Abstract
Attention deficit hyperactivity disorder (ADHD) is a controversial problem in sport since participants with this disorder often require banned stimulant medication while competing. Little information is available in the literature concerning this problem or whether sports people should be allowed to participate while on stimulant therapy. The intention of this review is to undertake a brief review of recent findings in ADHD, especially as they apply to sport, and suggest some guidelines that could then be applied by sporting bodies to allow ADHD sufferers to compete. Recent scientific evidence, clinical, genetic, and imaging techniques, confirm that ADHD is characterised by dysfunction in dopamine transmission in the frontal lobes and basal ganglia structures, regions associated with attention and behaviour. The dopamine transporter (DAT) regulates dopamine by removing excess. In ADHD people, the number and density of DATs and DAT binding sites are increased by up to 70 %. The dopamine agonist methylphenidate blockades DAT, significantly increasing extra cellular dopamine, so correcting the dopamine deficiency. Methods. A search of the English literature was made using Medline from the years 1980 to 2002.
The aim of this review is not to debate the use of stimulants or how often they are necessary or successful in this condition but to point out that a number of young sport people with ADHD require such medication on a regular basis. Although there are problems with their use as far as the International Olympics Committee (IOC) is concerned, it would seem most unfair to penalise sports people by having to give up their medication, even for a few days or at some arbitrary age, in order to compete.
Key words
ADHD - ADD - sport - IOC - DRWG testing - guidelines for sporting bodies
References
-
1
Schweitzer J B, Cummins T K, Kant C A.
Attention deficit hyperactivity disorder.
Med Clin N Am.
2001;
85
757-777
-
2
Volkow N D, Wang G J, Fowler J S, Logan J, Gerasimov M, Maynard L, Ding Y S, Gately S J, Gifford A, Francheschi D.
Therapeutic doses of oral methylphenidate significantly increase extracellular dopamine in the human brain.
J Neurosci.
2001;
121
1-5
-
3
Wolraich M L, Hannah Y N, Pinnock T Y, Baumgaertel A, Brown J.
Comparison of diagnostic criteria for attention deficit hyperactivity disorder in a country-wide sample.
J Am Acad Adolesc Psychiat.
1996;
35
319-324
-
4
Clarke A R, Barry R J, McCathy R, Selikowitz M.
Age and sex effects in the EEG: differences in two subtypes of attention deficit hyperactivity disorder.
Clin Neurophysiol.
2001;
112
815-826
-
5
Goldman L S, Genel M, Bezman R J, Slanetz P J.
Diagnosis and treatment of attention deficit hyperactivity disorder in children and adolescence.
JAMA.
1998;
279
1100-1107
-
6
Bagwell C L, Molina B S, Pelham W E, Hoza B.
Attention deficit hyperactivity disorder and problems in peer relations: predictions from childhood to adolescence. J.
Am Acad Child Adolesc Psychiat.
2001;
40
285-292
-
7
Tannock R.
Attention deficit hyperactivity disorder: advances in cognitive, neurobiological, and genetic research.
J Child Psychol Psychiat.
1998;
39
65-99
-
8
Pelham W E Jr, Wasbusch D A, Hoza B, Pillow D R, Gnagy E M.
Effects of methylphenidate and expectancy of performance, self-evaluations, persistence, and attributions on a social task in boys with ADHD.
Exp Clin Psychopharmocol.
2001;
9
425-437
-
9
Faraone S V, Biedermen J.
Neurobiology of attention deficit hyperactivity disorder.
Biol Psych.
1998;
44
51-58
-
10
Spencer T, Biederman J, Wilens T, Faraone SV.
Adults with attention deficit hyperactivity disorder: a controversial diagnosis.
J Clin Psych.
1998;
59
59-68
-
11
Mannuzza S, Klein R, Bessler A, Malloy P, LaPadula M.
Adult outcome of hyperactive boys.
Arch Gen Psych.
1993;
50
656-676
-
12
Campbell S B.
Behaviour problems in preschool children: a review of recent research.
J Child Psychol Psychiat.
1995;
36
113-149
-
13
McGee R, Partridge F, Williams S.
A twelve year follow up of preschool hyperactive children.
J Am Acad Child Adolesc Psychiat.
1991;
30
224-232
-
14
Robin A L.
Attention deficit hyperactivity disorder.
Adolesc Med.
1998;
9
373-383
-
15
McCann B S, Roy-Byrne P.
Attention deficit hyperactivity disorder and learning disabilities in adults.
Semin Clin Neuropsychiat.
2000;
5
191-197
-
16
Biederman J.
Attention deficit hyperactivity disorder: a life-span perspective.
J Clin Psychiatry.
1998;
59
4-16
-
17
Lynskey M T, Hall W.
Attention deficit hyperactivity disorder and substance use disorders: is there a causal link.
Addiction.
2001;
96
815-822
-
18
Elia J, Ambrosini P J, Rapaport J L.
Treatment of attention deficit hyperactivity disorder.
N Engl J Med.
1999;
340
526-531
-
19
Gittelman R, Mannuzza S, Shenker R, Bonagura N.
Hyperactive boys almost grown up. 1: Psychiatric status.
Arch Gen Psych.
1985;
42
937-947
-
20
Hechtman L.
Long-term outcome in attention deficit hyperactivity disorder.
Psych Clin N Am.
1992;
1
553-565
-
21
Weiss G, Hechtman L, Milroy T, Perlman T.
Psychiatric status of hyperactives as adults.
J Am Acad Child Psych.
1985;
24
211-220
-
22
Cantwell D P.
Attention deficit hyperactivity disorder: a review of the past 10 years.
J Am Acad Child Adolesc Psychiat.
1996;
35
978-987
-
23 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th Edition Washington DC; 1994
-
24
Safer D J, Krager J M.
A survey of medication treatment for hyperactive inattentive students.
JAMA.
1988;
260
2256-2258
-
25
Spencer T, Biederman J, Wilens T.
Pharmacotherapy of attention deficit hyperactivity disorder.
Child Adolesc Psychiat Clin N Am.
2000;
9
77-97
-
26
Jensen P S, Kettle L, Roper M T, Sloan M T, Dulcan M K, Hoven C, Bird H R, Bauermeister J J, Payne J D.
Are stimulants overprescribed? Treatment of ADHD in four US communities.
J Am Acad Child Adolesc Psychiat.
1999;
38
797-804
-
27
Biederman J, Spencer T.
Attention deficit hyperactivity disorder (ADHD) as a noradrenergic disorder.
Biol Psych.
1999;
46
1234-1242
-
28
Seeman P, Madras B K.
Anti-hyperactivity medication: methylphenidate and amphetamine.
Mol Psych.
1998;
3
386-389
-
29
Solanto M V.
Dopamine dysfunction in AD/HD: integrating clinical and basic neuroscience research.
Behav Brain Res.
2002;
10
65-71
-
30
Swanson J M, Sergeant JA, Taylor E, Sanuga-Barke E JS, Jensen P S, Cantwell D P.
Attention deficit and hyperkinetic disorder.
Lancet.
1998;
353
429-433
-
31
Castellanos F X.
Toward a pathophysiology of attention deficit hyperactivity disorder.
Clin Pediat.
1997;
36
381-393
-
32
Lou H C.
Etiology and pathogenesis of attention deficit hyperactivity disorder (ADHD): significance of prematurity and perinatal hypoxic-haemodynamic encephalopathy.
Acta Paediat.
1996;
85
1266-1271
-
33
Coyle J T, Snyder S H.
Catecholamine uptake by synaptosomes in homogenates of rat brain: stereospecificity in different areas.
J Pharmacol Exp Ther.
1969;
170
221-231
-
34
Giros B, Jaber M, Jones S R, Wightman R M, Caron M G.
Hyperlocomotion and indifference to cocaine and amphetamine in mice lacking the dopamine transporter.
Nature.
1996;
379
606-612
-
35
Krause K H, Dresel S H, Krause J, Kung H F, Tatsch K.
Increased striatal dopamine transporter in adult patients with attention deficit hyperactivity disorder: effects of methylphenidate as measured by single photon emission computed tomography.
Neurosci Lett.
2000;
285
107-110
-
36
Dresel S, Krause J, LaFougere C, Brinkbaumer K, Kung H F, Tatsch K.
Attention deficit hyperactivity disorder: binding of {99mTc}TRODAT-1 to the dopamine transporter before and after methylphenidate treatment.
Eu J Nucl Medicine.
2000;
27
1518-1524
-
37
Fischman A J, Bonab A A, Babich J W, Livini E, Alpert N M, Meltzer P C, Madras B K.
Rapid detection of Parkinson’s disease by SPECT with altropane: a selective ligand for dopamine transporters.
Synapse.
1998;
29
128-141
-
38
Madras B K, Gracz L M, Fahey M A, Elmaleh D, Meltzer P C, Liang A Y, Stopa E G, Babich J, Fischman A J.
Altrorpane, a SPECT or PET imaging probe for dopamine neurons: 111. Human dopamine transporter in post-mortem normal and Parkinson’s diseased brain.
Synapse.
1998;
29
116-127
-
39
Madras B K, Miller G M, Fischman A J.
The dopamine transporter: relevance to attention deficit hyperactivity disorder (ADHD).
Behav Brain Res.
2002;
130
57-63
-
40
Andersen S L, Teicher M H.
Sex differences in dopamine receptors and their relevance to ADHD.
Neurosci Biobehav Rev.
2000;
24
137-141
-
41
Dougherty D D, Bonab A A, Spencer T J, Rauch S L, Madras B K, Fischman A J.
Dopamine transporter density in patients with attention deficit hyperactivity disorder.
Lancet.
1999;
354
2132-2133
-
42
van Dyck C H, Quinlan D M, Cretella L M, Stanley J K, Malison R T, Baldwin R M, Seib J P, Innis R B.
Unaltered dopamine transporter availability in adult attention deficit hyperactivity disorder.
Am J Psychiat.
2002;
159
309-312
-
43
Volkow N D, Wang GJ, Fowler J S, Logan J, Gerasimov M, Maynard L, Ding YS, Gately S J, Gifford A, Franceschi D.
Dopamine transporter occupancies in the human brain induced by therapeutic doses of oral methylphenidate.
Am J Psychiat.
1998;
155
1325-1331
-
44
Gjone H, Stevenson J, Sundet J M.
Genetic influence on parent-reported attention-related problems in a Norwegian general population twin sample.
J Am Acad Child Adolesc Psychiat.
1996;
35
588-596
-
45
Goodman R, Stevenson J.
A twin study of hyperactivity.
J Child Psychol Psychiat.
1989;
30
671-689
-
46
Goodman R, Stevenson J.
A twin study of hyperactivity.
J Child Psychol Psychiat.
1989;
30
691-709
-
47
Levy L F, Hay D, McStephen M, Wood C, Waldman I.
Attention deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study.
J Am Acad Child Adol Psychiat.
1997;
36
737-744
-
48
Stevenson J.
Evidence for a genetic etiology in hyperactivity in children.
Behav Genetics.
1992;
22
337-343
-
49
Biederman J, Faraone S V, Keenan K, Knee D, Tsuang M T.
Family-genetic and psychosocial risk factors in DSM-111 attention deficit disorder.
J Am Acad Child Adol Psych.
1990;
29
526-533
-
50
Biederman J, Faraone S V, Mick E, Spencer T, Wilens T, Kiely K, Guite J, Ablon J S, Reed E, Warburton R.
High risk for attention deficit hyperactivity disorder among children of parents with childhood onset of the disorder: a pilot study.
Am J Psychiat.
1995;
152
431-435
-
51
Deutsch C K, Matthysse S, Swanson J M, Farkas L G.
Genetic latent structure analysis of dysmorphology in attention deficit disorder.
J Am Acad Child Adol Psychiat.
1990;
29
189-194
-
52
Faraone S V, Biedermen J.
Genetics of attention deficit hyperactivity disorder.
Child Adol Psychial Clin N Am.
1994;
3
285-302
-
53
Faraone S V, Doyle A E, Mick E, Biederman J.
Meta-analysis of the association between the 7-repeat allele of the dopamine D(4) receptor gene and attention deficit hyperactivity disorder.
Am J Psychiat.
2001;
158
1052-1057
-
54
Gillis J J, Gilger J W, Pennington B F, DeFries J C.
Attention deficit hyperactivity disorder in reading disabled twins: evidence for a genetic etiology.
J Abnormal Child Psychol.
1992;
20
303-315
-
55
Waldman I D, Rowe D C, Abramowitz A, Kozel S T, Mohr J H, Sherman S L, Cleveland H H, Sanders M l, Gard J M, Stever C.
Association and linkage of the dopamine transporter gene and attention deficit hyperactivity disorder in children: heterogeneity owing to diagnostic subtype and severity.
Am J Human Genet.
1998;
63
1767-1776
-
56
Birchard K.
Progress made in attention deficit hyperactivity.
JAMA.
1999;
353
1073
-
57
Still G F.
Some abnormal psychical conditions in children.
Lancet.
1902;
1
1008-1112
-
58
Sergeant J S, Steinhausen HC.
European perspective on hyperkinetic disorder.
Eur J Child Psychiat.
1992;
1
34-41
-
59
Biederman J, Faraone S V, Milberger S, Doyle A.
Diagnosis of attention deficit hyperactivity disorder from parent reports predict diagnosis based on teacher reports.
J Am Acad Child Adolesc Psychiat.
1993;
32
315-317
-
60
Dulcan M K, Benson R S.
Summary of the practice parameters for the assessment and treatment of children, adolescents, and adults with ADHD.
J AM Acad Child Adolesc Psychiat.
1997;
36
1311-1317
-
61
Mercugliano M.
What is attention deficit hyperactivity disorder?.
Pediat Clin N Am.
1999;
46
831-843
-
62
Zwi M, Ramchandani P, Joughin C.
Evidence and belief in ADHD. Editorial.
BMJ.
2000;
321
975-978
-
63
Greenhill L L, Abikoff H B, Arnold L E, Cantwell D P, Conners C K, Elliot G, Hechtman L, Hinshaw S P, Hoza B, Jensen P S, March J S, Newcorn J, Pelham W E, Severe J B, Swanson J M, Vitello B, Wells K.
Medication treatment strategies in the MTA Study: relevance to clinicians and researches.
J Am Acad Child Adolesc Psychiat.
1996;
35
1304-1313
-
64
Elia J.
Stimulants and antidepressant pharmacokinetics in hyperactive children.
Psychopharmacol Bull.
1991;
27
411-415
-
65
Smucker W D, Hedayat M.
Evaluation and treatment of ADHD.
Am Fam Physic.
2001;
64
817-829
-
66
Simeon J G, Wiggins D M.
Pharmacotherapy of attention deficit hyperactivity disorder.
Canad J Psychiat.
1993;
38
443-448
-
67
Shenker A.
The mechanism of action of drugs used to treat attention deficit hyperactivity disorder: focus on catecholamine receptor pharmacology.
Advances Pediat.
1992;
39
337-382
-
68
Swanson J M, Lerner M, Williams L.
More frequent diagnosis of attention deficit hyperactivity disorder.
N Engl J Med.
1995;
333
944
-
69
Volkow N D, Wang G J, Fowler J S, Gately S J, Logan J, Ding Y S, Dewey S L, Hitzemann R, Gifford A N, Pappas N R.
Blockade of striatal dopamine transporter by intravenous methylphenidate is not sufficient to induce self reports of “high”.
J Pharmacol Exp Ther.
1999;
288
14-20
-
70
Kuczenski R, Segal D S.
Effects of methylphenidate on extracellular dopamine, serotonin, and norephinephrine: comparison with amphetamine.
J Neurochem.
1997;
68
2032-2037
-
71
Solanto M V.
Neuropsychopharmocological mechanisms of stimulant drug action in attention deficit hyperactivity disorder: a review and integration.
Behav Brain Res.
1998;
94
127-152
-
72
Wilens T E, Biederman J, Spencer T J.
Pharmacotherapy of adult attention deficit disorder.
J Clin Psychopharmacol.
1995;
15
270-279
-
73
Arnold L E, Abikoff H B, Cantwell D P, Conners C K, Elliott G, Greenhill L L, Hechtman L, Hinshaw S P, Hoza B, Jensen P S, Kraemer H C, March J S, Newcorn J H, Pelham W E, Richters J E, Schiller E, Severe J B, Swanson J M, Vereen D, Wells K C.
National Institute of Mental Health Collaborative Multimodal Treatment Study of Children with ADHD (the MTA). Design challenges and choices.
Arch Gen Psychiat.
1997;
54
865-870
-
74
MTA C ooperative.
A 14-month randomized clinical trial of treatment strategies for attention deficit hyperactivity disorder. MTA Cooperative Group. Multimodal treatment study of children with ADHD.
Archives Gen Psychiat.
1999;
56
1073-1086.
-
75
Teicher M H, Anderson C M, Polcari A, Glod C A, Maas L C, Renshaw P F.
Functional deficits in basal ganglia of children with attention deficit hyperactivity disorder shown with functional magnetic resonance imaging relaxometry.
Nat Medicine.
2000;
6
470-473
-
76
Denney C B.
Stimulant effects in attention deficit hyperactivity disorder: theoretical and empirical issues.
J Clin Child Psychol.
2001;
30
110-113
-
77
Taylor E.
Development of clinical services for attention deficit hyperactivity disorder.
Arch Gen Pschiat.
1999;
56
1097-1099
-
78
Ahmann P A, Waltonen S J, Olson K A, Theye F W, van Erem A J, LaPlant R J.
Placebo-controlled evaluation of Ritalin and its side effects.
Pediatrics.
1993;
91
1101-1106
-
79
Schachar R, Tannock R.
Childhood hyperactivity and psychostimulants: a review of extended treatment studies.
J Child Adolesc Psych.
1993;
3
81-97
-
80
Gillberg C, Melander H, von Knorring AL, Janols L O, Thernlund G, Hagglof B, Eidevall-Wallin L, Gustafsson P, Koop S.
Long-term stimulant treatment of children with attention deficit hyperactivity symptoms.
Arch Gen Psychiat.
1997;
54
857-864
-
81
Perring C.
Medicating children: the case of Ritalin.
Bioethics.
1997;
11
228-240
-
82
Rey J M, Walter G, Hazell P L.
Psychotropic drugs and preschoolers.
Med J Aust.
2000;
173
172-173
-
83
Levin F R, Kleber H D.
Attention deficit hyperactivity disorder and substance abuse: relationship and implications for treatment.
Harv Res Psychiat.
1995;
2
246-258
-
84
Clure C, Brady K T, Saladin E, Johnson D, Waid R, Rittenbury M.
Attention deficit hyperactivity disorder and substance use: symptom pattern and drug choice.
Am J Drug Alcohol Abuse.
1999;
25
441-448
-
85
Riggs P D, Leon S L, Mikulich S K.
An open trial of bupropion for ADHD in adolescents with substance abuse and conduct disorder.
J Am Acad Child Adolesc Psychiat.
1998;
37
1271-1278
-
86
Biederman J, Wilens T, Mick E, Spencer T, Faraone S V.
Pharmacotherapy of attention deficit hyperactivity disorder reduces risk for substance use disorder.
Pediatrics.
1999;
104
20
-
87
King V L, Brooner R K, Kidorf M S, Stoller K B, Mirsky A F.
Attention deficit hyperactivity disorder and treatment outcome in opioid abusers entering treatment.
J Nerv Ment Dis.
1999;
187
487-495
-
88
Levin F R, Evans S M, Kleber H D.
Prevalence of adult attention deficit hyperactivity disorder among cocaine abusers seeking treatment.
Drug Alcohol Depend.
1998;
52
15-2
-
89
Bonn D.
Methyphenjdate: US and European views converge.
Lancet.
1996;
348
255
-
90
Boyle M H, Offord D R, Racine Y A, Fleming J E, Szatmari P, Links P S.
Predicting substance abuse in early adolescence based on parent and teacher assessments of childhood psychiatric disorder: results for the Ontario Child Health Study follow up.
J Child Psychol Psychiat.
1993;
34
535-544
-
91
Parran T V, Jasinski D R.
Intravenous methylphenidate abuse: a prototype for prescription drug abuse.
Arch Intern Med.
1991;
151
781-783
-
92
Chandler J V, Blair S N.
The effect of amphetamines on selected physiological components related to athletic success.
Med Sci Sports Ex.
1980;
12
65-69
-
93
Hickey G, Fricker P.
Attention deficit hyperactivity disorder, central nervous system stimulants and sport.
Sports Medicine.
1999;
27
11-21
-
94
Pelham W E Jr, McBurnett K, Harper G W, Milch R, Murphy D A, Clinton J, Thiele C.
Methylphenidate and base ball playing in ADHD children: who’s on first?.
J Consul Clin Psychol.
1990;
58
130-133
B. Corrigan
Institute of Sport Medicine · Concord Hospital
1 Lookout Ave · Dee Why · Sydney 2099 · Australia
Telefon: +02 9981 1796
Fax: +02 9981 4224
eMail: bc6@bigpond.com
