Pharmacotherapeutic undertreatment of ADHD in elite-level cycling and anti-doping regulations: Preliminary analysis from 2020–2021

Liebrenz, Michael; Smith, Alexander; Buadze, Anna (2022). Pharmacotherapeutic undertreatment of ADHD in elite-level cycling and anti-doping regulations: Preliminary analysis from 2020–2021. Sports Psychiatry, 1(4), pp. 137-143. Hogrefe 10.1024/2674-0052/a000028

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Attention Deficit/Hyperactivity Disorder (ADHD) in elite-level cycling is an overlooked area of clinical enquiry. Whilst former riders have raised awareness about ADHD, there is scant evidence about pharmacotherapeutic treatment levels of this disorder. This is a pertinent concern amidst contemporaneous anti-doping contexts, as common medicines for ADHD are prohibited during active competition by the World Anti-Doping Agency and thus require a Therapeutic Use Exemption (TUE). Methods: We conducted a preliminary investigation into pharmacotherapeutic treatment rates of ADHD in elite-level riders. We gathered secondary, publicly-available data about cyclists in the Registered Testing Pool (RTP) from the professional body, the Union Cycliste International (UCI), in 2020 and 2021. We then compared this with the total TUEs for prohibited medications granted on behalf of the UCI during this timeframe. Results: 1,265 elite-level riders were included in the RTP sample in 2020, as compared to 10 TUEs. 1,234 elite-level riders were included in the 2021 RTP sample, as compared to 10 TUEs. Discussion: Based on these data, we estimate that ADHD may be undertreated in this cohort of elite-level cyclists per general trends. We highlight the adverse mental health effects of medicinal undertreatment for ADHD and its implications for the sport. We also hypothesise potential reasons for this, including stigmatisation, negative conceptions of doping allegations, and possible medicolegal consequences. Conclusion: ADHD in elite-level cycling has received little coverage, especially in relation to treatment rates. Detailed research examining this issue and awareness campaigns are required to protect the mental health of elite-level riders.

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