(#9) Elite Athletes: The Role of Neuropsychological Testing When Providing Therapeutic Use Exemptions for "Banned" Substances

Abstract: In the World Anti-Doping Code: International Standard, Prohibited List, the World Anti-Doping Agency lists "Substances and Methods" prohibited "At All Times," and when athletes are "In-Competition." Substances prohibited "at all times" include anabolic steroids, hormones, diuretics, masking agents, and psychoactive substances in "so-called" recreational drugs. Substances prohibited while "in-competition" include psychiatric medications, notably, psychostimulants for treatment of attention deficit/hyperactivity disorder (ADHD). With an estimated ADHD prevalence of 7-10%, and increasing rates identified in adults, it was inevitable that elite athletes would be diagnosed with ADHD and treated with psychostimulants. Concern regarding the accuracy of ADHD diagnoses among elite athletes is warranted, particularly in the United States, where diagnoses are typically provided by primary care physicians and non-specialist healthcare providers unaware of NCAA and international antidoping standards. Given that a "Therapeutic Use Exemption" (TUE) might allow elite athletes to take "banned" substances during training, some may attempt to "fake" ADHD or, in a less Machiavellian sense, convince themselves through self-diagnosis that they have the disorder. This presentation outlines a neuropsychological consultation approach used with several hundred elite athletes over the past quarter century to help determine "need" for TUEs in individuals who have ADHD or other neuropsychiatric disorders, those who do not but believe they do, or those attempting to manipulate the system. The adequacy of diagnostic interviews to rule-in/out ADHD in elite athletes will be discussed.

Short Description: The World Anti-Doping Agency lists substances that cannot be taken by elite athletes. Anabolic steroids and masking agents are banned at all times; psychostimulants are prohibited while in-competition. Given that a "Therapeutic Use Exemption" (TUE) might allow access to banned substances, athletes may attempt to "fake" ADHD or self-diagnose. This presentation outlines a neuropsychological consultation approach used with several hundred athletes over a quarter century to help determine "need" for TUEs.

Name of Sponsoring Organization(s): Holy Cross College At Notre Dame