ADHD Medications and Pilots

[Ian]

I recently came across an article where a pilot was refused a medical because he was taking Ritalin for ADHD.

Later this was overturned by the AAT on the basis that CASA failed to adequately assess the situation.

https://hwlebsworth.com.au/adhd-diagnosis-not-fatal-to-aviation-medical-certificate-application-nam-v-civil-aviation-safety-authority/

 

CASA now appears to have the policy under review and are asking for comments.

https://www.casa.gov.au/licences-and-certificates/medical-professionals/dames-clinical-practice-guidelines/attention-deficit-hyperactivity-disorder-adhd#Attentiondeficithyperactivitydisorder(ADHD)

 

I find this stance interesting because a number of my work colleagues have been diagnosed with mild ADHD, take medication and I regard them as some of the top performers in their field both prior and post their diagnosis and subsequent medication.

It's even more interesting that given the penchant for Defence forces, included the US DoD to provide the very drugs prescribed for ADHD reducing the error rates and alertness for extended combat missions and high operational loads.

https://pubmed.ncbi.nlm.nih.gov/7661838/

https://jmvh.org/article/should-the-australian-defence-force-conduct-a-drug-trial-of-wakefulness-promoting-medications/

 

I'd be interested in people's thoughts on this matter as these same people are interested pursuing their pilots licence. Personally I think that numerous pilots appear to have traits which would fit on the spectrum which could be considered sufficient to get them diagnosed with ADHD.

 

If this is the case, would they be better pilots if this condition was treated?

 

[spacesailor]

If you ' hide ' your defects you can get away with many 

Defects . But are you safe in your Delusion .

Then again if not diagnosed ,  who is at fault .

Before the fifties, no one was diagnosed with ADHD

spacesailor

 

[Red]

I've only seen diagnosed cases of ADHD that are probably near the top of the scale in severity and wouldnt want to give any of these a Pilot's Licence.

The problem I see these days is the increasing tendency to diagnose conditions that are very mild as I believe everyone has  what could be catagorised as some character/personality/mental condition if you look closely enough...there is no such thing as normal.

Basically over diagnosis, a child who was just classed as being a bit naughty in the 60s and perhaps just grow out of it will now be 'special needs' and carry the  weight of that classification for life.

[Geoff_H]

Once mild cases of autism were called NSD (non specific diagnosis) now they are called autism and often ADHD.  People that were highly functional and have low interpersonal abilities were just regarded as different now they have something that needs examination and limitations.  My daughter is like that, has a phd in a medical field now writes AI software for a medical company. She would be limited in flying, she uses ADHD drugs.  Her worst feature is the drop kick she married and her subsequent boy friends.  I will not get diagnosed, the diagnosis may be limiting after over 40 years of flying.   

It is interesting that CASA now asks the industry,  rather than their own investigations, if the result of a rule change turns out to be wrong they can claim reduced responsibility.   

 

[skippydiesel]

"People that were highly functional and have low interpersonal abilities were just regarded as different now they have something that needs examination and limitations."

 

The following is speculation - I have no medical/psychiatric training.

 

Given:

• ADHD is a relativly modern diagnosis - did not exist in my childhood/youth. If it did, you were considered a tad strange, bit of a personality, on a diffrent planet, etc but generally accepted as being part of the broad spectrum of human behavior. Sure there were "bad" kids who likly need a more empathetic approach than flogging but most of them seemed to "make their way" eventually.
• Seems to be on the rise - why?
• The accompanying rise in the use of medications that users are likly to become dependent on. May have a long term negative impact on the user.

I agree with the observation that there is no such thing as a monochrom "normal" human being - we all exhibit a range of behaviours that I am sure can be plotted on a Bell Curve (BC) demonstrating that at some times/situations, we may stray from the central "normal" range of behaviour and a few unfortunates, permanently on the lower slopes, must "live" and manage their lives somehow.

 

I accept that people who exhibit traits that are at the extremes of the BC may need some chemical assistance, to function in society and on what I hope is rare occasions, this may require lifelong usage.

 

I speculate, that the apparent pandemic (if true) in ADHD (& other personality disorders) is as much a fashion statement, brought on by the media and parental anxiety, as anything else.

 

I lived for much of my youth in Ireland and later England - eccentricity (difference in social interaction & presentation) was celebrated (to a point). It seems Australians are far less tolerant, seeming to seek a bland adherence to "the norm" .

 

I suspect that most of those diagnosed with ADHD & similar, would eventually find their own way in life, without recourse to medications, special behavioural interventions, etc, just like everyone else.  

[sfGnome]

If you’ve watched a kid who’s been struggling to keep up in life suddenly be able to function after starting medication, you may not be so dismissive of either the diagnosis nor the treatment. No, it doesn’t need to be a ‘forever’ drug, nor does it turn her/him into a zombie. If you’ve experienced it, you’ll understand. If you haven’t, then please ignore all the mindless crap you read in the media and socials. 🙂

[spacesailor]

It's just the fact that the kids , say themselves, " I feel like a zombie " .

And they sometimes don't function as well as ' normal ' children 

Then ten years later he has a wife & his own kids , with a good paying job .

spacesailor

[skippydiesel]

55 minutes ago, sfGnome said:

If you’ve watched a kid who’s been struggling to keep up in life suddenly be able to function after starting medication, you may not be so dismissive of either the diagnosis nor the treatment. No, it doesn’t need to be a ‘forever’ drug, nor does it turn her/him into a zombie. If you’ve experienced it, you’ll understand. If you haven’t, then please ignore all the mindless crap you read in the media and socials. 🙂

Maaate: You don't know just how tough some kids upbringing was and yet somehow most  survived even flourish.

 

I have no desire to reinvent/impose the past but feel that the "pendulum" of how children should be raised, has swung from one unpleasant even nasty extreme, well past reason, to some hysterical, contonwool, entitled, chemical, digital,  mayhem. Children no longer roam the bush, play in the street, walk to school,  - they just play with their digital tools!😈

[pmccarthy]

14 hours ago, skippydiesel said:

- they just play with their digital tools!😈

So did we, but it was the pre-digital age.

[Jerry_Atrick]

On 02/10/2024 at 3:20 AM, skippydiesel said:

ADHD is a relativly modern diagnosis - did not exist in my childhood/youth. If it did, you were considered a tad strange, bit of a personality, on a diffrent planet, etc but generally accepted as being part of the broad spectrum of human behavior. Sure there were "bad" kids who likly need a more empathetic approach than flogging but most of them seemed to "make their way" eventually.

When I was a kid, HIV wasn't around and then it suddenly popped up.. Does it mean that it was not an identified disease because it wasn't around? There are newly defined existing diseases all the time. And in the case of ADHD and other mentlal health sufferes making their way eventually, not all do.. in fact the issue with these diseaeses, which some people have while being high functioning, is that they can lead to other mental illnesses, such as depression and suicide.. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371172/

 

Also, if there is a diagnosable and manageable condition that will help people make their way with normal rather than abnormal hinderance, why not facilitate that.. ADHD, ADD, anxiety disorders are all treatable - some don't need drugs, but CBT and practices; others need drugs to be able to receive CBT and other forms of treatment. Some who are low functioning and extreme do need drugs longer term. It helps them attain some normality which allows them to participate in activities, including flying where appropriate.

On 02/10/2024 at 3:20 AM, skippydiesel said:

Seems to be on the rise - why?

There are probably many factors - diet and processed foods are linked to mental conditions (mental conditions are actually physical conditions because there is usually some impairment from chemical imbalance to damage of the brain). Increase in the use of recreational dugs of different intesnities - althouth that can also be a funtion of mental health issues. Foetal alochol/drug syndome, etc. Also, as there is much better understanding of mental health conditions, it gets communicated more. More sedentary lifestyle. Also, relatively recent advances in brain science have identified nuero-plasticity (being able to reprogram the synapses of the brainf through repetition).. so technoloigy such as social media; advertising, etc, are all probably contributing. In addition, genetics plays a role, and as the populaton grows, so too will the number of people with mental illness.

 

On 02/10/2024 at 3:20 AM, skippydiesel said:

The accompanying rise in the use of medications that users are likly to become dependent on. May have a long term negative impact on the user.

Yes, there is still much research required on the different types of drugs and their use, because the brain chemistry is quite complex and drugs are approved and dispensed purely on statistical observations -unlike some drugs to treat "physical" conditions, the various different types of drugs have something like 60% efficiency.. and even in the same person, they don't always work at different time. The point about long term effects applies just as much to drugs that treat physcial conditions. Many people who are on Ibopruphen types drugs often suffer longer term issues such as stomach ulcers and renal issues. We know the opioids longer term impacts - these all treat physical conditions.

 

On 02/10/2024 at 3:20 AM, skippydiesel said:

accept that people who exhibit traits that are at the extremes of the BC may need some chemical assistance, to function in society and on what I hope is rare occasions, this may require lifelong usage.

 

I speculate, that the apparent pandemic (if true) in ADHD (& other personality disorders) is as much a fashion statement, brought on by the media and parental anxiety, as anything else.

 

I lived for much of my youth in Ireland and later England - eccentricity (difference in social interaction & presentation) was celebrated (to a point). It seems Australians are far less tolerant, seeming to seek a bland adherence to "the norm" .

 

I suspect that most of those diagnosed with ADHD & similar, would eventually find their own way in life, without recourse to medications, special behavioural interventions, etc, just like everyone else.  

Of course, you're welcome to your opinion, but this is an area where I would leave to the experts. In the sector of the industry I work in, there is a disproprtionate number of people with observable mental health conditions from Autism to the ADD/ADHD and anxiet disorders. I manage one directly and I can tell you, this is not a case of a few people just being left field. The press likely whip up a storm about the fringes... but in the middle of it, when you see the impact is really has on people, and read the science, you may change your tune.

 

Not picking on you pesonally - your opinions are held by the vast majority of people - myself included - until I had to face it, although thankfully, at least in my adult life, not as a patient.

 

And that is the rub... it is far more debilitating than most (not all) physical conditions.

[Geoff_H]

2 hours ago, Jerry_Atrick said:

And in the case of ADHD and other mentlal health sufferes making their way eventually, not all do.. in fact the issue with these diseaeses, which some people have while being high functioning, is that they can lead to other mental illnesses, such as depression and suicide..

So true.   Can't tell you how I know.  Happens to a friend of mine. 

[spacesailor]

What do those with their problem's do . I had no education  or interaction with other children , from 3 to somewhere about 8 due to ' osteomyelitis ' .

How do you pass tests , when you get " brain freeze " when sitting any type of 

Mental tests .  Can't even spell my four letter surname correctly on a test paper .

Those questions are written for a standard subject,  not someone who has a different way of thinking. 

spacesailor

[Ian]

I believe that CASA is taking feedback on this subject at the moment after they found that rejecting pilots because of a diagnosis and on medications was found to be incorrect. However I believe that there's a bigger issue at play here.

There's an article on diagnosis trends here which reflects an increase from 6% to 10%.

Personally I believe that a number of people in this category would make fantastic pilots and they are interested. They are high functioning people, I'm saying that not in terms of amongst their peers but amongst the population in general, we're talking lawyers, doctors, scientists project managers etc.

[skippydiesel]

Hi Jerry,

 

You make a strong, well articulated case. I am certainly better informed BUT not completely convinced.

 

I believe that much of the epidemic in ADHD, is self inflicted histeria, brought on my a combination of a generational (seismic) change in the way children/youth behave (glued to electronic devices) popularist inaccurate information (same devices) the media (same devices) and parental lack of responsibility & blame shifting ie do not take responsibility for their child's behaviour - lets dose him up, with the bonus of added teacher attention and acceptance of what would otherwise be unacceptable behaviour . 

 

Your analogy to HIV - AIDS is problematic, in that it is a viral infection complicated by a host of secondary infections. True ADHD sufferers are born with the problem - there are no lifestyle choices involved or unfortunate exposures.

 

Dont get me wrong, I am sure there are genuine ADHD sufferers, who need/benefit from various therapies.

 

As for pilots with ADHD - surely this would be a case by case  ruling. I would expect that ADHD would, like most human conditions, have a spectrum from mild to severe. I have no idea at what point an aspiring pilot would be considered a danger to himself/the community.

[onetrack]

The primary factor involved, is whether any medication affects brain function, and in what manner. There's a substantial number of medications that affect your driving/operating/piloting skills - and this information is readily available from the drug manufacturers, and the medical profession.

However, just in my personal opinion, I believe a lot of drug manufacturers, and even medical professionals often downplay the full effect of medications.

I know I've taken medications that adversely affected my skills and decision-making, and I wasn't advised fully on all the side-effects. I would hazard a guess this is because everyone is affected a little differently by various medications.

 

From what little I've read about ADHD medications, they're touted as a gift from God, with amazing results, and little side effects. I'd have a more reserved opinion on that angle, purely because of the power of drug manufacturers, and how they can influence even medical professionals.

I was under the impression that the main drugs used to treat ADHD are all from the amphetamine family. These drugs are commonly nicknamed "speed" drugs, simply because they stimulate brain function.

In the case of ADHD, it appears the amphetamine drugs operate on brain function in a highly beneficial manner - unlike the illegal methamphetamine drugs.

Naturally, the legal drugs are produced to a medical standard with proper QC, unlike the illegal ones.

 

However, the bottom line with amphetamines is, they are addictive - and the other question also remains, with regard to someone needing to take a legal prescription of amphetamine, is - what happens when they're piloting, and they forget to take their medication? 

I believe the situation as regards someone piloting with a need to medicate, to function effectively, is a question that needs to be addressed on a simple case-by-case basis, with extensive medical professional input, and not a "one case fits all" scenario. Just my .02c worth.

[facthunter]

The OLD test was would you want your wife and kids to fly with that person?

[Cyrano]

43 minutes ago, facthunter said:

The OLD test was would you want your wife and kids to fly with that person?

Wife-NO

Ex wife........depends on how many beers I've had :)

[spacesailor]

skipy. onetrack .

Addictive amphetamines. 

I was given lots of  " opiates " when as a child in hospital . Just to stop my screaming . ( pain killer/sleep inducer ) Probably high as a kite for many years .

Raised without interaction with other's. This media is a godsend to people who for 

whatever reason can' t get on with people .

To me ' talking ' with others on this forum is akin to " the men's shed " .

It's absolutely great .

Many thanks to all my formulite friends. 

spacesailor

 

[spacesailor]

Update and rectified error. 

Echuca was my invite . Phew, was it that long ago .

I hope that generous person is not overly offended .

spacesailor

[facthunter]

I looked up Formulite. Nev

[facthunter]

I looked up Forumite. Nev

[spacesailor]

I looked up forumites , but it came back " members ".

Very ' impersonal ' for " friendly " members .

Please correct  my wording as I need that correct member ' name ' .

Awaiting breathlessly,  in trepid anticipation. 

spacesailor

 

[Jerry_Atrick]

On 04/10/2024 at 1:09 AM, skippydiesel said:

I believe that much of the epidemic in ADHD, is self inflicted histeria, brought on my a combination of a generational (seismic) change in the way children/youth behave (glued to electronic devices) popularist inaccurate information (same devices) the media (same devices) and parental lack of responsibility & blame shifting ie do not take responsibility for their child's behaviour - lets dose him up, with the bonus of added teacher attention and acceptance of what would otherwise be unacceptable behaviour . 

 

Again, you rwelcome to your beliefs, but what evidence are you offering up to support your beliefs. Don't get me wrong, I do think that there are some people who are all to willing to try use labelling as an eexcuse for what is not actually the disease - an ADHD and anxiety disroders (as opposed to a natural anxiety reaction that is temporary and in direct response to some external stimuli) are diseases and caused amongst other things by checmical imbalances of the brain. Here is a non-academic article, for example:

Anxiety Disorders: Causes, Symptoms, Treatment & Types

MY.CLEVELANDCLINIC.ORG

---

Anxiety disorders are a group of mental health conditions that cause fear, dread and other symptoms that are out of proportion to the...

 

Some of the factors that cause it are self-inflicted and lifestyle choices - sustained mind-bending drug abuse (of which alcohol is one), or the foetal syndromes of absorbing this from the parents. For example. And yes, there is evidence that the technology devices of today do contribute to it. However, recent studies show you can get ADHD like symptoms; again they are temporary; but excessive screen time is not currrently thought to cause ADHD (but I have seen studies where it can exacerbate it. Be that as it may, even if it does cause ADHD, how is it hysteria (in this context)? It isn't some excessive fear resulting from fake or temporary symptoms.  Again, I take your point that there are some people - and I have no idea if it is a minority, majority and to what extent, that are willing to label themselves or their kids with ADHD, OCD, and other anxiety disorders (ADHD is not anxiety, by the way). because it is convenient to have to take responsibility for the behaviour. But clinicians and psychiatrists are usually pretty quick to sort the wheat from the chaff - but as with all walks of life, mistakes are made as well.

 

And yes, to control rowdy kids, parents do sometimes take to non-prescriptive drugs, or GPs, who often have little training in the area (a GP is Aus is a qualified doctor - in the UK, it is a specialty and requires a couple of years extra training post qualification). So, they may just prescribe lower level anti-depressant such as Ritalin, Valium, Prozac (sp?). . But drugs such as Sertraline, Atomoxetine and the like, which target different brain chemical imbalances, are usually only prescribed by the psychiatrist .And they have to be tightly managed per patient, because the reality, they are largely prescribed based on observable sets of symptoms, which indicate what the likley checmical imbalance is, but it isn't always and last time I read up on the subject, a) the drugs had a lead time before they started woking (4 weeks for Sertraline). And dosages are monitoried; they ususally start with small doeses and wait for the effects to determine whether or not to increase the dosage or leave it as it is.

 

And for some, the drugs are used only to allow the patient to receive other therapy in a calm state. The main therapy is cogniitive based therapy (CBT), which is used to try and effectively reprogram the brain through the discovery of nueroplasticity - where literally the brain waves and synapse passages of through redirect through the brain. Interesting stuff - suggest everyone look it up, as it can be of great benefit even for people without a recognised mental health coondition. So, once the drugs have served their useful purpose (assuming they have and the patient is non-dependent on them), they have to come off in stages depending on their current dosage.

 

I could go on.. but this is not the sort of stuff for the parent wanting to calm their kid's behaviour down..  And so, yes, some of them do label and go the easy option, the ones that are treated by clinicians are largely going to be fair dinkum and it is very tough to see.

 

 

 

On 04/10/2024 at 1:09 AM, skippydiesel said:

As for pilots with ADHD - surely this would be a case by case  ruling. I would expect that ADHD would, like most human conditions, have a spectrum from mild to severe. I have no idea at what point an aspiring pilot would be considered a danger to himself/the community.

Spot on. Also, the nature of the drug they are on (if they are) and the impact if they forget to take it for a couple of days.

On 04/10/2024 at 1:46 AM, onetrack said:

From what little I've read about ADHD medications, they're touted as a gift from God, with amazing results, and little side effects. I'd have a more reserved opinion on that angle, purely because of the power of drug manufacturers, and how they can influence even medical professionals.

I was under the impression that the main drugs used to treat ADHD are all from the amphetamine family. These drugs are commonly nicknamed "speed" drugs, simply because they stimulate brain function.

In the case of ADHD, it appears the amphetamine drugs operate on brain function in a highly beneficial manner - unlike the illegal methamphetamine drugs.

Naturally, the legal drugs are produced to a medical standard with proper QC, unlike the illegal ones.

Historically amphetamine based drugs were used to treat ADHD, but there is a move away from theres as technology progresses. Atomexetine is one of the main emerging  drugs that treats ADHD and it is selective norepinephrine reuptake inhibitor (SNRI) that increases the amount of norepinephrine in the brain; again looking at the chemical imbalances. Amphetamines certainly have side effects and are addictive. SNRIs also have side effects, and the dosage is used to manage them with the patient's physiology. Of course, if poeple are going to resort to illegal drugs, one can't really have a conversation about it.

 

On 04/10/2024 at 1:09 AM, skippydiesel said:

As for pilots with ADHD - surely this would be a case by case  ruling. I would expect that ADHD would, like most human conditions, have a spectrum from mild to severe. I have no idea at what point an aspiring pilot would be considered a danger to himself/the community.

This is spot on, but unlike it being amade up disease that people muddle though with - the reality is a lot different.. and I just wanted to address that.

Edited October 5 by Jerry_Atrick

[skippydiesel]

"Again, you rwelcome to your beliefs, but what evidence are you offering up to support your beliefs. "

 

Observation, comparison and a long life - Non too scientific. I put this to you; How did society manage before the availability of diagnosis & treatment of kids who were perhaps a bit naughty/short attention span? Your answer may be badly, however I would suggest that the majority of "suffers" learned to manage their "symptoms" and went on to make their place in society. Regrettably a few ended up in asylums/jail. Asylums are now out of fashion, the habitants are on the street and the jails are now a flourishing industry in their own right such is our success with social/individual behaviour engineering.

 

"......excessive screen time is not currrently thought to cause ADHD (but I have seen studies where it can exacerbate it"

 

It's not the actual screen time - it's the substitution of play/imagination/exercise/face to face social interaction/etc with an electronic device (screen time). The devices themselves are completely neutral (much like a gun)- it's the over & miss use, thats the problem.

 

From time to time, I used to pass through a large housing estate, not far from where I live. Not a child/youth to be seen on weekend/holidays. One day we had an area wide, day long, electricity failure - kids everywhere, playing talking to each other, no doubt getting up to mischief - doing what kids should do. I had no idea so many young people lived in that community, until the "blackout".  Power back on - no kids.

 

History is littered with medical trends/fashion. Most have some basis in fact/need/efficacy - for a few. In time, the enthusiasm dies down, a more rational/measured approach takes over and we move on to the next wonder drug/therapy.😈

 

[Jerry_Atrick]

13 hours ago, skippydiesel said:

How did society manage before the availability of diagnosis & treatment of kids who were perhaps a bit naughty/short attention span? Your answer may be badly, however I would suggest that the majority of "suffers" learned to manage their "symptoms" and went on to make their place in society.

The question how on earth did society survive before the advent of x is a furphy. It did. Does it mean society should stagnate and not progress and make it better for all members? We survived without aircraft, cars, or modern agriculture.. shall we go back to those days?

 

You're mixing up a short attention span with a disease that affects normal functioning. A naughty kid will respond to appropriate parenting. ADHD kids (and adults) don't because they ae incapable of doing it and all that happens by not recognising and treating it is they, their family, their class are all badly affected; and so to can the generl public as it persists and intensifies (think anti-social behaviour). So, yeah, society functioned, but don't you want society to function better? I do, and it is selfish because I don't want to have to become affected by uit.

13 hours ago, skippydiesel said:

t's not the actual screen time - it's the substitution of play/imagination/exercise/face to face social interaction/etc with an electronic device (screen time).

That is exactly what the term screen time means.. It doesn't means staring into a blank abyss or doing their homework. What else do you think they do on the screen?

 

13 hours ago, skippydiesel said:

History is littered with medical trends/fashion. Most have some basis in fact/need/efficacy

History isa also littered with misplaced scepticism based on no real experience of what peopel are talking about. This is not a "new" fad... It has its origins as far back as the late 1700s and in 1902 was seminal work.

ADHD History

WWW.NEWS-MEDICAL.NET

---

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurological conditions in children, characterized by marked...

 

But, hey in the face of easily found research, you can have your views. The science begs to differ, and I tend to follow the science.

Edited October 6 by Jerry_Atrick