Attention deficit hyperactivity disorder (ADHD)

Guidance for medical examiners when assessing a patient for either a general topic or condition – attention deficit hyperactivity disorder (ADHD).

Attention deficit hyperactivity disorder (ADHD)

• A disorder that generally manifests in childhood with symptoms of hyperactivity, impulsivity, and/or inattention.
• Symptoms affect cognitive, academic, behavioural, emotional, and social functioning.

Aeromedical implications

Effect of condition on aviation

• Inattention, in turn its effect on multi-tasking in aviation, with implications for working memory, situation awareness, task prioritisation, task accomplishment, and time management
• Premature and / or ill-considered actions
• Restlessness and excess of movement causing distraction
• Impulsivity with excessive involvement in speech or activities resulting in errors have potential for consequences
• Emotional dysregulation or effect of comorbid mental health conditions may have adverse impact on performance

Risk factors

• ADHD not in remission
• Need for medication

Approach to medical certification

Based on the condition

• In full remission without any medication

Based on treatment

• No safety-relevant medication such as stimulants

Demonstrated disease-free status or stability

• Absence of symptoms for a minimum of 6 months after treatment completed.

Risk assessment protocol - information required

New cases

• Copies of medical records from date of diagnosis to the present
• Copies of records from Medicare detailing consultations and prescription of medications
• An up to date assessment by the treating paediatrician or psychiatrist if available detailing:
  • history of condition
  • precise confirmation of the diagnosis with reference to DSM-5 criteria
  • co-morbidities, including drug and alcohol use
  • requirement and response to treatment
  • current clinical status with respect to DSM-5 criteria
  • current functional status, with reference to collateral information if available from school, family, workplace etc.
• Completion by the paediatrician/psychiatrist and the chief flying instructor of the ADHD instructor’s questionnaire form 420 regarding symptoms in the context of and noting the implications to both the normal day to day life and the conduct of aviation was previously required, but form 420 is currently unavailable while it is undergoing review. Please contact us if you have any feedback or questions in relation to this.
• Copies of academic records and employment history
• Copies of traffic infringements and criminal records
• Copies of any special investigations performed such as QEEG or neuropsychological testing
• Follow-up plan
• Previous specialist reports if available.

Renewal

• May be subject to annual review by an appropriate specialist on a case by case basis.

Indicative outcomes

• Unrestricted certification is possible if in full remission without medication

Favourable

• ADHD diagnosed in childhood and treated with no persisting symptoms without medication for at least past 6 months
• Adult ADHD not on any treatment for at least 6 months

Unfavourable

• ADHD with symptoms persisting in adulthood, likely to impair performance
• ADHD requiring treatment

Pilot and controller information

• Instructor questionnaire and annual specialist reports for 5 years following cessation of treatment. After 5 years consideration of removal of surveillance requirement.
• Any recurrence must be reported to the DAME
• Diagnosis of adult ADHD in a pilot requires grounding and need for any treatment may impact the ability to exercise the privileges of your medical certificate.