Doctors suspicious about rocketing number of British athletes ‘with ADHD'

Telegraph

a day ago

There has been a sharp rise in athletes in Britain using ADHD drugs while competing, amid fears the medication could be abused to enhance performance.
Data obtained by Telegraph Sport shows there has been a more-than threefold increase in just five years in the number of therapeutic use exemptions (TUEs) granted at national level for athletes diagnosed with attention deficit hyperactivity disorder. There has also been a more-than fourfold rise in the number of TUE applications during the same period (2019-24).
The data comes from a Freedom of Information request to UK Anti-Doping, made amid concerns that TUEs for ADHD drugs may have become too easy to obtain.
Medication such as ritalin has long been linked with so-called 'brain doping', most notoriously by students sitting exams. But studies show ADHD drugs also boost athletic performance and they are banned in competition by the World Anti-Doping Agency.
Concerns of misuse within sport are focused on the adult diagnosis of a disorder that is normally identified in childhood – at an age where there is no prospect of the TUE system being abused – and that does not necessarily require medication to treat.
Ukad told Telegraph Sport it was unable to provide a breakdown of how many TUEs for ADHD it had granted to athletes who had first been diagnosed as adults. That raises questions about whether it is adequately monitoring any trends that may warrant further investigation, particularly given the sharp increase in the total number of those using ADHD drugs while competing.
The data provided by Ukad showed that the number of TUEs it granted for ADHD rose from 19 in 2019 (from 24 applications) to 63 last year (from 106 applications). Some of those may have been from repeat applications. Football had the largest number of applications granted during that period, which climbed from just two in 2019 to 16 last year. Rugby union, cricket and rugby league were the next most prevalent sports.
Telegraph Sport submitted its Freedom Of Information request after one doctor, who has worked in some of those four sports, raised concerns about potential ADHD medication misuse.
Responding to the findings, the doctor– who spoke under the condition of anonymity – said: 'You'd have to question sometimes whether these diagnoses are true or whether these are diagnoses which help facilitate somebody having something, a medication, which enhances performance.
'ADHD is what I'd describe as a 'soft' diagnosis. It's a diagnosis which is in the opinion of a so-called expert. And there is no one speciality which is equipped to diagnose somebody with ADHD.
'The huge performance advantage, from a physical and from a mental point of view, of taking ADHD medication would either give your team a boost or individually raise you to a higher level that you might not have been able to reach without it.
'And whilst the majority of people who work in sport are scrupulous, there are some people who are not scrupulous – whether that be doctors, physios or agents involved in the management of players.
'If you've got a player who is struggling performance-wise and you get 10 per cent of their cut, it doesn't take a genius to go, 'Well, it could be that he has ADHD'.'
Another doctor, who has worked both for Premier League football clubs and at international level, said TUEs in sport for ADHD had 'gone through the roof' and that it was 'easy' to obtain a diagnosis.
In the required medical assessment for the condition, an ADHD specialist such as a psychiatrist would ask a subject about their history of symptoms, particularly if they started in childhood, as well as assessing how work and interpersonal relationships are affected, and their medical history.
Yet, suggesting the condition was 'probably' being over-diagnosed when the opposite had occurred historically, the second medic added: 'The problem is, of course, that it's all relatively subjective and, therefore, it's difficult to say to someone, 'I disagree. I don't think you've got ADHD'.'
John Brewer, a former Ukad board member and science and medicine expert, said: 'If I was still the science and medicine expert on the Ukad board, as a non-executive director, I would certainly be probing the executive team to try to get us some information or an explanation behind that type of increase in ADHD applications if that had been brought to the board.'
He added of ADHD: 'It's a little bit like asthma. Because if you ask me to fail an exercise-induced asthma test, I could do that very easily, even though I don't have asthma. Because I know what to do and it's dead straightforward to do it.
'It doesn't take a lot, dare I say it, to work out what people are looking for when they are conducting subjective assessments, in order to get that prescription.'
Suspicion falls on 'rogue doctors'
Michele Verroken, a veteran in th e war on drugs in sport who ran anti-doping at UK Sport before Ukad was formed, said any investigation should look for 'rogue doctors' who may be behind multiple applications.
'Anti-doping organisations should be looking at any clusters, any population increases,' she said.
'They should be looking for potential patterns of abuse, because that helps all anti-doping organisations understand if they've got over-emphasis by certain medical people in the way that they're treating and supporting performance training, and whether they're medicalising the whole approach to what's going on.'
Dr Oliver Runswick, a senior lecturer in performance psychology at King's College London, has carried out research into the impact of exercise on those with ADHD. He said being physically active was 'an incredibly good symptom-management tool' and suggested athletes actually could be 'better at managing' their symptoms than non-athletes.
Dr Runswick, who has also worked in sport, said he would expect those with ADHD 'severe' enough to require a TUE to be struggling with 'day-to-day' living. He added: 'You'd have to be outlining some pretty severe symptoms, which would make it almost impossible for you to be a professional athlete.'
The sharp rise of athletes in Britain using ADHD drugs is in stark contrast to the trend in the United States, another country in which diagnosis of developmental disorders in the general population has been on the increase. Data obtained from the United States Anti-Doping Agency (Usada) showed a decrease in the number of TUEs it has granted for the condition over the same period (2019-24).
One sports organisation that publishes its TUE data for ADHD is Major League Baseball, a move triggered by the performance-enhancing drugs scandal that engulfed it in the early 2000s. This transparency has coincided with a major fall in the number of TUEs granted, which almost halved between 2014 and last year.
A Ukad spokesperson said: 'ADHD is a debilitating disorder that can have a profound effect on the way an individual functions, regardless of whether they were diagnosed with the disorder in childhood or as an adult.
'Our primary concern is to ensure that only athletes properly diagnosed with ADHD are granted a therapeutic use exemption. Whilst there is the possibility that athletes could attempt to misuse the TUE system, we have put in place the following measures to safeguard against this risk: Our ADHD TUE policy sets out the type of clinician who we accept ADHD assessments from, and the medical evidence required to support TUE requests, which is in line with UK best-practice guidelines regarding the diagnosis and treatment of ADHD. We have highly experienced psychiatrists on our TUE committee who are involved in the review of all ADHD TUE applications submitted to Ukad. The TUE committee also has the option to request a second opinion in instances whereby a diagnosis is ambiguous.
'Whilst the increases observed in the FOI data appear significant, the prevalence of athletes being treated for ADHD with stimulant medication in 2023 was 0.41 per cent of the UK national TUE pool. This is lower than the estimated prevalence of ADHD in adults, which is three to four per cent in the UK. The prevalence rate of 0.11 per cent of UK national TUE pool athletes being treated for ADHD with stimulant medication in 2021 is also lower than the 0.27 per cent of Olympians at the Tokyo Olympic Games being in receipt of a TUE for ADHD.
'Ultimately, the UK TUE prevalence data on ADHD is not out of place with national population and global athlete statistics [in a way that would] suggest that the increase in ADHD TUE approvals in recent years is down to athletes misusing the system.'
Ukad also said the proportion of athletes it granted ADHD TUEs was in line with data indicating around 11 per cent of people with the disorder in England received medication for the condition.