This past weekend I logged 1.4 hours of Pilot In Command time. This isn’t new — I’ve got over 300 hours under my belt — but for the last six months, there’s been some significant doubt about whether I would ever be able to fly again thanks to a 20 year old ADHD diagnosis that was holding up my medical. I didn’t have a clear guide to what would happen or how to navigate this process, so I wanted to write up my experience to help others who might be going through a similar ordeal.
Why ADHD Is An Issue
Pilots need to be attentive and alert, constantly scanning instrument panels and looking out the window for traffic. All of these are repetitive tasks that someone with ADHD might not be able to adequately perform, especially when piloting a commercial aircraft. From the FAA’s website, this is their statement on that situation:
Attention-Deficit/Hyperactivity Disorder (ADHD), formerly called Attention Deficit Disorder (ADD), and medications used for treatment may result in cognitive deficits that would make an airman unsafe to perform pilot duties.
The key difference between this and other disorders is that with ADHD, there are no medications approved by the FAA for use as a treatment. From the AOPA:
Some of the medications that individuals take for ADHD are Adderall, Concerta, Ritalin, Strattera, Vyvanse, and Dexedrine. Take note: These medications are either amphetamine-based or methylphenidate-based stimulants. The FAA does not accept the use of any of these medications.
So for those with this disorder, there doesn’t seem to be a path to the left seat. The disorder itself is disqualifying, and the medication used to treat it isn’t permissible. The only way out is to prove that you don’t actually have ADHD.
Like many 90’s kids, I was consuming too much sugar / caffeine (on top of just being a normal, energetic kid) and my parents thought that I had Attention Deficit Disorder — as it was known at the time. They brought me to a specialist while I was in elementary school, who diagnosed me and prescribed a low dose of Ritalin which I continued to take on a daily basis until sometime in middle school.
That was nearly 20 years ago. Maintaining a healthier lifestyle, I have since then completed high school, college, and have a decently successful career in tech. I have never felt the need to go back on that medication and promptly forgot about it.
A Quick Trip to the Doctor
I was issued a first class medical certificate in 2014 without any issues. ADHD isn’t something that’s asked on the 8500-8 form (application for a medical certificate) — it only asks about medication currently being used, and in the history section it broadly asks about neurological issues. It didn’t even occur to me to include my childhood diagnosis, and the doctor didn’t ask many questions, and certainly not any pointed ones. He rubber stamped my application after a quick pee in a cup.
When I went back in April of this year to renew my first class medical, this time the doctor asked the right question. “Have you ever been on any long term medication?” It triggered a memory of being on Ritalin for ADD and I told him about it.
What I appreciate is that my AME was calm, cool, and collected. He let me know about next steps and gave me a vague idea of what’s about to happen. He told me he couldn’t issue a medical certificate that day and instead needed to send a letter to the FAA to follow up. In the meantime, I could still fly under my current medical certificate since this wasn’t an outright denial — but he could not directly issue me my medical certificate. That would have to come from the FAA directly at this point.
Step 1: Medical Records
The one thing that the AME told me to do immediately, which was super helpful, was to start tracking down my old medical records. He said that would be the first thing the FAA would ask for and it might take some time to collect.
The logic is pretty straightforward. They’re looking to verify that the ADHD diagnosis was made and that medication was issued. Maybe I mis-remembered something and it was a different disorder, but the medical records would be clear.
In my case, this was easier said than done. According to HIPAA requirements medical records only need to be maintained for about five years following the end of treatment, and most shops would rather purge those records than have them sitting around waiting for a data breach or theft. I was, understandably, concerned since my treatment was nearly 20 years ago, but thankfully my pediatrician at the time had kept the records and was able to send me a copy.
The records they had were treatment reports from a specialist to whom they had referred me, only containing a brief narrative of what was going on and prescriptions that were issued. This was enough to confirm the diagnosis, but not enough to confirm that I no longer needed the medication.
I tried to get a copy of the full medical records from that specialist, but in the intervening 20 years (A) they had retired, (B) their office had dissolved, and (C) the facility they were treating me at had closed. So that wasn’t happening.
I gathered all of this information proactively, knowing thanks to the AME’s advice. Six weeks after he submitted his letter to the FAA, a note finally arrived in my mailbox asking for, and I quote:
- A personal statement detailing your ADHD history and medication use.
- Al treatment records and evaluation from the physician(s)who prescribed the ADHD medications in the past.
I get the feeling that if I were able to produce some documentation from the treating physicians to the effect that I no longer suffered from ADHD, the rest of this may have gone much quicker. But unfortunately I didn’t have anything even close. I just had a note that at some point we discontinued the medication, not that I no longer had ADHD.
Step 2a: Neuropsychological Exam Prep
The FAA sent their request for my medical records on May 8th. They processed my request on June 10th. On July 11th, they sent the next request, which was exactly what I had hoped to avoid:
In order to issue my medical certificate, they requested that I be evaluated by a forensic neuropsychologist to determine if I still had ADHD. The request came in a single sentence from the FAA, but there were a lot of sub-requirements that really only became clear when you read further into the documentation.
Oh, and they gave me 60 days to complete all of the necessary steps and submit the results in a single mailing.
Before even attempting the exam, you need to gather all the necessary documentation so the neuropsychologist can make a thorough assessment of your situation. The FAA published a PDF talking airmen through what documentation is needed prior to the exam, and it includes:
- All medical records pertaining to the ADHD diagnosis
- Academic records, including transcripts, from school if diagnosed as a child including IEPs and academic awards from time both on and off the medication
- A copy of your driving record from every state in which you lived for the last 10 years
- All previous psychological reports (if any)
- Any reports from psychological hospitalizations
- A complete copy of your FAA medical records
As it turns out the items I thought were easiest actually took the longest to get back.
The treatment records were already provided in the first submission so I made another copy and held onto them.
I started with the FAA medical records, as the PDF from the FAA includes a handy reference to where to find that. I filled in the form and sent it back, arriving and being acknowledged by the FAA on July 31st.
Those records would eventually arrive… on September 30th. For those keeping count at home, that’s well more than 60 days. In fact, that’s 81 days from start to finish just to get those records. So, just to recap: the FAA gives you 60 days to fulfill their request, but the only documentation aspect that they are directly responsible for providing you (to then provide back to them)… takes 80+ days for them to fulfill. And the neuropsychologist was unable to finish their report before they had those records, so that’s another two weeks before I could even submit anything back to the FAA.
All in all I had to ask for three extensions to ensure they didn’t send the enforcement arm of the FAA on my tail.
Academic records was next on the list and was about as problematic as the medical records. This was something that I went through between elementary school and middle school, and while I absolutely got report cards in the mail there’s no way my parents saved them longer than a few days. Those were lost to the ages. I was able to pull a copy of my transcript from Penn State though, which I hoped would give me partial credit.
The only thing left that I could actually provide was my driving record from each state for the last 10 years. Which was a bit tough — I’ve lived in four states in that time period. There is no centralized driving record database, so I needed to individually go to each state, submit a request for my records, pay a fee, and wait for the results to come in the mail. Surprisingly this was fairly quick considering the bad reputation for the DMV. Certainly, better than the FAA — but that’s a pretty low bar.
Records in hand, I trundled off to the forensic neuropsychologist for my assessment.
Step 2b: Forensic Neuropsychologist Exam
What I found interesting about my trip to the neuropsychologist was that apparently I was a bit of a rare treat. Their job is to act in an official capacity to perform an assessment and render an opinion on my mental capacity, which is normally something that happens for people who want to do things like claim an “insanity defense” for their murder trial. Not really a pleasant conversation to have. Which apparently made spending a day chatting with me a welcome departure from their normal clientele.
The very first thing I did when I got there was pee in a cup. The test was to screen out any ADHD medication I might be taking, which would show up in my urine up to a month after I stopped taking it.
Urine test completed, I spent a little time chatting with the psychologist, giving my family history and talking about why I was now sitting in his office. It was very informal and only took a few minutes.
The remainder of the day was for the testing. To be as impartial as possible, the FAA seems to favor objective tests with measurable results over subjective assessments, and every single test over the next few hours was designed to be as boring as possible.
Here’s each test that was performed and what it entailed.
Administered on a computer, this series of tests is about the cognitive abilities of the test taker and specifically for those in the aviation environment. Tests include:
- Backward Digit Span (BDS): Recall of a sequence of visually presented digits in reverse order.
- Math: Traditional math word problems with multiple choice answer format.
- Visual Sequence Comparison (VSC): Comparison of two simultaneously presented series of letters and numbers.
- Symbol Digit Coding (SDC): Substitution of digits for symbols using a key, followed by immediate and delayed recall of symbol-digit pairs.
- Matching to Sample (MTS): Immediate recognition for a checkerboard pattern.
- Manikin (MAN): Mental rotation task requiring respondent to identify the hand in which a rotated human figure is holding a flag.
- Divided Attention (DAT): Task employs a visual monitoring task, which is presented alone and in combination with the Visual Sequence Comparison task.
- Auditory Sequence Comparison (ASC): Comparison of two series of tone patterns.
- Pathfinder (PF): Visual sequencing and scanning task that requires respondents to sequence numbers, letters, and an alternating set of numbers and letters.
- Shifting Attention (SAT): Rule-acquisition and rule-application test requiring mental flexibility and conceptual reasoning.
- Dual Task (DTT): Consists of two tasks, each of which is performed alone and then together as a simultaneous test. One task is a visual-motor tracking test. The second task is a continuous memory task involving serial digit recall.
This was probably the test I was most concerned about, but in reality wasn’t that bad. The hardest sub-task was the Dual Task, which was simultaneously trying to keep an artificial horizon level and recalling some numbers.
This is a verbal fluency test. The proctor will give you a prompt of a letter and ask you to name a category of items which start with that letter. For example, food starting with “P” might include pizza, pineapple, poppy seed bagels, etc. You then are asked to name as many as you can think of in a set time period.
CPT / TOVA
The Continuous Performance Test is about whether you can correctly press a button when a “stimulus” is shown on a computer screen and ignore it in other situations. In my version, the computer would display a series of letters and I needed to press the button when the displayed letter was an X. It would appear randomly, at varying speed, and often multiple times in a row. This would continue for some time.
The Minnesota Multiphasic Personality Inventory is a series of a few hundred statements for the test taker to mark as “true” or “false” on the paper. Things that stood out in my mind are statements like “I enjoy hunting” and “my father was a good man”. These are then cross referenced to produce a personality report.
This test is designed to assess how well you can process auditory inputs. A proctor puts on a pre-recorded tape where a person reads off a string of numbers. The goal is to add each subsequent number to the previous one and respond with the sum. Here’s an example of how that would work:
Recorded Person: 2
Subject Response: 6
As you might have figured out, the hard part is remembering the previous number and adding it to the one the recorded person just said before they say the next number. You want to remember the number that just came out of your mouth but you need to immediately forget it instead.
As the test goes on the numbers come faster and faster, and this process goes on for a good 30ish minutes.
Trail Marking Test
The test taker is presented with a sheet of paper with letters or numbers arranged on a page. They are asked to start from one of those numbers and draw a continuous line through the correct series of letters or numbers. They might be all numbers, they might have alternating patters, any number of challenges. The test taker is asked to perform this task as quickly as possible. The challenge is finding the next item in the series.
The Wide Range Achievement Test asks the test taker to read and understand word problems within a specific time frame, perform the calculation and respond with the correct answer.
Conners Adult ADHD Rating Scale
Probably the most straightforward of the questionnaires, this one asks some very obvious questions about whether you have the symptoms of ADHD.
Once all of the tests were completed they packaged up the results and sent them directly to the FAA. I never got a copy.
Potential Step 3: Demonstrated Proficiency
I never got this far. As you’ll see in a second things worked out for me, but if they hadn’t I would have needed to prove to the FAA that I was capable of performing the tasks of a pilot. Basically I would have needed to go take a flight with a medical examiner in the back seat and a flight instructor at the controls and prove that I could perform all of the tasks. This would have killed any chance I had for a 1st class medical, but at least I would be able to fly.
Step 4: Receive Medical Certificate
On November 15th, about 7 months after my AME first flagged my case, I finally got my new medical certificate in the mail. Attached was a caution from the FAA to be aware of my past history with ADHD and be cautious if any of those symptoms started appearing, but in the envelope was an unrestricted 1st class medical.
What I want to point out most of all is that while this process was long and tedious and cost a significant chunk of cash (probably around $5,000 all told) the people at the FAA were surprisingly polite and helpful. The handful of times I called in to talk about a question I had or check on the status of some paperwork they were super nice and helpful, even going out of their way to help me get an extension on the deadlines.
Moving forward, every time I go for a medical certificate I now need to notify them that I have a previous ADHD diagnosis. But I can say that the FAA has already gone through their process and it’s a known non-issue, providing the reference number from the documentation they provided as proof.
So were you able to fly as PIC under your old medical while you went through this whole process, or did the FAA reach out to suspend your older medical?
I could fly under the old medical until it expired, according to the AME. The new one wasn’t denied, it was deferred, which is a crucial distinction.
Thats good. Did you get a hard time about the fact you hadn’t disclosed ADHD on your first medical? Or were they cool given it was an honest mistake based on poor wording in the mexexpress form
I actually didn’t get any pushback from that aspect that I could detect. They seemed to take my word that it was an honest mistake. Like I mentioned the folks at the FAA seemed to be some of the nicest government employees I’ve dealt with – much nicer than the ATF.
I am currently going through the same thing with the FAA right now. I just took the neuropsych exam last week for the second time. I was informed that overall I did really, really well (I didn’t do well the first time). My AME and I will be submitting my packet soon. Do you have a special issuance? or is your 1st class a regular certificate with no special requirements for renewal? Thanks! Congratulations.
Regular first class medical. The only thing I got that’s different is the FAA sent a letter cautioning me to keep an eye on any potential deterioration of mental condition, but that’s it!
what did you do to help increase your second time taking the test
Awesome post. Thank you so much for providing that insight. I am currently in the process of setting an appointment for the psych eval. Little nervous, but confident that I will do well. Where did you have your evaluation done? I live in Dallas and I’m struggling to find a place that has history with the FAA and that can get me in soon.
Winston, did you receive any feedback on why you did poorly the first time? Any tips/recommendations for when I go in to take it?
All insight is much appreciated!
Wonderful synopsis, Nick, and THANK YOU for writing it! I’m a corporate pilot / ATP and I’m walking my son through the same steps you described above. I struggle with the fact that my wife and I did what we thought was best for our son when he was younger to get him tested and treated for ADHD. I somehow knew this was going to be a hurdle that we’d have to negotiate at some point, and that point is here! So, we’ve started his primary training in the hopes that, after jumping through the necessary hoops, he will eventually end up with a medical. And that’s exactly what your narrative does…it gives us hope!
Mike – thank you for sharing your story. Wondering if you have any advice a year later? My son was hitting puberty when the pandemic started: on line school (read utube), fighting with siblings, my telecommuting husband was frustrated in the basement… you get the picture. I gave up and with great intentions in mind contacted child’s phycologist. Based on very bios and negative reviews (from frustrated parents and teachers) he got the label of adhd. He tried the medication for 1.5 months (adderol), but we did not notice any change and the teen was very against taking it. Now hormones calmed down and things are so much better, he is almost a different person, but the label is stuck. He is now doing great at school, his cap leaders are praising him and growing him to be the next cadet commander in a few months. I feel extremely guilty as a parent for giving up too early and not researching ADHD/flying topic. Do you have any suggestions on further steps: could we request a child psychologist to reverse/remove a medical diagnosis of ADHD? Would it even matter for the FAA medical exam? Is it better to see an AME who is a HIMS at the same time? If neuropsychogical evaluation is a must, how could we get it covered under the insurance? Thank you to all for any feedback and advice.
Hey Erin! My son was 16 when we went through the process. I believe it takes age under consideration, but I can’t say for sure. The testing that the FAA usually mandates through a HIMS Neuropsychologist in called the CogScreen AE (Aeromedical Edition). Here is a link to CogScreen’s website that discusses the subtests used: https://cogscreen.com/Overview.aspx. They’re essentially “brain games” that analyze ability to focus, divide attention, remember patterns, etc. Some people subscribe to a service called Lumosity to prepare for the tests and get a feel for the types of questions asked. But we did not do this. From what I understand, you can’t really “study” for them. But games like that may help with the familiarity. Dr. Jacob Lutz is with Fort Wayne Neuropsychology and is an FAA-approved HIMS Neuropsychologist. We chose to make the trip to see him and he was fantastic (spent the previous night in a local hotel since we got started early the next morning). But that was our experience and I’m sure there are other worthy doctors out there. Here is a link to FAA HIMS doctors: https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/AeromedicalNeuropsychologistList.pdf. Schedule an FAA Med Exam with your chosen AME and explain the situation. They can help with any questions you have filling out the MedXPress application. The FAA will then likely require the testing prior to issuing the medical (it may take some time to hear back). Then you can go see the neuropsychologist, if required. Hopefully the testing goes well and your son will be issued his medical.
Warren Dunes is awesome! Climbing that sand kicks my butt! If you wanna have some real fun, head up the lakeshore an hour north and take a ride with Saugatuck Dune Rides! Drivers are awesome and it’s a real kick! Good luck and let me know if you have any other questions!
Wow – quite the struggle. Glad it turned out well. My son had his 1st Medical almost 2 years ago (he’s 17). This was deferred and now, after 2 years off medication and finally having the financial resources to go ahead with the testing, I’m not sure if I should start a new application or resume where the old one left off. Does anyone have any guidance? I’m in S. Florida and would be grateful for any contacts who might be able to assist.
This is a good read, my friend is going through this right now.
My son (17) is going through this now. He had ADHD meds as a young kid and hasn’t been on them for 4 years (all of high school). Good student, leader in his activities, perfect driving record, never has been in trouble. He had the initial battery of the pysch exam yesterday and they found 3 potential concerns. So he needs to return to have the “supplemental battery” in a few weeks. He said he had trouble with adding numbers quickly in one of the tests – he’s never been great at that. Is there still hope? We’re just so very worried for him.
My son, also 17, was in the same spot last year. He didn’t do so well on the initial battery, so he had to go through the supplemental battery. Luckily, the doctor in Fort Wayne that we saw planned for this situation and we were able to knock them both out in the same day (followed by a quick urine test to ensure there were no ADHD meds in his system). Got his FAA First Class medical about 3 months later and we’re in the home stretch of finishing up his Private Pilot training. There is most certainly hope! Good Luck! As an aside, I’m not sure a normal functioning adult could perform those tests correctly!
Did he end up passing the supplemental battery?
I cannot tell you how much I appreciate this post. Was ‘diagnosed’ with ADHD by my family practitioner after answering questions off a questionnaire that he had. I’ve taken medications off an on in the 7 years since then but have been off for about a year and cannot tell a difference. I do bring it up with my current family doctor every time we have an appointment and she agrees that I am in a good place.
Long/short; went in for my exam a couple months ago and got my letter today asking for the personal statement, statement and records from my doctor, and statement from my instructor. Not really worried about any of them, but slightly worried about the personal statement. I’ve searched online for examples and I am not seeing anything. Did you find an example to work off of, at least for formatting and what to include?
This is such a BS rule. If a drivers license is adequate for getting a sport pilots certificate why isn’t it adequate to get a PPL?? It’s virtually the same exam and same skills required for both certificates, one just requires less airtime than the other. Furthermore, if you do have ADD and the meds are adequately treating it then there’s zero reason it should prevent somebody from getting a medical. It’s extremely ironic that the military hands out Dexedrine to their pilots (who don’t even have ADD) to keep them sharp and alert during long mission but somehow in the FAA’s infinite wisdom the same med is a disqualifier for a medical. I know two different physicians that have been diagnosed with ADD as young adults and have taken medication for years to treat it and they had no trouble getting a license to practice medicine. In fact, they’re both ER docs, they’re required to think on their feet, process a lot of information, and make quick decisions to save lives. But yeah, the clowns at the FAA consider the meds as a disqualification. Utterly stupid.
can they determine weather or not you have ADHD during the examination only if you disclose this information to them and the medications you are taking. Or are their certain documents you need to bring with you.
Looking for an example of their personal statement for assistance with formatting. Want to use something that was associated with a success story obviously.
I’m in the middle of this very thing. I took my neuropsychological in Houston on April 12th. It took the FAA weeks to get my medical records (although I’m not sure what they had since i never got a medical certificate to begin with back in 2013 when i started this process) but they sent it to the Dr last week, finally and i got a letter form them after my physical with a HIMS AME in Killeen. I’m kind of confused by the letter i got thought because it said nothing about a cogscreen or a sleep study as the original denial letter did in 2013. It just asked for a personal statement on ADD and information from my doctor about the ADHD diagnosis (i was just prescribed medication after I complained of having issues at a job I hated) and for information on what was a generalized anxiety disorder diagnosis from when i was going through some stuff back in 2008 but other than that they weren’t asking for anything they were asking for in the letter from 2013 and my PI# hasn’t changed so it’s not like they don’t have the old info from 2013. It’s like the HIMS AME performed some sort of magic trick and cleared the other stuff up although i won’t feel good about it until i get my medical certificate (i’m only trying for 3rd class PPL) The testing i had was exactly what you described above. I wonder if we didn’t see the same neuropsychologist down south of Houston near NASA.
Thank you for this post. This gives me hope for my son who is interested in aviation but was diagnosed with adhd.
Thank you for this excellent post. My son is going through this as well and we are just beginning the process. Does anyone have any insights as to what the “Personal statement detailing your ADHD history and medication use,” should contain? Is this supposed to be just the history of diagnosis and years meds were taken (with dosages etc), or should it be more about his experiences with the diagnosis and meds, how he was diagnosed, and key in on misdiagnosis/outgrowing the diagnosis?