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ADHD, medication and class 1 medical
Hello,
I'm a regular user of the forums, posting here under a different name due to desire to maintain confidentiality. I would be very grateful for some advice on a medical issue. I'm an aspiring commercial pilot, recently been diagnosed (as an adult) with ADHD (combined type) and prescribed Concerta (a slow release stimulant medication). From the CAA medical web page I gather that ADHD is a condition which will require additional psychological assessment before a class 1 can be awarded, and that medication for the condition will usually be disqualifying. My questions specifically in relation to this are: 1. Will relatively mild ADHD usually be a bar to a Class 1? The CAA guidance states "An individual with on-going ADHD will not (by definition) be able to complete pilot training" which seems to imply the condition will only be a bar if it is so severe as to prevent an individual successfully undertaking flight training. The disorder has not prevented me achieving excellent academics (including a professional qualification and post-graduate degree), my PPL and a successful professional career so I have good reason to believe it would not be a bar to advanced flight training in my case. 2. Is Concerta a disqualfying medication, and are there any alternative mediations for the condition which would be acceptable for a class 1 medical. 3. I would be happy to cease medication if necessary to achieve a class 1 as the disorder can be managed through lifestyle changes. If I was to do this how long would I need to be medication free for before I could be granted a class 1? Thank you very much in advance for the replies! |
Here's a cut and paste from a South African aviation website that dealt with much the same topics. The relevance is limited but perhaps it's of interest?
Re: Re: ADHD / Concerta / CAA - verdict Unread postby henkbo » Mon Jan 13, 2014 7:57 am I have been officially notified by CAA that ADHD is a disqualifying condition for all classes. I applied for Class 4 (had a Class1) and was categorically told in writing that I do not qualify. I have given notice that I will appeal the decision - only problem is now it is going to cost me R1,800 just to have it reviewed. That excludes all the additional medical costs now to try and show the Medical Review Board that you are NOT a danger to anyone. I went solo already busy with PPL flying out of FACT - and the flying school would have not allowed me to go solo if I was not competent! I am not even sure if I am now allowed to fly a kite within 10nm radius of a registered airfield.... So my advice for anyone who wants to fly and suspect they have ADHD - stay away from the prescription pills. Also - don't mention anything about ADHD....just make sure you have systems in place to stay focused. henkbo Flight Planning Posts: 8 Joined: Mon Feb 07, 2011 9:18 am Top Re: ADHD / Concerta / CAA - verdict Unread postby erasmus » Wed Feb 12, 2014 11:41 pm Henkbo do you really have ADHD? I cannot believe that a true ADHD sufferer would be able to even start an aeroplane, go through all the checklists and for example taxi it safely and you have gone solo and progressed well. You will do yourself a good favour to get other opinions, two or even three from different respected psychologists or psychiatrists about your diagnosis which looks just wrong to me (but I am a layperson so it is just an observation). Too many cases of ADHD are not true and it destroys people's lives while they are actually quite normal on the personality spectrum. People are too quick to label a learning difficulty with ADHD. Fact is to learn anything is just really hard work and to learn to focus is a skill you have to develop. Today's society is on a slippery path of quick fixes and pill popping and goodness knows where it will end. Just the fact that you could go solo means you can focus intensely, and a real ADHD sufferer cannot - not even on medication. Landing is a controlled collision with a planet. erasmus Power on stall Posts: 349 Joined: Fri Oct 16, 2009 8:33 pm Location: Centurion, Pretoria Top Re: ADHD / Concerta / CAA - verdict Unread postby slysi » Thu Feb 13, 2014 1:28 pm Trouble is that the SACAA has a list of drugs that disqualify you immediately. I think we can debate till we are blue in the face about a condition/drug that MAY impact your flying ability. Some of these drugs improve your life but this is not taken into account by the SACAA, if they are on the list and you take them then you are unfit to fly. I am expecting the same outcome on Tuesday but will then take advice to come off my pills, if possible. Alternatively change the treatment to the "approved" SSRI's. If one does this when can one reapply for medical clearance? Simon Hebron Pilot in Training User avatar slysi HASSELL checks Posts: 272 Joined: Wed Nov 23, 2005 5:03 pm Location: Roodepoort, Gauteng Top Re: Re: ADHD / Concerta / CAA - verdict Unread postby JarrydZ » Tue May 13, 2014 8:35 pm Just to bring this thread back to life, was there ever a SAFE (even homeopathic) alternative medicine found for people that suffer from concentration problems? Smoke on, Go! User avatar JarrydZ Rolling Posts: 154 Joined: Wed Jun 30, 2010 1:16 pm Location: Runway 20, Ysterplaat Top Re: ADHD / Concerta / CAA - verdict Unread postby Flymed » Wed May 14, 2014 7:51 am Methylphenidate is probably the safest. The problem is that all of these drugs by necessity works directly on the brain matter, and therein lies the problem. Side effects are therefore unpredictable and may even be the total reverse from what is expected. Homeopathics on the other-hand may be of the worst possible drugs to take because these compounds were in most cases never really studied and no data is or was collected into a data-bank for reference when needed. In most cases the full chemical composition is also not known. ICAO say that all homeopathics are undesirable, mostly based on the above reason. Cloud level creates clarity and respect. Flymed Frequent AvComer Posts: 637 Joined: Mon Feb 11, 2008 11:53 am Location: Intercare Glenfair Boulevard, Cnr of Lynnwood and Daventry,Lynnwood Manor, Pretoria 012 3688800 Top Re: ADHD / Concerta / CAA - verdict Unread postby Superfueler » Wed May 28, 2014 3:52 pm Such hipocracy, Concerta no, Ritalin no, any stimulant ,no but in the airforce (the UK and the US at least...they dole out Amphetamines as "go Pills" and tranqs as "no go " pills to bring you to sleep. Amphetamines are to Ritalin like Rocket Fuel in comparison with highly addictive properties. Superfueler Frequent AvComer Posts: 657 Joined: Thu Aug 31, 2006 12:49 pm Location: White River Top Re: ADHD / Concerta / CAA - verdict Unread postby Flymed » Thu May 29, 2014 8:21 am Superfueler wrote: Such hipocracy, Concerta no, Ritalin no, any stimulant ,no but in the airforce (the UK and the US at least...they dole out Amphetamines as "go Pills" and tranqs as "no go " pills to bring you to sleep. Amphetamines are to Ritalin like Rocket Fuel in comparison with highly addictive properties. Only if you refer to the Vietnam war. No Amphetamines are dished out anywhere. |
Ignorance is bliss?!
Winnerhofer,
What qualifies you to make such a statement? The psychiatrist who diagnosed me is a leader in the study of ADHD, quoted repeatedly by various medical journals as a world authority in the field. What are your credentials in this area? |
Medical Enquiry
ADHD is normally diagnosed between 6 and 12, and it is rare for a sufferer who is undiagnosed to progress to the dizzy heights of a commercial license. You dont mention how close you are, your symptoms etc etc. Sadly ADHD is also common amongst the middle class worried well. So there is good reason for other posters to be cynical and trying to manage off drugs which allows you to continue your career aspirations may not be as daft as it sounds. As always, only get referred to a specialist from your GP, be ready to get a second and third opinion, and beware doctors who claim to be world leaders. Good luck |
Radgirl,
Thanks for your response which I have no doubt is well intentioned. Although symptoms of ADHD need to have been present since childhood for a diagnosis to be made a great many sufferers are not picked up at this point and continue to exhibit symptoms into adulthood. In adulthood the symptoms manifest themselves very differently. I am a case in point having been diagnosed in my early 30s. Unfortunately ADHD is a common condition (first identified in the 18th century) which despite earlier ignorant posts is quite rightly regarded as very real by the UK CAA, in common with many other national licensing authorities. Hence I have asked specific questions in relation to UK class 1 medical requirements regarding ADHD. I have no desire to debate diagnostic error, or whether ADHD exists in the first place. |
Your best recourse is to overturn the ADHD diagnosis.
How that gets done in an environment where consultants make a living diagnosing the condition is an accomplishment beyond most of us, and most certainly beyond true ADHD sufferers. Absolutely stay away from psychotropic drugs. If you can not get on with daily life without psychotropic drugs, you will likely not find a CAA that will grant you a medical. It is only in the last decade that some CAAs have been allowing certain antidepressants as it became apparent that pilots suffering clinical depression were foregoing treatment to protect their license. As far as regaining a medical is concerned, you are better off with a diagnosis of alcoholism than ADHD. Pilot unions deserve credit for putting in place protocols to regain medicals for those suffering from alcoholism and clinical depression. Note that these are conditions that typically arise during a working career. Those with precluding conditions diagnosed or misdiagnosed in childhood never get to fly. |
may I be so bold as to suggest your original questions are the wrong order of priority.
Having had a PPL, then had health issues and medication leading to grounding, and eventually returned to flying I know some of the pressures, although I'm not earning a living from it. However if a friend were to ask me I would always suggest the following: 1) Stabilise your health first. Figure out if you can manage it med-free. If you can - give it time, months to be sure. 2) if you can't manage without meds then don't beat yourself up. do what your doctor advises. DO NOT make this decision based on flying. The ONLY caveat would be if theres different treatment options of which one of more are approved for flying. Even then, take this information to your doctor (not your AME) and choose a treatment plan based on what's best for your health. Medications which are explicitly disallowed are listed in the UK CAA website. Everything else is not disqualifying based on the medication, but the underlying condition it is being used to treat. So I would ring the CAA and ask: A) is any form of ADHD disqualifying. I suggest NOT if it does not interfeee with safe flight - or whatever the wording is. B) what medications are approved for maintaining "remission" - you may need to have a couple of examples that your doctor would approve as examples otherwise you may get a "it depends" answer. |
Marioair,
Thanks for your response. Yes indeed you make an excellent point. However in my case I am confident I can live successfully without medication required - I have been diagnosed only in the last few months in my early 30s. Prior to this have achieved good academics, career, PPL and 200 + incident free P1 hours. I don't mean to sound like Im bragging but want to emphasise I am fully capable of functioning to a high level without any medication or treatment. The diagnosis is largely based on childhood experiences and behaviours which I have learned to minimise in adulthood. I only hope this is not to be the undoing of my commercial flying ambitions! Although the diagnosis has answered a great many questions regarding struggles in my life so far, had I looked into class 1 medical requirements in more detail I would have avoided getting diagnosed in the first place. I have made the CAA aware of the diagnosis and will need to await their advice as to testing etc. Thanks for the replies all, and a very happy new year! |
It's good to hear you can manage off the meds.
Best of luck with the CAA - let us knw what they say! |
I only hope this is not to be the undoing of my commercial flying ambitions! Although the diagnosis has answered a great many questions regarding struggles in my life so far, had I looked into class 1 medical requirements in more detail I would have avoided getting diagnosed in the first place. The FAA has a blanket prohibition for flying with ADHD medications. They recently established procedures to appeal the denial, but they are extremely onerous, costing many thousands, and amount to challenging the diagnosis. I would expect the CAA regulations to similar. So the reason for my response is to point out to others, be they in FAA, CAA, or another jurisdiction: Never, ever accept an ADHD diagnosis, or the medications therof, without considering the effect it might have on a current or future desire to fly. |
Surely the physicians focus is on treating the patient rather than concerning themselves with any potential career ambitions? Successful treatment is often reviewed more favourably (of course not always) than unresolved or indeterminate conditions and the associated treatment.
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Not at all
A physician's responsibility is the well being of his patient in all aspects provided the wider community is not put at risk. I often see patients who had an inhaler prescribed as a child during a cold and thought they had an asthma label. They are not asthmatic. As Obgraham correctly pointed out, beware of labels and diagnoses, especially when they do not rely on imaging, histology or biochemical results. I cannot really see the point of shooting oneself in the foot, and still question whether someone can obtain a PPL and follow a career with This problem. I see children who clearly have this diagnosis. They will never take a flying lesson. Sorry OP, I know you have responded to this response, but it needs emphasising for the benefit of others |
Radgirl,
Quite right if I had researched the question more thoroughly I would undoubtedly have avoided the diagnosis. I remain hopeful that I will be able to jump through whatever hoops the CAA requires. I do not require medication to function and can quite happily go back to management of the disorder through lifestyle. A key part of this management will be a career change (preferably into aviation!). The nature of a flying role lends itself better to the nature of the condition than the previous office based roles I have undertaken - key strengths being multitasking ability and a personality profile which thrives on structure yet retains the flexibility to depart from this where necessary. Intrigued by your comment "I see children who clearly have this diagnosis. They will never take a flying lesson." Is this because their symptoms are very severe? My thinking on the condition is that it is a spectrum disorder which manifests itself differently in different individuals according to where they sit on the spectrum. My reading on the subject suggests that people diagnosed in childhood will be the more severe end, displaying obvious symptoms, whereas those who make it to adulthood with no diagnosis will be at the mild end, will often have developed coping strategies which result in them slipping through the net. |
Enquiry:
We're at risk of venturing into discussion more appropriate to JetBlast than here. What you are saying about the condition being a spectrum is quite true, but with different implications. Many of us believe the criteria for this diagnosis have been expanded well beyond what was originally described, both for children and for adults. Whether that is a good thing or a bad thing is subject to opinion. Unfortunately the aviation authorities only have one pot into which all these cases are dumped, and become subject to their rather strict rules of eligibility. That's why this has become such a frequent area of conflict for fliers. Perhaps it is time for a comprehensive review of the condition and its aviation implications. I'm not so sure there is a will for it yet. |
There may well be no will for the thing but there will certainly be no way for it unless people who are convinced of their capability to function as flight crew challenge whatever protocols might be in place in the corridors of aviation medicine.
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Look into Dr Amen’s book on Healing ADD...He has countless books on healing/improving the brain which are excellent. He is a leading brain expert who has conducted over 80,000 brain scans. He is well respected in the US. He also has videos on you tube by googling “Dr Amen ADHD you tube". Also google adrenal fatigue & look at the symptoms list.
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Eighty thousand brain scans would take one man a long time. I rather think that's the latest score card for the Amen Clinics, of which there are at least eight. Daniel Amen works closely with the Saddleback Church where he has a plan named after him.
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I am struggling to find the peer reviewed research from this leading expert
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A few observations on ADHD, and some caveats:
My experience is with FAA and Psychiatry in USA. No experience in UK. Qualifications: Psychiatrist. Board certification in Geriatrics, Addiction, and Psychosomatic Medicine. I teach Addiction and Psychiatry at FAA Aeromedical Examiner Courses. ATP and Flight Navigator with 10,000 accident free hours. ADHD is way over diagnosed in my country. Yes, it exists. So does Bipolar Disorder. But much too often, Bipolar is used as an excuse for bad behavior and ADHD is used as an excuse for poor performance. I call them "excessive excuse disorders." ADHD is normally diagnosed in early childhood as inattentiveness or hyperactivity become apparent, obvious, and clearly connected with poor academic performance. It is very much over diagnosed in adults with a good academic record. There are well qualified Psychiatrists who argue for adult onset or adult diagnoses, but these are in the minority. Applicants for an FAA Medical Certificate will be denied for two reasons: 1. ADHD? In a cockpit? Really? Underlying condition is a safety issue. 2. Stimulants? Really? See list of side effects. Safety issue. If you were applying for FAA certification, I would advise you to shed both the diagnosis and the medication if you want to fly. I doubt that FAA would approve any level of medical certification with a valid diagnosis of ADHD and current consumption of stimulants. I would not advise you to pursue an argument with FAA for certification with dx and meds. I think you would be wasting your time and money. Hope this helps. |
Welcome, Bushpilotone. I think you have summarized the matter very nicely, and is in complete accord with what I know from FAA on this matter. I can't imagine other jurisdictions will be much different. Your qualifications on this topic speak for themselves.
As for the other character mentioned above, the only term I can come up with is that of a sound more commonly associated with a Duck. |
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