ADHD, Sport and Elite Athletes
Simone Biles, Noah Lyles, Michael Phelps, Adam Peatty, Louis Smith, Nicola Adams. What do all these people have in common? If you said Olympic athletes, you’re not wrong but that’s not the answer I’m looking for. What’s that? You guessed it. They all have ADHD.
We hear a lot about ADHD and sport, about how physical activity improves ADHD symptoms, and that was quite a list of elite ADHD athletes that I pulled out at the start there. But how much of this is confirmation bias, or me cherry picking the athletes to talk about, and how much of this is real? I’ve been looking into the science to find out more.
And it turns out that there’s not a huge amount of science, especially when it comes to elite sport. And on the elite sport side of things a lot of the research is actually a bit dubious or just shows no real correlation between the aspects they studied. However, having said that, as this body of research increases there are themes that start to emerge and we’re going to talk about them today.
I also want to share that I intended to do this video about neurodivergence and sport in general, but there’s even less out there on Autism, Dyslexia etc than there is on ADHD and the autism stuff that is out there shows no correlation on elite sport and basically just that autistics who do sport get positive benefit from it so there isn’t much to talk about here. So we focus on ADHD today as that’s where the research is at.
Now I come into this as someone who is a bit biased here because I love sport and exercise and have been participating in some kind of formalised exercise or other since I was eight years old. Through this I’ve made so many friends in my life who are near and dear to me and I have to say, anecdotally, that from my perspective it seems like there are way more neurodivergents in sports that I’ve been involved with than the general population.
Now that might have something to do with the sports I choose, famously the Brazilian Jiu Jitsu community is full of autistics, and I’ve come across quite a few ADHDers myself there too, but I also think it could have something to do with our profiles.
Neurospicies, and especially ADHDers are just more likely to have hobbies, and we’re more likely to be incredibly dedicated to our hobbies. So it makes sense that if you enter an organised hobby as an adult, like organised sport, then the chances are you’re probably going to come across other neurospicies there.
Yep, this is how I spend my Saturdays.
So with that in mind, we’re going to look at both the pros and cons of having ADHD when doing sport, the benefits of sport on ADHD (that part isn’t just confirmation bias!) before looking at what the actual stats are on ADHD and elite athletes. So let’s take it away with Part 1: The Negative Side of ADHD in Sports.
So the negative sides of ADHD in sport probably won’t be too suprising to hear. We get distracted more easily and have a hard time managing our attention, which I’m sure has caused many of us to completely miss the ball when it’s coming our way because we were deep in thought about something completely different.
Emotional dysregulation can also be an issue and one study found that boys with ADHD displayed higher levels of aggression, emotional reactivity and disqualification than their non-ADHD peers (Johnson & Rosen, 2000).
However, something that is interesting is that while I found this paper referenced in more recent papers on adults, none of them actually linked aggression and sport in ADHD adults, only speculating that this might be an issue. We’ll get into the topic of how sport benefits ADHD later, but this does make me wonder whether this means that sport is a conduit for ADHD children to learn how to manage some of these difficult emotions better so that by the time they reach adulthood they’re much more equipped to deal with the feelings that lead to aggression than they are during childhood.
Studies also refer to impulsivity which makes us more likely to get involved in substance misuse which of course isn’t really a benefit to our sporting careers. They also mention comorbidities of depression and anxiety, something we know co-occurs with ADHD more than the general population, to be something that could negatively impact our sporting performance (Han et al., 2019), (Katzman et al, 2017).
Finally, I want to talk about ADHD and concussions because this is an area where there has been research already. There have been studies that have found that ADHDers have greater concussion symptoms, are more likely to have had a previous concussion and are more likely to experience concussion in the sporting season (Iverson et al., 2021), (McLeod et al., 2018).
However, the paper Neurodiversity in elite sport: a systematic scoping review is somewhat critical of this conclusion. They highlight that ADHDers tend to have a worse cognitive performance at baseline assessment and refer to a separate meta analysis of ADHD and concussion which only found two studies that had a statistical association between ADHD and prolonged concussion recovery with only 21 participants total between the two studies. The only study in the review designed specifically to assess ADHD and sports related concussion recovery did not have any significant findings.
I’d love to see more research done in this space because if we do genuinely struggle more with concussions and recovery then I think this is really important to know and be aware of to better protect ourselves, but right now, the research is just not there to be able to draw final conclusions on this topic.
One of the reasons I will never do MMA despite being interested in it conceptually is because I value my brain too much to risk the concussion…
Part 2: The benefits of ADHD in sport
While an inability to regulate focus was listed as a con in the previous section, there’s actually an argument to be made about distractibility being a pro because it means that we can notice things that are out of the ordinary and react to them a lot more quickly.
This difficulty regulating attention also leads to things like hyperfocus, where we can get completely engrossed in the task at hand and block out distractions, presumably different distractions to the ones we noticed in the previous point, which could be a benefit in sport, possibly even crucial for high performance (Moran et al, 2018).
Now I read a lot of research on ADHD and one thing that I find particularly polarising in the academic work on ADHD is whether they consider us to be hardworking or not. Many papers point to our lack of conscientiousness and suggest we’re not hardworking, we’re not resilient etc. Whereas others, including the paper Do Athletes Have More of a Cognitive Profile with ADHD Criteria than Non-Athletes? Which I’m using as a resource for this video, really stress that ADHDers are incredibly hard working and that ability to work very hard is fundamental to our sporting performance.
The way I reconcile these two opposing views on whether we’re hardworking or not is how you look at executive function. If someone is struggling with executive function and you don’t understand that, you might conclude that they are not hard working, when in reality behind the scenes they are working incredibly hard to try and work around their executive function challenges and I’ve read many studies looking at lived experiences of ADHDers in the workplace (Hogstedt et al., 2022), entrepreneurship (Wiklund & Shepherd, 2005) and now sport that all conclude that we are hardworkers and being hardworking has personally been part of my self-image long before I ever suspected ADHD.
But I’m digressing here and getting off topic. Hardworking was considered a big pro of ADHD when it came to sporting performance.
And finally, we have abundant high energy, and I don’t think you need me to tell you why that’s beneficial to sporting performance!
I ended up doing a lot of athletics running at school, not because I was good at it, just because I had boundless energy that my peers were too cool for ;).
Part 3: The benefits of sport on ADHD
Earlier this year I put a video out about how to improve executive function, not strategies to manage executive function difficulties but how to improve your overall baseline in executive function. I’ll link the video above if you’d like to watch it, but ultimately it broke down four conditions needed to improve executive function:
The activity should continually challenge a variety of executive functions in new and different ways.
The activities should be personally meaningful and relevant and inspire a deep commitment and emotional investment between the participant and the activity and even towards other people like the instructor or other participants.
It should have a mentor or guide who helps you develop on a personal level as well as within the activity.
It will provide joy, reduce feelings of stress and loneliness and inspire self-confidence and pride.
When I look at this list I can immediately see how sports can fit into this. Working on staying calm under pressure, regulating your emotions when losing or even when winning so that you don’t slip up, remembering strategies and responding live to the situation during the match, event or whatever your sport has, exercises all three sub-categories of executive function.
Organised sports often have a coach who acts as a mentor or guide and for someone committed to sport who loves and enjoys it, it absolutely is personally meaningful and provides joy. So I don’t think it’s a stretch to suggest that sport improves the executive function aspect of ADHD (and in fact, in the book chapter referenced in this video, we did find this to be the case for at least Martial Arts, with the caveat that exercise for exercise sake does not have the same results).
In the paper “Do Athletes Have More of a Cognitive Profile with ADHD Criteria than Non-Athletes?” they refer to physical activity having a positive effect on inattention and hyperactivity, as well as having a positive effect on stress, decreasing anxiety and depression as well as decreasing bad conduct and poor impulse control.
Physical Activity as a whole was found to improve all ADHD symptoms and improved “individual’s overall attitude and personal development, cognitively and emotionally, as well as academic performance”.
Sport has stimulation, it has structure and it has continuous reward, all things that ADHD brains enjoy. It can also make socialising easier by giving a purpose to the socialisation rather than trying to socialise for socialising’s sake. Exercise also increases dopamine and norepinephrine, something that is low in the brains of ADHD children and adolescents (Suarez-Manzano et al., 2018).
In the previously mentioned study “Do Athletes Have More of a Cognitive Profile with ADHD Criteria than Non-Athletes?”, it was found that high performing youth athletes with ADHD experienced significantly more challenging ADHD symptoms during their school time than they did during their time playing sports, which could indicate that elite sport could be a good career path for people with ADHD for whom symptoms get in the way of normal education. And speaking of elite sport…
Honestly so much of my social life has surrounded sport and making friends through sport.
Part 4: How Prevelant is ADHD in Elite Sport?
So I’ve heard the statistic before that elite athletes are more likely to have ADHD and of course I’ve pondered over the question itself since watching the Olympics earlier this year and noting how many top performing athletes are open about having an ADHD diagnosis. So I set out to find the answer, and unfortunately it’s not as straight forward as I’d hoped.
I was inspired by a pre-publication paper, “ADHD Among High-Level Athletes and Its Potentially Beneficial Role in Athlete Development” (at the time of writing, I think it’s out now) that I could only access the abstract of, but it made bold claims, stating that ADHD symptoms were present in elite athletes at approximately four times a higher rate than previous studies that have used ADHD diagnoses or medical reports. They also found that there was a higher rate of ADHD in intermediate and high level athletes than in lower level athletes.
The study I referred to earlier, “Do Athletes Have More of a Cognitive Profile with ADHD Criteria than Non-Athletes?” found that when they compared high level youth sport athletes, these are students enrolled in the Swedish national sports talent program, considered among the most talented in the country, against their peers in their schools, they found that the athletes had much higher ADHD symptoms (as assessed by a psychotherapist) than their non-athlete peers and this was especially significant within school.
A 2023 metaanalysis of neurodiversity in elite sport (Hoare et al, 2023) found multiple studies confirming that elite athletes may present with higher ADHD rates than the general population.
And finally, in a statistic that I found particularly interesting, the 2019 paper “Attention-deficit/hyperactivity disorder in elite athletes: a narrative review” looked at the Therapeutic Use Exception for Major League Baseball in the US. The TUE as it’s called publishes the number of players who receive permission to take a medication on the World Anti-Doping Agency Prohibited List.
Now stimulants for ADHD are on that list, so the MLB is publishing statistics of all players that received permission for stimulant ADHD medication. For the offseason of 2017 to 2018 through to the end of the 2018 season, 101 players were granted permission for ADHD stimulant medication. That makes up 8.4% of all players.
Now depending on who you ask, 8.4% could be about right for the incidence of ADHD in the general population (although this is fiercely debated, and ever paper I read for this report had a wildly different idea of the prevalence which they stated as fact) but let’s consider this a little more closely.
This is the number of players who received permission to take stimulant medication for their ADHD. Now I don’t know at what rate MLB declines permission but I’d have to guess that there’s probably at least one MLB player who got given a no. Beyond that, stimulant medication isn’t the only form of ADHD medication, and non stimulant medication is now widely used for people for whom stimulant medication doesn’t work. On top of this, many people who have ADHD don’t get medicated at all, and there are also likely to be players that haven’t been diagnosed at all.
So even if we take the upper estimate of prevalence in the community, which tops out at about 10% maximum in the many statistics I have read, I would think that there’s more than 1.6% of players that have either been denied permission for their stimulant medication, or are on non-stimulant medication, no medication at all or haven’t been diagnosed, which leads to another study pointing towards ADHD being more prevalent in elite athletes than the general population.
Collecting cards is a thing they do in baseball, right?
Conclusion
So how do I conclude this? Well what we’ve learned is that although ADHD has some aspects that might make sport more challenging, it is also incredibly beneficial to sport, and sport is incredibly beneficial to ADHD, and we see that reflected in the fact that elite athletes have ADHD at higher rates than the general population.
Now based on my audience statistics, I’m pretty sure you, the viewer, are probably a little bit too old to become an elite athlete, so what can you do with this information? Well, for one thing, if you’re a parent with an ADHD kid, they’d probably benefit from being put into sports, you never know where they’ll end up with it.
But also sport is all round good for you too. It’s good for your heart, for your lungs. It’s good for your bones and muscles. It releases endorphins, those feel good chemicals that last even after you’ve finished, and most importantly, it’s good for your ADHD too.
So go out there and find a sport that you love and enjoy and make the most of it. And if it ends up being Judo or Jiu Jitsu, well I may well see you on the mats.
References:
Study: Sports behavior of ADHD children, (Johnson & Rosen, 2000)
Attention-deficit/hyperactivity disorder in elite athletes: A narrative review (Han et al., 2019)
Attention and concentration, (Moran et al., 2018)
Neurodiversity in elite sport: a systematic scoping review, (Hoare et al, 2023)
If this resonates with you and feel you would be interested in talking to an adhd and autism-friendly coach, feel free to get in touch. If you’re looking for more blog posts, you can find them here.
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