Developed in collaboration with CASA Medical.
Attention Deficit Hyperactivity Disorder (ADHD) is a diagnosis based on the way a person thinks and behaves. It is a neurodevelopmental condition that has features of developmentally inappropriate levels of inattention, impulsivity, and hyperactivity. The diagnosis is made based on a comprehensive and detailed assessment including clinical and neuropsychological assessments along with a person’s developmental, educational and occupational history. Aviation medical certification will rely on these reports combined with aeromedical and operational risk assessment to decide whether there is any impact on aviation safety.
The impact of ADHD can vary from minimal to profound and may vary based on the environment in which the person is living and working. Most people with ADHD are able to function within their social, working and home environment using cognitive and behavioural strategies. Safe aviation operations for certain people with ADHD can be achieved provided the challenges are identified and managed, and people can thrive in the aviation industry when it is inclusive for neurodiversity.
| ADHD: Strengths | ADHD: Challenges |
|---|---|
| Creativity | Difficulty focusing |
| Energy | Impulsive behaviour |
| Intuition | Disorganisation |
| Quick comprehension | Forgetfulness |
| Positive risk taking | Oversharing |
| Empathy | Negative risk taking |
| Ability to hyperfocus | Mood instability |
Medication can be helpful for some people with ADHD to function effectively and safely in their aviation roles. When ADHD is well managed with medication, the person has overall better mental and physical health, reduced rates of substance use, lower rates of anxiety and depression. When taken effectively, ADHD medications are beneficial in the following ways:
| Domain | Untreated ADHD | Treated ADHD |
|---|---|---|
| Attention | Distractible, poor focus | Improved focus, better task completion |
| Impulsivity | Risky decisions, poor judgement | More deliberate actions, better risk assessment |
| Organisation | Disorganised, forgetful | Structure routines, improved memory |
| Safety risk | Elevated | Reduced with effective management |
CAA NZ Av Med may approve the use of medications to treat ADHD for holders of Class 2 and Class 3 medical certificates in certain circumstances. These decisions are reserved for CAA NZ AvMed (cannot be made by AMEs). Use of ADHD medications is safety-relevant for aviation operations both directly and due to associated medication risks (such as cardiovascular and mental health complications).
If a non-stimulant medication is approved, it must be used continuously to be able perform aviation duties and managed under the supervision of a consultant psychiatrist.
If a stimulant medication is approved, it must be used as directed for aviation duties and managed under the care of a consultant psychiatrist. Specifically, stimulants must be at consistent therapeutic levels while undertaking aviation duties. Refer to the table below for guidance and if any doubt exists, contact CAA NZ for advice.
| Drug | Therapeutic window | Duty limit post dose |
|---|---|---|
| Methylphenidate Sustained release | 1 hr to 6 hours | 2 hours to 5 hours |
| “Ritalin LA” | 1 hour to 8 hours | 2 hours to 7 hours |
| “Concerta” oros system | 1 hour to 12 hours | 2 hours to 11 hours |
| Lisdexamphetamine | 1 hour to 13 hours | 2 hours to 12 hours |
When planning aviation operations using these therapeutic windows, due consideration should be given to matters such as fatigue management and operational contingency planning (such as delays and diversions). This is important for safety, even where there is no workplace or regulatory requirement.
For more information, see Medical Manual: ADHD.
