ADD and the FAA again.

[Terry M - 3CK (Chicago)]

Take a look at the attached thread. I was incorrect, it seems, in stating ADD was a DQ condition. You have to take the cognitive tests with the FAA. But I could swear I read here and on the other board you were out with that diagnosis. Insight?

 

[AggieMike88]

Rather than rely on a Facebook post, here is the referenced article written by Gary Crump of AOPA

ADHD AND THE FAA
WHAT IS IT AND HOW DOES THE FAA LOOK AT THIS CONDITION?
February 1, 2018 By Gary Crump

Attention Deficit Hyperactivity Disorder (ADHD), formerly referred to as Attention Deficit Disorder (ADD) is considered by some to be a condition of the new millennium because of the numbers of individuals affected, including many adolescents and teens who are being treated for symptoms often associated with the condition. Unfortunately, these young people being treated are applying for medical certification and receiving an unhappy surprise when the FAA determines that they are not qualified for certification because of the diagnosis and/or use of disqualifying medications.



ADHD is a complex disorder to diagnose. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines ADHD as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by” the following symptoms:

"Inattention: Six (or more) of the following symptoms [that] have persisted for...6 months ... that negatively impacts directly on social and academic/occupational activities:

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or other activities...;
2. Often has difficulty [remaining focused] in tasks or play activities...;
3. ...Mind seems elsewhere, even in the absence of any obvious distraction...;
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or work-related duties...;
5. Often has difficulty [in] organizing tasks and activities...;
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort...;
7. Often loses things necessary for tasks or activities...;
8. Is often easily distracted by extraneous stimuli...;
9. Is often forgetful in daily activities....

Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that…negatively impacts directly on social and academic/occupational activities:

1. Often fidgets with or taps hands or feet or squirms in seat...;
2. Often leaves seat in situations when remaining seated is expected...;
3. Often runs about or climbs in situations where it is inappropriate...;
4. Often unable to play or engage in leisure activities quietly...;
5. Is often 'on the go,' acting as if 'driven by a motor' ...;
6. Often [talking] excessively;
7. ...Completes people’s sentences [or] cannot wait for turn in conversation...;
8. Often has difficulty [in] waiting his or her turn...;
9. Often interrupts or intrudes on others...."

The condition presents with a common scenario seen by health care providers and by the FAA Aerospace Medical Certification Division: “My son’s teacher said he couldn’t sit still in class and was disruptive, so they sent us to our physician who placed him on medication”; “I was started on medication at the insistence of my parents who thought I have ADD.” There are many student pilots out there who are taking the stimulant or stimulant-type medications and find out only when they go to the aviation medical examiner that both the medication and the condition are unacceptable for medical certification and receive a denial.

The FAA requires an extensive evaluation if an applicant for medical certification has been diagnosed with (an important point to keep in mind!) or is currently taking one of the medications used to treat this condition. If medications are being taken, they must be discontinued for at least 90 days and you will be asked to undergo a neuropsychological evaluation with a clinical psychologist or neuropsychologist. The testing is very familiar to the psychology world and consists of a battery of different tests that measure various areas of neurocognitive functioning. The evaluation is quite comprehensive and generally takes six or more exhausting hours to perform. The complement of tests provides an objective way for the clinical psychologist to test for ADHD and any other underlying pathology that affects one’s short and long-term memory, ability to multitask, and to understand and comply with instructions, and many other “executive” tasks. The psychologist can compare one’s scores to “normal” functioning individuals, rather than against the applicants’ own baseline scores since there is no baseline testing to compare to! This is one of the objections that opponents have for this type of evaluation process.

Many young folks are placed on these medications without ever being tested. They are prescribed the meds based on parental or personal concerns about attentiveness to tasks such as job or school performance or other demonstrated history. In many cases, people who are treated for apparent symptoms don’t really have ADHD, but in order to rule it out, a formal clinical evaluation should be done.

Some of the commonly-prescribed medications that individuals take for ADHD are Adderall, Concerta, Ritalin, Strattera, Vyvanse, and Dexedrine. All these medications are disqualifying for medical certification purposes!

If an applicant for a medical certificate has the diagnosis of ADHD and/or is taking medication for symptoms, the FAA requires a comprehensive evaluation to determine if the diagnosis exists. If someone really does have ADHD as reflected in the evaluation, the FAA will not be able to grant any class of medical certification.

 

[AggieMike88]

But I could swear I read here and on the other board you were out with that diagnosis. Insight?

I recall the conversations here similar to Mr. Crumps article that if you have a confirmed diagnosis from the properly qualified psychiatrist or psychologist, then your chances of obtaining medical certification are slim.

If you are improperly diagnosed (like many kids were), then testing is required to overturn the diagnosis. But you a,so run He risk of having the diagnosis confirmed which could shut the door on certification.

 

[Terry M - 3CK (Chicago)]

That was my understanding (and I had linked that article in my response earlier today - you can see it in the thread I posted).

Thanks.

 

[bbchien]

That was my understanding (and I had linked that article in my response earlier today - you can see it in the thread I posted).

Thanks.

It’s actually far more complicated than that. ADD is just one of a subset of cognitive disorders which represent the spectrum of how humans comprehend.

When a community physician uses essentially outmoded behavioral criteria to make a “diagnosis”, these are proxies for laboratory measurable brain processing performance.

The problem is that the testing is expensive.

It’s also complicated by the fact that the affective disorders (depression, mania) all negatively affect cognition. So community practitioners often add adderal to the mix in a depression.

So when a community doc calls ADD what he is really doing is calling out “this person is not cognitively normal”. This may be permanent and hard programmed, but might be “secondary”, e.g, “cognitive disorder unspecified” because 99% of the time, he is really not qualified to say more. Johnny gets the ADD code so that insurance pays for his pills.

The only specialist IMO who is qualified to make such distinction neuropsychologist and at that may also need a psychiatrist as well.

School counselor? Not qualified in any way shape or form. Parents need to INSIST, nee pay, for a semi quantative psychology evaluation before accepting “pilling” Johnny. It could be something else in entirety.

What we have going on is this country should be a title 9 scandal. Districts get added financial assistance for every child on pills.
***

What FAA wants is to know that Joe Pilot can outperform the BOTTOM 15th percentile of known aviators, off meds. If that is the case then “whatever it is that Joe Pilot might have, “can’t be all that bad”.....