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ADHD/ASD and CASA medicals

Old 27th Jul 2021, 22:17
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ADHD/ASD and CASA medicals

Question for the PPRuNe brains trust. A friend of mine has been diagnosed with ASD/ADHD. Has anyone dealt with CASA regarding their medical? Just interested to hear if there are any issues as far as CASA are concerned? Will it effect gaining or maintaining a Class 1 medical?
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Old 27th Jul 2021, 22:59
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You could start with the Medical section of the CASA website.

CASA - Medical
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Old 28th Jul 2021, 08:10
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Yes it is a huge issue.
We have had students who have been taking drugs for ADHD and you can expect months of delays, if it is even possible to get the medical at all. One who was a supervisor in construction working at heights and CASA said he was "Likely to take unaccceptable risks and be impulsive".
Much better if people don't get a label stuck on them and other people accept them for the amazing people they are instead of saying they are "suffering" from something and filling them with pharmaceuticals and giving them a label that can cause prejudice and make doors slam in their faces for the rest of their lives.
Instructors are given this form to fill in. Read it and weep.
Form 420 (casa.gov.au)

Anyone who has any experience with people along the spectrum (who in my experience make very good pilots indeed) will know that this really shows that the people in CASA know nothing at all about it. I have taught many students on the spectrum and IF they want to be pilots they are the complete opposite of the behaviours shown and their level of focus and attention to detail is extraordinary. However if they are being forced into flying against their will by pushy parents they may exhibit some of those behaviours, as would any student who wants to be doing something else.
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Old 28th Jul 2021, 11:11
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It's desperately, desperately sad to me, witnessing the inexorable medicalisation of normal and the alacrity with which bureaucracies like Avmed intervene, control, restrict and ultimately destroy in the name of some noble cause. These days, we're all just a collection of 'conditions' to be 'managed' by the medical industry.

Everyone wants to believe that pilots of aircraft are mini supermen and superwomen, and Avmed is ever-ready to make that perception happen. So many 'conditions' precipitate Avmed searches of the internet to find whatever 'evidence' can be found to cast a 'condition' in a light that gives rise to catastrophic risks justifying micro management or destruction.

I'm frequently impressed by the genius of satirists who cut through all the bullshit to expose the truth. There's an episode of The Simpsons that deals with the fad of ADHD drug diagnoses sweeping through the youth of Springfield (i.e. society in the real world). When Bart's parents ask the smooth talking pharmaceutical company doctor - dressed of course in a lab coat - whether the ADHD drugs sold by the company work, she responds: "The only thing more effective is exercise".
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Old 28th Jul 2021, 11:23
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instead of saying they are "suffering" from something and filling them with pharmaceuticals
That's why the CEO of CSL took home $43m of salary last financial year.

There is a whole industry making a living with flow on effects out of categorising people into some kind of spectral disorder. Totally agree, most are absolutely warm and gentle, but occasionally there's a rough nut in the group and it's a bit of a shame they are all tarred with the same brush when they should not be.

Funny thing about these professors of psychology, I once worked for a health group and one of our departments dealt with the research into human behaviours. One day one of my regular suppliers of computer equipment flipped from driving Aussie muscle cars to European sports cars and lent me his BMW M3. After fanging it around the streets in front of the premises during lunchtime I came back to work only to see these professors had turned purple in the face by trying to contain their jealousy (and misconceptions). They really are full of it, absolutely.
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Old 28th Jul 2021, 23:18
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Originally Posted by Clare Prop View Post
Instructors are given this form to fill in. Read it and weep. Form 420 (casa.gov.au)
Did anyone else notice this nice little quip that looks like they're trying to be funny? And on an "official" form that AvMed will use to decide if said student get's his medical!
Originally Posted by CAsA Form 420
often leaves seat in classroom or in other situations in which remaining seated is expected.....May not sit still in pre-flight briefings. Hopefully does not get out of seat in flight!
WTF?

My young bloke is on the spectrum, with ADHD thrown in for good measure and does indeed demonstrate many of those behaviors outside the cockpit. However, he loves his flying and I dunno how he does it, but puts them to one side and can climb at a constant IAS, hold heading and altitude without a problem and could probably fly the lateral portion of an approach within IFR tolerances - and I'd have no trouble believing he could pull of a decent landing if he could reach the rudder pedals or throttle! He is 8!

I know a train driver who was diagnosed with ASD as an adult and spent 6 months off the road having to redo his medical with the Company CMO (who apart from the bare minimum, has zero psychology training it turns out). Apparently as part of the assessment she asked him to remember 5 words at the start of her assessment and he had to repeat them at the end. When it came time to, he got 1 out of 5, and she was stunned. "Don't you think that's a serious problem? I told you, you had to remember those 5 words!"

His answer was along the lines of "Nope, 5 meaningless words in an interview to determine if I can do the job I've been doing for the last 13 years mean nothing to me. But I can tell you down to the milimeter the track gauge in each state of Australia, can tell you how how many volts the main alternator can put out, I can tell you the compressive or tensile force limits of our wagons and can mentally calculate how much force in tonnes I'm putting into the front coupler based on traction horsepower. For anything I need to remember I either write it down, or put it in my phone." From what he told me, she wasn't particularly impressed with his answer, but nonetheless signed him off Fit for Duty - Unconditional. His psych obviously had no problems with him doing rail safety-critical work!

This is from the CASA site and I can't say I'm overly thrilled with their expectation that a CFI - who may well be an expert in all-things aviation, but is unlikely to have any medical training is being expected to provide comment on how ASD/ADHD impacts a student in their normal lives outside of aviation. Using the below, my young bloke would be denied a medical, even though he can fly pretty damn well given his age. My advice to him when he goes for a medical would be to say nothing! I think he'd be in company with an awful lot of other (mostly damn good) Australian pilots in that regard, unfortunately. I've highlighted a couple of important bits...
Originally Posted by CAsA
Attention Deficit Hyperactivity Disorder (ADHD)
Aeromedical Implications
Effect of condition on aviation
Premature and ill-considered actions
Restlessness and excess of movement causing distraction
Impaired split attention affecting multi-tasking and situational awareness

Approach to medical certification Based on the condition

In full remission
Based on Treatment
No safety-relevant medication such as stimulants

Demonstrated Stability
Absence of symptoms for a minimum of 6 months after treatment completed. (Reflects DSMIV diagnostic criteria)
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-IV criteria
Co-morbidities, including drug and alcohol use
Requirement and response to treatment
Current clinical status with respect to DSM-IV 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 and autism spectrum disorder instructor’s questionnaire form 420 (PDF 617.14 KB) regarding symptoms in the context of and noting the implications to both the normal day to day life and the conduct of aviation. Attached questionnaire
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

Favourable
Stable off medication for at least 6 months and satisfactory reports
Instructor questionnaire and annual specialist reports for 5 years following cessation of treatment. After 5 years consideration of removal of surveillance requirement.

Unfavourable
Recurrence of symptoms
Stimulant medication

Last edited by KRviator; 29th Jul 2021 at 01:24. Reason: Fixed quote syntax
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Old 29th Jul 2021, 03:18
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Appalling.
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Old 29th Jul 2021, 05:32
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From what he told me, she wasn't particularly impressed with his answer, but nonetheless signed him off Fit for Duty - Unconditional.
Sounds to me like the usual empowerment posturing from a HR person who is probably utterly useless and just wants to hide it.

A few years back the small team I worked in was "chosen" for deep HR review. The funny thing about this particular team was that we were quite deliberately dysfunctional with our interpersonal working relationships with each other but we still got the work done (think MASH 4077), so we just turned up the dysfunction level to 11 for the review. The poor HR girl didn't know what to make of it let alone what to report back, and after a few weeks the review was cancelled.
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Old 29th Jul 2021, 08:09
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CASA AVMED, like many of the empire’s streams could not function outside of the organisation. They simply do not understand the process of risk assessment and mitigation. Their approach is complete avoidance of any level of risk.
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Old 31st Jul 2021, 12:22
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Another scenario….. Pilot has current Class 1 and flies for an aviation company. He/she goes through the testing process and is diagnosed with ADHD. Does he/she have to then inform Avmed and employer? If so what would Avmed then do?
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Old 31st Jul 2021, 16:15
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Originally Posted by Alice Kiwican View Post
Another scenario….. Pilot has current Class 1 and flies for an aviation company. He/she goes through the testing process and is diagnosed with ADHD. Does he/she have to then inform Avmed and employer? If so what would Avmed then do?
Why on earth would he/she go through the testing process in the first instance?

But the answers are 1) Yes and 2) No idea. Avmed is a total mystery.
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Old 31st Jul 2021, 17:14
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This should be warning for many parents who might have a child that exhibits ASD tendencies but is borderline.

Do you want to give your child that baggage, permanently on his/her my health record that could cause this kind headache in the future? Get the support and social skills training needed to let them succeed, but a diagnosis won’t change them. There are a hell of a lot of highly successful folk with ASD. Some of them good pilots too. Some probably not. Just like any other humans. Some can fly, and some can’t. That form 420 is incredible. Even an attempt at humour half way down.
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Old 1st Aug 2021, 08:41
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Clare Prop, very well said.

I find it more than ironic that CASA's form 420 part 'g' questions whether the student loses their toys? Has this been lifted from a child psychologists' training manual? Seems like a glaring lack of attention to detail for mine. I'd like to know the CASA personnel behind this form's creation. Hardly suited to remaining in the Forms Office and should be relocated to another department. They should be tested. Its a disgrace!

But hang on, I've never actually seen a student bring toys to flight school. Oh my god! They've all got it!
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Old 1st Aug 2021, 11:18
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I am genuinely saddened to see that attempt at a "joke" within Form 420 - "Hopefully does not get out of seat in flight!"
That's absolutely appalling - they call themselves a professional "Authority" - this is a Form that has the potential to end someone's dream career - and they throw that in there, likes it's some kind of joke to them?
The fact the form exists at all is disgraceful.
Shame on them.
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Old 1st Aug 2021, 14:06
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Originally Posted by compressor stall View Post
This should be warning for many parents who might have a child that exhibits ASD tendencies but is borderline.

Do you want to give your child that baggage, permanently on his/her my health record that could cause this kind headache in the future? Get the support and social skills training needed to let them succeed, but a diagnosis won’t change them. There are a hell of a lot of highly successful folk with ASD. Some of them good pilots too. Some probably not. Just like any other humans. Some can fly, and some can’t. That form 420 is incredible. Even an attempt at humour half way down.
So true...but there are parents out there who either see it as some kind of fashionable tag, are after NDIS funding, or want to drug their children into "normality" instead of allowing them to develop their gifts and excel in the things they are interested in. Students of mine, absolute geniuses and excellent pilots, one of whom could describe every system in a space shuttle to the last detail, have not been able to get a medical because of this, thier parents and CASA have robbed them.
My first thought was also that it had come from some kind of dumbed down article about the behaviour of children who are bored in school. The first person I was asked to fill it in for was a gentleman his late sixties who had been an instructor for decades and was now going to lose his medical unless someone could answer the questions, but as I had never flown with him I couldn't do it. He had been diagnosed with ADHD and had no traits remotely resembling anything on there and I had known him for years.
Without people on the spectrum, we would probably still be living in caves. We certainly wouldn't be using computers connected to the internet. They are not freaks, it is not a "disorder", they are the next stage of evolution and denying them the chance to be pilots because of an arbitrary test done by unqualified people is so wrong. Importantly, these people are not risk takers, they are not going to hurt anyone, they might not want to make small talk on the flight deck but why should that exclude them?
CASA would have grounded Neil Armstrong!
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Old 2nd Aug 2021, 04:18
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The Form 420 provides a ghastly insight into the mindset of CASA Avmed. I'd prefer not to think about what the other hundreds of forms contain.

I'm not surprised at the inappropriateness of the attempted 'joke' that some arrogant arsehole put in the Form. It's 'funny' alright - in the sense of weird.

Make no mistake: This stuff is the product of people with a noble cause. They consider that they must know everything that, in their opinion, is relevant to something that, in their opinion, has some consequence - any consequence - for the safety of air navigation.

Make no mistake: They will come up with any excuse to demand information and tests and examinations to 'satisfy' them, and to restrict and destroy flying careers and aspirations. It's their crusade.

MalcomReynolds' post above is, sadly, typical of many participants in aviation these days. (I do hope that's not your real name, as CASA will come after you for advocating for non-compliance with the law.)

What worries me most is not that people are withholding information from CASA Avmed. After all, there is no causal connection between Avmed's level of knowledge or ignorance, its level of expertise or incompetence or its level of satisfaction or dissatisfaction about anything, on the one hand, and a person's objective medical fitness on the other. What worries me most is that some people may not be approaching qualified professionals when in doubt about something, for fear of what CASA Avmed will do if they find out. That is why - and I've said this publicly before - CASA Avmed is in my opinion now a force inimical to aviation safety.

Be very, very, very careful before you expose yourself, or a loved one with aspirations of flying, to the risk of a 'diagnosis'. Very careful. There is almost no end to the conditions that you and your loved ones can be found to have, which conditions can be 'fixed' by some drug or therapy or gizmo or procedure that the medical industry is happy to supply and CASA Avmed will feel obliged to seize upon.

CASA Avmed treat a diagnosis as an objective truth (but will reject, out of hand, the opinion of the diagnosing professional to the effect that the diagnosed condition is cured or creates insignificant risks). CASA Avmed will then search the planet for whatever evidence they can find to cast the diagnosed condition in the worst possible light and as high a risk as possible, then demand information and the most intrusive and - in some cases - risky tests and examinations as they can come up with to 'satisfy' them, notwithstanding that qualified professionals with ethical and clinical duties to their patient take a different view. I've also said this publicly before: Any idiot with access to the internet can do what Avmed does.

Beware the diagnosis!
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Old 2nd Aug 2021, 06:54
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Is everyone at CASA screened for ADHA/ASD I wonder.
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Old 3rd Aug 2021, 01:11
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Can anybody point me to an accident report that states the cause as the pilot having a diagnosis of ADHD or ASD?
Also, if anyone has contacts that are psychologists I would be very interested on their take on the use of this form for a layman (flying instructor) to evaluate someone for a condition that CASA consider as so dangerous that they must never be allowed to take control of an aircraft..
I also have a theory that many of the diagnoses are a form of Munchausen's by proxy, just from my own observations and coming from a family where some members would make Sheldon Cooper look neurotypical but don't have a label stuck on them.
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Old 3rd Aug 2021, 08:00
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I listened to a fascinating conversation between Richard Fidler and Gordon Parker, the latter being the founder of the Black Dog Institute.

The whole conversation is worth listening to, but I did laugh along with them at this point (after about the 16 minute mark):
So many patients get this uninformed diagnosis of major depression which is just homogenising multiple differing depressive conditions and then they then get the treatment that reflects the background discipline of the particular practitioner. So for instance, if you go to a doctor and get a diagnosis of major depression, then you’re probably going to get a drug. If you go to a psychologist with the same type of depression, you’ll probably get cognitive behaviour therapy. If you go to a counsellor you’ll get counselling and if you go to a lady wearing a kaftan you’ll get crystal therapy. And to my mind, that’s got the story the wrong way round; where the background discipline or training of a practitioner shapes the therapy. And then the therapy is a sort of one size fits all model.
Tell CASA Avmed that you have been diagnosed with “major depression” and strap in while the ‘experts’ swing into action.
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Old 4th Aug 2021, 02:45
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Devil

Jeez Clare,

I've just read that link in #3, and, I've just gotta say...I think I qualify.......
Unless its 'Oletimers' catchin' up.....

The CASA medical 'empire' has outgrown its REAL function - 'Is This Person Safe To Fly'.
The 'power' has gone to its head - IMHO.
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