So how did it play out you ask? Why have you not posted in so long? I will attempt to elaborate here.

My 3rd class medical certificate was granted, but only after I discontinued Adderall in April of 2008 (yes, over one year ago). After being off the medication for 9 months, a letter from my treating physician stating I had stopped taking the medication, and another full psychological evaluation and a urine drug screen immediately following, I was finally granted the certificate.

So, what is the take home message here?

In my opinion this tells us two things definitively now. First, that it is possible to jump through all the hoops the FAA requires and actually obtain the certificate. Second, with this being the case it seems clear that it is the medication the FAA takes issue with, and not simply having the diagnosis. That is, you can have a history of the diagnosis and this will not automatically disqualify you from obtaining a 3rd class certificate. In my initial NTSB hearing, one of their witnesses testified that both the condition itself was disqualifying independent of the medication, and that taking the medication was disqualifying independent of the diagnosis. So, this is an important distinction to tease out as we move further.

So what is next?

Overall, the next phase is to set things in motion for an overall rules change. This will be a several-pronged approach, part of which will be letter writing to the FAA by me, letter writing to my state Congressmen (and any of yours out there if you are interested in getting involved) drafting of a bill or bills to submit to Congress for an overall rules change, and submission here on the website of the various research articles I have been compiling in support of our stance.

You will soon be able to view these articles by following the RESEARCH link on the home page. As you will read (if you haven’t already), there continues to be mounting evidence suggesting that treatment of ADHD should be encouraged from the standpoint of safety while driving. This of course supports what I always felt should be done by the NTSB and the FAA.

I have been poised now for quite some time to launch this next phase and am excited to begin its implementation. I would encourage any and all of you to get involved NOW! If you would like to contact your Congressman but are not sure what to write, I will have copies of the letters I will be writing to my state lawmakers. You will be welcome to use them to send to your respective state Congressmen or Representatives.

Ladies and Gentlemen, I want to again extend a big Thank You to everyone for supporting this site, telling your stories, and asking your questions. I can assure you I will now be fighting even harder for all of you now and for those who will come in the future. I view it as my duty to make sure everyone is given a fair shot at realizing their dream to fly, ADHD and all. I do not take this challenge lightly, nor do I believe it is an obstacle I/we cannot overcome. If all of you out there bring a common voice, then I will find, write, and submit the necessary documents and distribute them to their necessary destinations. And please, if any of you have any additional ideas as to how to further advance this cause, please feel free to contact me. I know many of you have extremely creative minds out there!! Lets tap into them.

Thanks again. Now lets get started on the next phase!

Dear Member,

If you are ignorant then so am I and every supporter of this site!! What you are doing is called deductive reasoning! You are obviously able to “see” what many cannot.

To address your question regarding which medications our government has historically given to pilots (and perhaps astronauts), the answer is YES, the medications are essentially the same as those which we use to treat ADD/ADHD. That is, they are all stimulants. In the study I am familiar with, pilots were given a medication called Dexedrine (dextroamphetamine). Ritalin, perhaps the most historically referenced stimulant used in the treatment of ADD/ADHD, is also known as methylphenidate or Concerta. Adderall, for additional comparison, is a “mixed salt” of amphetamine/dextroamphetamine. Basically, they are all structurally similar, work through similar pathways, and have varying half-lives which affects how often the individual should take the particular medication.

It stands to reason that if the government (FAA) had research data strong enough to link this class of medication to an untoward number of accidents, deaths, adverse health events in pilots, etc they would:
1.) Discontinue their use immediately (for they would knowingly be putting pilots and other aviators in harms way, not to mention grossly abusing tax dollars to an even higher degree)
2.) Publish this study or studies and aggressively promote their findings as way to support current policies which forbid their use in general aviation.

The reality is, there isn’t evidence to support their continued dispostion. What they do have are long standing policies written in perverbial stone which are based on false assumptions, PRESUMPTIVE adverse side effects, and not on evidence based medicine. Furthermore, if the side effects of these medications occurred at a statistically significant level and/or had clinically significant outcomes to warrant such rigid policy, the FDA (Food and Drug Administration) would have pulled the medications off the market. Bar none.

When it comes to medication safety, the FDA is the final word in this country. In fact, in 2004 there was a fair amount of press surrounding Canada’s choice to temporarily pull Adderall off their market due to concerns about its role in sudden cardiac death in several children. It was eventually placed back on the market with an updated Black Box warning. Not given much press compared to the initial decision to pull if off the market were two extremely important details:
1.) The FDA here in the U.S. did NOT follow Canada’s lead and pull Adderall off the market. This was because when the data were analyzed in greater detail it was determined that a majority of the children who passed away from sudden cardiac death and were concurrently taking Adderall ALREADY HAD UNDERLYING CARDIAC ABNORMALITIES. This wasn’t known until after autopsies were performed. A few of them were also in extremely stressful environments (i.e. it was extremely hot during the event,) when they passed.
2.) The FDA advisory panel assembled to look into Canada’s decision put out a statement that they did not feel there was enough evidence to recommend to the FDA in the U.S. that Adderall be pulled off the market, in part because there was no specific link (in otherwise healthy individuals), that Adderall had ever directly resulted in death of a patient. In the end, the FDA agreed to leave things as they were but add a Black Box Warning to similar to what Canada uses.

Then, fast forward to my hearing with the NTSB where the FAA “experts” testified that Adderall is simply dangerous and how it has a Big Bad Black Box Warning, how its level in the blood stream changes from moment to moment and therefore cannot be checked or monitored, etc. etc. Conveniently, they chose (or perhaps they truly didn’t dig enough to see) to leave out exactly how the warning came about and to which population of patients the warning most applied. Instead, they attempted to use extremely wide brush strokes and paint any and all of us who took or had taken Adderall or other stimulant medications into their Neanderthal “Adderall=Bad Medicine=Bad Pilot=You No Can Fly” Category. Anyway……sorry to digress.
I have always asserted that I understand the job of the FAA is to protect general aviation. In the event that someone is taking a particular medication and because of the medication are unable to perform airmen duties, then I completely support and understand their stance in this regard. But there needs to be something more than theoretical concern. If the FAA is going to continue to deny medical certificates to airmen who are otherwise perfectly qualified to fly simply based on theoretical outcomes, they need to have some data to back this up.
Look, I’m not advocating that anyone and everyone who has ADD/ADHD and takes Adderall, Ritalin, Concerta,Vyvanse, or any other stimulant should automatically qualify for a medical certificate, nor should they automatically not qualify. For comparisons sake, there are cases in which individuals have diabetes (non-insulin dependent) and are able to fly after proving stability of their condition. Does this mean these individuals are automatically guaranteed to never have another episode of low blood sugar while flying? Of course it doesn’t. Or, consider the airmen who the FAA has granted medical certificates to who were taking narcotics to help control back pain. Which is more likely to affect an individuals ability to pilot an aircraft; a medication that is chemically similar to coffee or one that is often sedating can result in cognitive slowing? I wonder if the Air Force allows pilots to fly who are diabetic or who are taking narcotics? Or, consider the airman who was recently granted his medical after undergoing a heart transplant, (which by the way I felt was the right thing to do and is an amazing story)? When you consider a condition in which the airman will be required to take anti-rejection medications for the rest of his life and has a baseline increased risk of developing blood clots compared to before he underwent the transplant, how does the FAA justify that he would be of no increase risk to himself or general aviation yet I would be?
The answer certainly isn’t based on objective results, or at least not in my individual case. In the eyes of the FAA, I (and through extention,all of you) pose increased risk to general aviation because we have a condition which falls under the “mental” category. That’s it! Nothing more! Nothing to substantiate the position other than a general, unjustified aversion to a particular class of medication and diagnosis. It’s acceptable to have high blood pressure which is adequately treated with medication and still be able to fly, but it’s not acceptable to have ADD/ADHD treated effectively with medication and still be able to fly. Is it not possible to envision a scenario where an individual who normally has mildly elevated blood pressure treated with medication could somehow wake up some morning and for whatever reason have a normal blood pressure and not be aware of it? I don’t think this is unimaginable whatsoever. Now imagine this same individual on the way to his favorite airport that morning as he taking his medication en route just as he has so many times before.
Finally, try to imagine (I know, this is an outlandish scenario) the outside chance that by virtue of him taking his normal medication when his blood pressure was unbeknownst to him already borderline low (perhaps he took Levitra or Viagra the previous evening) that he could end up in a situation once airborne where taking the medication tips the balance and drops his blood pressure to the point he becomes incapacitated and unable to fly.
I can tell you from my experience working in the Emergency Room that there are significantly more situations where mental status changes due to low blood pressure has brought someone to the hospital than there are instances where individuals taking Adderall have come in after suffering a heart attack or arrythmia because of it. To be honest, I don’t suspect my low blood pressure scenario has occurred with much frequency, if at all, in aviation recently. I do, however stand firmly by the proposition that this scenario is highly more likely than the Adderall scenario. The FAA is missing the point I’m trying to make here which surrounds the concept of basing decisions and policies on each individual objectively and not on speculation or false expectation. That’s all I’ve advocated for since the beginning, knowing that some people with ADD/ADHD wouldn’t qualify either on medication or off. Similarly, not every individual with diabetes or high blood pressure would necessary take the steps and responsibility to be sure their condition was adequately treated, but most would.
I will be writing about the above examples in greater detail as soon as I hear the final disposition on my case (as of yesterday I was informed my file is complete and in the final phase awaiting disposition). Soon visitors will actually be able to follow links and subsequent discussions in the “Additional Research” tab for the first time since this site was established! Oh Happy Day!

Kookie, how old is your son? Depending on his age I might suggest different books to read more about ADD/ADHD. In my opinion,I still feel two of the best books to read are “Driven to Distraction” then “Delivered From Distraction", both of which are co-authored by Jerry Hallowell and John Ratey.
I think you will find, over time, the condition your son has been gifted with here has no business containing the word “deficit” in it. Due to his “disorder” he will likely have the energy, creativeness, tenacity, and directness which will leave many others behind in his wake, regardless of what he chooses do. He will likely be “deficient", but only on a meter that could somehow measure different levels of boredom. For all the “deficits” that this “disorder” will shackle him with, he will likely think more quickly and see things more quickly than most of his peers. My guess is he’ll really like sports in some facet. If he is like many of us with ADD/ADHD, for some odd reason he might really like swimming as a sport. (refer back to comment about having high energy levels.) If he truly has ADD/ADHD and the choice is to use a stimulant medication to treat it, and if is works as it should, then he will hopefully be better able to harness everything I’ve touched on above and realize his inborn gifts to their fullest extent. Rather than being pegged as “that kid who has ADD", I think the next generation of kids, diagnosed and treated appropriately, will more often the envy of other kids because of their unique abilities and not labeled in a way they were previously.

To summarize: I realize I am a bit biased when it comes to advocating for these changes . I understand that but I try to remain objective. However, I feel I have a very unique “view” of this condition from the perspective of someone who went undiagnosed and untreated for the first 27 years of my life. I consider myself extremely fortunate I learned I had ADD when I did and to the physician who listened to my extremely long story and helped confirm my diagnosis and adjust my treatment. It forever changed my life. Now I feel as though it is my duty to children like your son and all others who come after me to not only offer support and to advance our understanding of ADD/ADHD, but also to take the lead as it relates to the FAA in order to effect policy change so that one day we no longer have to choose between adequate treatments which helps harness this gift (I mean “disorder") and whether or not we can legally be pilots.

ADD/ADHD and the desire to fly I feel will forever be linked. Where you’ve got one I guarantee you’ll find a high incidence of the other. I don’t think all of you who visit this site and sign up as members merely carry a diagnosis of ADD/ADHD but don’t fly or want to fly. I also don’t believe you are all just pilots who for some reason stumbled upon some niche ADD/ADHD site and signed up but have no interest in ADD/ADHD.
Of course the reality is that most of you are both pilots and have ADD or ADHD, and are no doubt excellent pilots. I would bet most of you are very “Driven” individuals as I have had the opportunity to e-mail or talk with several of you who certainly are.
Some of you have made the decision to either avoid diagnosis so that you can continue to fly legally in the eyes of the FAA. Some of you undoubtedly falsified your medical because, I believe, your love to fly outweighed the chance you would be caught. Some of you are somewhere in the middle between suspecting you have ADD/ADHD and feel you would likely benefit from treatment but perhaps reluctant about what steps you should take and what level or risk you are comfortable with as it pertains to the FAA. For what it’s worth (though probably nothing , if you’ve passed your check ride with a certified flight instructor at whatever level, I’d be happy to fly with any and all of you.

The lingering question remains, “Will the FAA catch up to this reality or will they continue to foster an environment that, in the face of absolutely no evidence to support current policy, encourages individuals to either avoid disclosing the diagnosis, actively avoiding a diagnosis altogether, or perhaps discontinuing a necessary medication simply so they fit into some arbitrary category in the minds eye of the FAA which then somehow renders them safe to become or continue to be a pilot?” My burning desire and ultimate goal of this endeavor continues to be one thing and one thing only, and that is policy change that evaluates individuals on their skill and merit as a pilot in an objective, consistent, and fair way.

Thanks again to everyone for posting. As always, together WE WILL PREVAIL!!
I am officially taking design ideas for the 1st Annual ADHD Pilots booth design to be put on display at Osh Kosh! Any takers?

In the meantime, for those of you who read this blog but have not been to my main webpage, the address is www.adhdpilots.org.It’s more up to date with what has been going on with ADD/ADHD recently I will be posting to the site with my proposed next step of action in this matter. In my opinion, we are at a critical point in this process simply because I sense that there is enough awareness out there now that many more future pilots with ADD/ADHD are essentially being “forced” to go the way of non-disclosure on their medical applications and a result of what has happened with my case. It is extremely frustrating to know I was honest throughout the whole process, only to be denied my medical based on taking a medication that has not been proven to have any causal link in adverse aviation outcomes. Furthermore, the FAA has admitted they do not have a system in place that can adequately check whether or not pilots are falsifying their medicals so that they may continue to fly. It appears to me that as it pertains to ADD/ADHD and the overwhelming evidence in support of stimulant therapy as well as nothing more than theoretical adverse events, the FAA has essentially taken what I like to call the “ostrich” approach. That is, they think if they simply put their head in the sand that the issue no longer exists and isn’t becoming worse. If my website is even a microcosom of what is taking place around the country, then I think it is obvious that the FAA is going to have a much larger issue to deal with here. My hope is that they will look at the data objectively and stop assuming that persons with ADD/ADHD in some way universally lack the skillset required to become or continue to be pilots.
Thanks again for subscribing. I’ll be in touch through here or the website.

Tyghe Nielsen, MD

One of my first orders of business with this site is to determine if there is anyone out there who has either had experience or knows someone who has had direct experience with obtaining a 1st, 2nd, or 3rd class medical certificate while being treated with medication for ADHD/ADD. If there are individual cases where exceptions have been made based on a case by case basis,I think this would definetely help the overall cause. If there are not existent cases, I hope to forge the way toward becoming the first.
It it my hope that not only will there be individual exceptions considered based on individual histories, it is belief that the FAA will eventually amend the current regulations in light of recent evidence. Recent evidence suggests that persons with ADHD/ADD who are adequately treated do not pose increased risk to themselves or others as it relates to driving accidents. These people are, in most instances, safer individuals when they take their prescribed medications. My vision, as it relates to aviation, stems from the concept that as a direct result of the current regulations there are licensed pilots out who either don’t seek appropriate treatment for fear of losing their medical certificate, or they simply do not disclose they are taking any medication. If this is true,as I suspect it is, I feel the current system encourages non-disclosure of information which by itself poses an increased risk to aviation safety. In a system where honesty and self-disclosure is paramount, the current system is heavily flawed. It would seem as though the current system of obtaining a pilot medical certificate actually creates more potential risk by promoting non-disclosure of medical information than it would if those treated with medications were encouraged to be honest. It is my stance that those who have benefitted from treatment, with the appropriate medical documentation and monitoring, should be able to seek appropriate treatment without fear of losing their medical certificate.
In a future blog I intend to outline additional reasons why I feel the current system is not only flawed, but to an certain extent is discriminatory against people who are able to prove that not only are they competent pilots but that they pose no more risk than the general population of pilots to the aviation community. I would like to extend my thanks to everyone who posts here at this site!