one fly with a person whose functioning was negatively impacted by characteristics such as these? 

Remember, real ADHD is defined by negatively impacted functioning. Medication used to treat ADHD can have additional negative effects.

Do you see why this may be of concern to the FAA, and why you should possibly be concerned as well? 

Unfortunately, many, many folks who were just the busy ones, were labeled with ADHD and started on medications. You know them. Their teacher and parents just needed to “do something.” That something was having the kid started on medication. And now they are grown up and want to become pilots. That is when you see them, and where the frustration begins when they find out that they need to go through “hoops” to get their medical certificate. Or, they despair of getting it at all, and decide to not pursue flying.

Wheat from chaff

Because ADHD has real effects, as shown in the list above, the task for the student pilot’s healthcare provider, the AME, and the FAA Aerospace Medical Certification Division is to figure out who has the “real” deal, (and has it badly) and will unlikely be able to safely function in command of an aircraft, and who was just the busy one but whose behavior has no negative impact on their functioning.

So what do you do?

• What is NOT going to help the student is to stop their ADHD medications just before their medical exam, and to withhold the ADHD diagnosis from their 8500-8. (“Oh, I don’t have that anymore, and I’m not taking any medication”) That just adds a regulatory compliance problem to their medical problem. The medical history questions on 8500-8 are lifetime (have you ever had...) questions. Not the way to make a good impression on the FAA.

• Familiarize yourself with the FAA Guide For Aviation Medical Examiners (AME Guide) section on ADHD. 

• Let the student know that they will need to disclose all their medical history and medications to the AME when they get their exam. They will have to get medical records from their regular doctor as well as an exam from a psychologist or neuropsychologist. They should strongly consider a consultation visit with an AME prior to scheduling their actual flying class physical. 

• Tell them that having all their paperwork ready before the flying class physical could literally mean the difference between getting their medical certificate on-the-spot, and a 6-12 month delay.

• Tell them not to despair. The FAA has a pathway for most folks to get their certificate, once it can be established that their condition or medications do not represent an unreasonable risk.

We want to be a resource to you, so reach out to us at Fargo Flight Physical, where our mission is to keep you flying…safely!