A few weeks ago, Major League Baseball announced changes to its Joint Drug Policy. Changes to the process for collecting, securing, and shipping urine samples garnered most of the media attention. That process came under scrutiny after Ryan Braun successfully appealed a positive drug test by showing that the then-existing protocol, was not strictly followed.
But there were other changes, too. Under the new policy, major league players who request exemptions in order to take prescription medications for Attention Deficit Hyperactivity Disorder (ADHD) will need the approval of a three-expert panel. Under the old policy, one person reviewed, and decided on, requests for Therapeutic Use Exemptions.
Why the change? Since 2007, more than 100 major leaguers have been granted exemptions each season in order to take drugs like Adderall and Ritalin, stimulants that help ADHD sufferers focus for long periods of time. And it's been growing slightly every season, from 103 in 2007 to 111 in 2011. That's about eight percent of all major leaguers.
Some ballplayers have spoken publicly about their ADHD and the steps they've taken to overcome the often debilitating symptoms. Mets center fielder Andres Torres is the subject of a film about his struggles with ADHD. Gigante chronicles Torres' ten-year odyssey through the minor leagues as he battled ADHD symptoms but refused to face them. When he finally started on prescription medication, it changed his life. Indians starter Derek Lowe and Nationals first baseman Adam LaRoche played together on the Braves in 2009 and helped each other cope with ADHD. Others deal with it more privately.
In 2006, the National Institutes of Health estimated that ADHD affects a little more than four percent of the adult population. The discrepancy between the incidence of ADHD in the general adult population and the significantly higher incidence in professional baseball raised a lot of eyebrows. Critics charged that the rules for obtaining a Therapeutic Use Exemptions were too lax and players were too easily finding doctors to give an ADHD diagnosis and prescribe medication. Like other stimulants, Adderall and Ritalin boost energy and focus. The modern equivalent of greenies, critics charged. That led to the change in the drug policy, which is intended to put a lid on exemptions for ADHD medications.
Were the concerns justified? Could there be factors leading to a higher incidence of ADHD in professional baseball players than in the general adult population?
There is some uncertainty regarding the prevalence of ADHD in adults. Dr. Ari Tuckman, a psychiatrist who specializes in ADHD and who formerly served on the board of the Attentive Deficit Disorder Association, says the latest figures show that five percent of American adults have ADHD. But other experts say that ADHD often goes undiagnosed, especially in adults who have suffered with a variety of symptoms for a long time but never received proper care. ADHD sufferers often experience other mental health problems, like depression, anxiety, and drug and alcohol addiction, making the ADHD more difficult to find, especially by doctors unfamiliar with the disease.
According to Dr. Edward M. Hallowell, a child and adult psychiatrist who served on the Harvard Medical School faculty from 1983 to 2004, approximately 80 percent of adult-ADHD is undiagnosed. As such, Dr. Hallowell wasn’t surprised to learn that eight percent of Major League ballplayers had been diagnosed with ADHD. Professional athletes have greater access to good medical care than does the average American adult, making proper diagnoses more likely.
There is also uncertainty about whether ADHD affects adult men at a greater rate than adult women. If so, then finding that eight percent of Major Leaguers have the disease, as compared to five percent in the adult population as a whole, may not be inconsistent at all. Women, of course, don’t play Major League baseball. The latest figures from the Centers for Disease Control and Prevention show that adolescent boys are diagnosed with ADHD at nearly a 3:1 rate compared to girls. But, again, those numbers may be more a function of how ADHD is exhibited in boys versus girls, leading to a lower rate of diagnoses for girls. Both Dr. Tuckman and Dr. Hallowell say that recent studies show adult women and men suffer ADHD symptoms at about the same rate.
And then there’s the issue of a relationship between ADHD and high-achieving professional athletes. Neither Dr. Tuckman nor Dr. Hallowell is aware of any studies suggesting a higher incidence of ADHD among professional athletes. But Dr. Hallowell pointed out that adolescent boys with ADHD tend to gravitate to activities that demand a great deal of physical energy and that such physical exertion produces chemicals in the brain that help with focus. Dr. Tuckman echoed a similar point, noting that boys with ADHD who are otherwise good athletes will play sports as a way to build self-esteem. That may lead, somewhere down the road, to a higher incidence of ADHD among those who ultimately become professional athletes.
Even with these uncertainties, both experts were pleased to see MLB tightening the process for obtaining a Therapeutic Use Exemption. Professional athletes will look for any edge, they said, and only those who truly require ADHD medication in order to properly function should be permitted to take it. Moreover, Dr. Hallowell added, Ritalin, Adderall and similar drugs do not produce a super-focusing effect for people without ADHD. Those drugs work by altering the brain’s chemistry. According to Dr. Hallowell, if a ballplayer’s brain chemistry doesn’t "need" altering, then he’s more likely to experience the unpleasant side effects of the drugs -- like elevated heart rate, elevated blood pressure, insomnia and weight loss -- and none of the benefits.
In the end, Dr. Tuckman noted, "when ADHD is appropriately diagnosed and the medication is appropriately prescribed and taken, it doesn't give someone with ADHD an edge any more than giving contact lenses to someone who is far-sighted."