ADHD : ADHD Medicine Abuse By Athletes

Jason Mazda, The Press of Atlantic City, Pleasantville, N.J.

When Major League Baseball suspended Carlos Ruiz in November for 25 games after he tested positive for Adderall, many fans wondered why the Philadelphia Phillies catcher didn't have a prescription.

Millions of Americans -- including many children -- are prescribed Adderall and other stimulants to treat Attention Deficit Hyperactivity Disorder, or ADHD. If Ruiz had been one of them, he would not have been suspended.

Considering how many children take ADHD drugs, however, Ruiz's case raises a much bigger question: Do these stimulants actually enhance athletic performance?

No data are readily available to answer that question. But Dr. Christopher Keenan, a pediatrician who lives in Northfield, said he has observed the effects of the drug based on what patients and their families have told him.

If a person does not have ADHD or takes too high a dosage, the drugs should not provide an athletic advantage, he said. However, the drugs could help if used correctly by patients who need them.

"They can pay better attention to what's going on, what the coach is saying," said Keenan, 57, who works with Harborview CHOP Care and serves as Shore Medical Center's Service Line Chief of Pediatrics. "They're not daydreaming when they're out in the field, which would be the same kind of thing that you'd have in the classroom setting. ... So, in that effect, it has the potential to improve their game."

About 5.1 million Americans were prescribed medication for ADHD in 2011, according to the health care information service IMS Health. Detailed age data were unavailable, but a large portion of those prescriptions likely went to children, since the disorder until recently was widely believed to be limited to youth. The federal Centers for Disease Control and Prevention estimated in 2011 that 5.2 million Americans ages 3 to 17 had been diagnosed with ADHD.

The drugs are illegal without a prescription, and nearly every sports league from high schools to the pros follows the same guidelines. The New Jersey State Interscholastic Athletic Association, for example, includes amphetamines (which are contained in Adderall) and methylphenidate (better known as Ritalin) on its list of banned substances, but its bylaws make an exception for a "written prescription by a fully licensed physician, as recognized by the American Medical Association, to treat a medical condition."

"If the kid is under a prescription, then he's under a doctor's care," NJSIAA Executive Director Steve Timko said. "I think the physician would be able to determine a student-athlete's ability to compete. If everything is controlled, there wouldn't be any reason why the kid wouldn't be operating under the same levels as everyone else."

Timko, who serves on the Medical Advisory Committee for the National Federation of State High School Associations, said the abuse of stimulants is not a big concern for the NJSIAA. Steroids and concussions, he said, are more pressing issues.

Perhaps it's not a big concern because there is no consensus as to how much the stimulants actually help athletes.

Gene Allen, coach of the defending state Group IV champion Atlantic City High School boys basketball team, said he has no experience with athletes taking Adderall or Ritalin. But he said he has had youth who might have benefited from better concentration.

"(Concentration) plays a very significant role as far as a kid's ability, just in practice, in learning the nuances of basketball," said Allen, who teaches special education at the school. "I just think it plays a huge role in terms of the ability to concentrate and then go out and apply what you've been taught, particularly in certain scenarios against certain opponents."

The drugs can have other effects, though. Dave Mauriello, coach of one of the area's top wrestling programs at Hammonton High School, said he has seen Adderall and Ritalin have a negative effect on athletic ability.

"The medicines have definite medical responsibilities and things that they handle, and it's valuable in the classroom," said Mauriello, 42, a Hammonton resident and a health and physical education teacher at the school. "With regard to wrestling, one of the things that I've noticed is, while their attention is better, it seems like their reactions are slower, and their physical aggressiveness is diminished as a result of the medication as well."

Keenan said that's more likely due to using too high a dosage. He said that if an athlete appears slower, it's more likely a condition called "zoning."

"If the dose is too high, it's hard for the kids to shift their attention to something else," Keenan said. "So it looks like they're zoned."

He said aggressiveness should not be affected, though the drugs could lessen an athlete's impulsiveness and creativity.

John Stout, who has coached the Southern Regional High School wrestling team to South Jersey Group IV titles seven of the past eight years, said that from his experience, the issue has to be looked at on a case-by-case basis. Stout, a 41-year-old Waretown resident who teaches special education at the school, noted that the drugs can affect certain youth differently depending on their situations.

"I think if there's a kid who has an attention-deficit situation where he can't pay attention during practices or whatever it is, and he just has a hard time taking in information, and it's able to level him off so he can absorb the information that's being told to him, whether it's in wrestling practice or whether it's in math class, it doesn't really matter. That's the designed effect for the medication," Stout said. "But some kids, it takes them down too far where it makes them extremely tired and takes away too much of that."

Other questions remain, too. The assumption is that stimulants are prescribed for academic purposes and that any effects in the realm of sports are secondary. But what happens when an athlete seeks a prescription with sports as the primary reason?

Keenan said he would not prescribe the drugs in that case. The potential side effects -- including heart attacks, strokes, psychosis or hallucinations -- become even more of a threat when the dosage is too high, which Keenan said is often the case with people who use the drugs without prescriptions.

Keenan said a patient needs to be having trouble in several areas, such as school, home and work. Athletics can be one of them, but Keenan said he would even be skeptical enough to look closer at the patient's history in that case.

"The focus should not be on the athletic field," Keenan said. "It really needs to be in all environments that they're having difficulties."

Contact Jason Mazda:

609-272-7193

JMazda@pressofac.com

(c)2013 The Press of Atlantic City (Pleasantville, N.J.)

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