Original publication date: January 28, 2023
Last Updated: February 9, 2024
Author: Max Skyler
Topic: Flight Physiology
Number of Comments: 0
On face value, ADHD can be perceived, by many medical professionals, as a clinical condition that intrinsically impairs a pilot’s fitness to fly. While there may justifiably be grounds under which ADHD may render a pilot medically unqualified to fly, the question remains as to whether or not it is truly as debilitating as it made out to be. Safety is unquestionably of the utmost priority when it comes to the medical standards enforced by the FAA, and therefore its stance on ADHD indeed merits some level of scrutiny, in order to better understand and truly appreciate what this means for pilots who may suffer from this condition.
The FAA categorically deems any individuals who are clinically diagnosed with ADHD or who are actively taking medication specifically prescribed to treat ADHD, as medically disqualified from piloting aircraft, until and unless they can be assessed as no longer exhibiting symptoms, sans medication.
Having said that, simply being diagnosed with ADHD in and of itself does not automatically equate to putting a nail in the proverbial coffin of one’s aviation ambitions. Gaining medical clearance to fly would require a concerted effort, which may involve working closely with one’s treatment specialist, to work toward the goal of achieving a degree of drug-free wellness, to then ultimately qualify to become a pilot. The FAA does provide guidance to Aviation Medical Examiners (AMEs) on how to diagnose, evaluate, and monitor the progression of a prospective pilot’s ADHD, and ultimately pave the way for them to potentially obtain the coveted medical clearance needed in order to fly.
Instructions for Pilots Suffering From ADHD
Whether you are an aspiring pilot, you are a student pilot, or you are already a licensed pilot, if you have been diagnosed with ADHD or you are currently taking medication that is used to treat ADHD, the FAA has offered guidance on the steps you must take in order to seek the necessary medical clearance in order to fly.
- You must undergo a medical examination, administered by an AME.
- Under the authorization of the AME, you must undergo a clinical examination, to be administered by an FAA-approved neuropsychologist.
- Your medical records must be forwarded to the neuropsychologist.
- You must be free of any ADHD medication for at least 90 days prior to the neuropsychologist exam.
- Undergo a urinalysis drug exam.
- The results of your neuropsychology exam must be shared with your AME.
Medical Certification Requirements For Pilots
All pilots are required to obtain and maintain a current, non-expired medical certificate, in order to be legally allowed to exercise the privileges of a pilot license.
There are 4 classes of medical certificates that are available to pilots, depending on what you intend to do as an aviator:
| Medical Certification Class | Purpose |
| 1st Class Medical Certificate | Required for airline pilots |
| 2nd Class Medical Certificate | Required for commercial aviation, excluding flying for airlines |
| 3rd Class Medical Certificate | Required for non-commercial, general aviation operations |
| BasicMed | Required for restricted general aviation operations |
ADHD is considered a disqualifying medical condition for all classes of medical certification. However, an ADHD diagnosis in and of itself does not immediately shut the doors on your aviation career. While it is a journey, your ADHD condition is certainly not insurmountable, if you are determined to overcome it.
Prohibited ADHD Medications That Pilots May Not Consume
The FAA maintains a catalog of common medications, for the treatment of various medical conditions, and its official stance on the consumption of each with respect to the permissibility to operate an aircraft.
ADHD medications are unconditionally and categorically prohibited, as per an index published by the FAA subtitled “Do Not Issue – Do Not Fly”.
Therefore, it goes without saying, that if you suffer from ADHD, but you have aspirations of being a pilot, you must avoid or wean yourself off of any medications that are specifically used to treat this condition, along with any other medications listed on the aforementioned, referenced links.
Guidance For AMEs On How To Evaluate Pilots For ADHD
The FAA offers guidance for AMEs on how to evaluate pilot candidates for ADHD, who are seeking to obtain the required medical clearance in order to fly. AMEs themselves do not actually conduct the required evaluations. The responsibility for evaluating a potential ADHD patient rests with an FAA-approved neuropsychologist.
The results of the neuropsychology evaluation are then shared with the AME, who compiles all of the fact-based evidence to make the final determination as to whether the candidate meets the criteria to be deemed medically fit to operate an aircraft.
Attention-Deficit / Hyperactivity Disorder (ADHD), which formerly used to be known as Attention Deficit Disorder (ADD), and the consumption of the associated medications for its treatment, harbor the potential to impair one’s cognitive ability to maintain focused, attentive, and vigilant whilst piloting an aircraft. The ability to exercise and maintain proper judgment while flying, from preflight, to take off, to cruise, to landing, is self-evident as a prerequisite for being able to fly.
This not only applies to the condition itself, but also to the medication that is used to treat it.
Neuropsychology Evaluations For Pilots With ADHD
The FAA has published the minimum testing requirements which must be carried out, for a comprehensive ADHD evaluation.
Patients must undergo at least one initial battery of tests. If there are any concerns or red flags raised during the initial battery, then the patients must be subjected to a second, or supplemental battery of testing.
The initial battery of tests typically consists of the following:
- A comprehensive background review.
- Interviews with individuals who can vouch for the patient’s behavior. Examples of such individuals may include:
- Parents
- School teachers
- School counselors
- Employers
- Flight instructors
- Administration of FAA-specified neuropsychology tests. The details of how these tests are conducted are not available to the general public, and are only available to authorized professionals via a secure website. This is for the purposes of maintaining the integrity of the tests.
- Urine drug screening tests. These tests are designed to check for the presence of ADHD medications in the candidate’s system. This includes testing for psychostimulants, as well as amphetamine and methylphenidate.
On this latter point, regarding drug screening, it is worth mentioning that it is also required that pilot candidates must be drug-free of any ADHD treatment medications for at least the 90 days prior to the medical exam.
In the event that the pilot candidate fails to satisfactorily pass the initial battery of tests, they will then be subjected to a supplemental battery of tests, the details of which are also classified in order to maintain the integrity of the test.
The purpose of this secondary round of testing is further resiliency of the testing process, whereby the neuropsychologist may positively or negatively ascertain or rule out whether the patient truly has ADHD/ADD or their prognosis may have been misidentified, possibly even in conjunction with any comorbid disorders or ailments.
Reporting of Neuropsychological Evaluation Data To The FAA
The FAA publishes a comprehensive list that enumerates the documentation that is required to be submitted to the AME, subsequent to the completion of the neuropsychological evaluation of a potential pilot candidate. This includes all available records and information on the patient’s history, diagnosis, treatment, and clinical evaluation results.
Furthermore, any other information that can be used to supplant the pilot candidate’s profile, which can facilitate in the decision-making process in determining their fitness to fly, can also be submitted for consideration as well. For example, driving records, criminal records, educational history and academic performance, statements from flight instructors, family members, employers, can all be taken into consideration and should be submitted as well.
Once the neuropsychologist submits this data, along with his overall prognosis and recommendation, it then becomes the responsibility of the AME to make the final determination whether or not to issue the pilot a medical certificate.
If the AME finds that the data is inconclusive to either approve or deny the candidate’s application for a medical certificate, and that their case merits further review, then they have the right to defer the decision to the FAA.
When this happens, the case is then submitted for review, in order to obtain what is known as a Special Issuance certificate.
Special Issuance Medical Certification For Pilots With ADHD
In an effort to accommodate individuals with ADHD who wish to become pilots, the FAA does offer an alternative pathway toward obtaining medical clearance to fly, through what is known as a Special Issuance.
As the name implies, this requires special handling and greater individualized scrutiny, apart from the standardized medical certification process.
If a pilot candidate fails to meet the criteria to pass a standard 1st class, 2nd class, 3rd class, or BasicMed medical exam, then they may apply through the Special Issuance process.
What this affords the would-be pilot to be able to do is be granted a provisional medical clearance. It could be provisional in the sense that it is:
- time-based, meaning that the medical authorization is for a shorter period of time than that of a standard medical certificate
- granted with certain conditions that must be met in order to be able to legally fly
- granted with certain restrictions or limitations on what the pilot can or cannot do
Unlike a standard medical certificate, a special issuance certificate is conditional and provisional. This means that the privileges to fly can potentially be rescinded or suspended at a later date, either temporarily or permanently, if the conditions imposed forthwith, fail to be maintained.
Special issuance certificates may take longer to obtain, since they involve greater scrutiny, under the direct review of FAA personnel. Typically the AME will defer the medical authorization decision to the FAA, in order for a special issuance certificate to be considered. This can add to delays in processing, whereas AMEs typically have the authority to grant medical clearances on the spot.
As a general rule, according to 14 CFR § 67.401b of the Federal Aviation Regulations, if it can be demonstrated that an individual’s disqualifying medical condition is stable, not getting progressively worsening, and who can demonstrate that they are capable of performing the duties of pilot-in-command safely, competently, and without endangering public safety, they may be eligible to be granted a Statement of Demonstrated Ability (SODA).
What Is The FAA’s Stance On ADHD?
Statistically speaking, the vast majority of aviation accidents are due to pilot error. Based on data compiled and maintained by the National Transportation Safety Board (NTSB), most accidents can be attributed to a lapse in the pilot’s cognitive performance and the exercise of sound judgment with respect to the aeronautical decision making (ADM) process, be it through distractions or otherwise.
While not all such accidents may attributable to ADHD, with only 2.5% of adults being known to have been diagnosed with this condition in the United States, it has been deemed by the FAA to be a condition that can exacerbate a problem that any and all pilots could potentially be susceptible to, if proper vigilance is not maintained.
It is possible that some pilots may fail to disclose their bout with ADHD to their AME and may pass the medical exam with flying colors (no pun intended). But it is not unheard of that accidents have occurred in which toxicology reports have later revealed that the pilot was taking medication for the treatment of ADHD at the time.
It is not the goal of the FAA to deny anyone a pilot’s license. On the contrary, the FAA seeks to promote aviation and encourage more people to become pilots, especially since we often times hear reports that there is projected to be a shortage of pilots to meet the growing demands of aviation, over the decades to come.
Having said that, the FAA is entrusted with the mandate to ensure the safety of the general public. If an individual can be deemed unfit to fly, the denial of their medical clearance is being done so, with the interests of general public safety in mind.
As an aviation enthusiast, if a person suffering from ADHD is determined to fly, they can seek the advice and counsel of their AME on what type of lifestyle changes they can make, in order to seek treatment and therapy to reign in their condition, and thus ultimately be able to obtain their medical clearance to fly.