Ritalin, ADHD, and Major League Baseball

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Spring Training has started for professional baseball, and college baseball teams have been at work since January. It is time to get in shape for the 2008 baseball season.

I love baseball - always have. I was an "All Conference" pitcher and Captain of my college baseball team. I coached at a University for four years and have coached at the High School level for four more. I was a "bird-dog" scout for the Cleveland Indians and the Texas Rangers for a few years, and I have coached Little League teams forever. My nephew is a pitcher in the Minnesota Twins organization, and a legitimate prospect. Really, I love baseball.

But there is a strange and perhaps disappointing story about ADHD and MLB that has come out since the release of the Mitchell Report.

It seems that in 2006 there were 28 major league players who had diagnoses for ADHD, and were receiving treatment with stimulant medication during the season. They were permitted to receive such treatment with stimulants through MLB's "Therapeutic Use Exemption" program. Now, there is no story here - at least not yet. There was no story until MLB placed the use of amphetamines on their "banned substances" list. Then things changed.

In 2007 the number of TUEs requested by major league players jumped from 28 to 103 for Attention Deficit Hyperactivity Disorder. This increase was so startling that even some sleeping Congressmen woke up and decided to make it an issue for the media as a part of the House Oversight and Government Reform Committee hearings on the abuse of performance enhancing drugs in Major League Baseball.

Other "experts" jumped into the media conversation as well. “This demands an explanation. There’s something fundamentally wrong them going from 28 to 103,” said Dr. Gary Wadler, chairman of committee that determines the World Anti-Doping Agency’s banned-substances list. “If we had this percentage increase in the general population, it would be on the evening news as a national epidemic. It’s an outrageous number.” Wadler said the ban on amphetamines in 2006 appears to be tied to the increase. No kidding. “I can’t prove anything. Certainly you put all the facts together, I think that’s a reasonable explanation,” he said. “Might there be others? I guess so. It could be an anomaly year of some sort.”

Even ADHD guru Russell Barkley, a well-known ADHD expert, was interviewed on the topic. He said that while children with ADHD are often drawn to sports, which could explain the relatively high number, the sharp increase in one year is more difficult to explain.

Note to Dr. Barkley: In the average baseball game there will be less then 18 minutes of "action" per 150 game. Baseball does not draw ADHD kids to it, except perhaps for pitchers and catchers. Most ADHD kids who play the outfield will quit by the age of 12. Try martial arts, swimming, tennis, soccer, basketball, or hockey instead.

There are 30 Major League teams. They each have a 40 man major league roster, and a 25 man roster for "active players" during most of the season. As players came and went off of major league rosters there were 1,354 athletes who were subject to random drug testing during the course of the 2007 major league baseball season. That means 8.2 percent received permission from their team physician and Dr. Bryan Smith, baseball’s independent program administrator, to use Ritalin and Adderall, stimulants better known as treatments for hyperactive kids.

Baseball already has made changes in the TUE process for 2008. Before a player will be allowed to use a drug, the team physician must send the prescription to the independent administrator for approval before the player uses the substance.

So should Ritalin, Adderall, or other stimulants be viewed as "performance enhancing drugs" as steroids and HGH now are?

No. Ritalin, Adderall, and other stimulants are treatments for a real medical condition called ADHD. If the condition exists with a player, and he has been diagnosed by a real medical doctor, and that player goes through the MLB exemption process, then he should be allowed to receive his prescribed treatment.

This is nothing like taking illegal or controlled substances, without a doctor's prescription, to make an athlete bigger, stronger, faster.

I have seen Ritalin improve reaction time in subjects, improve time on task, and improve focus. During the course of a long season these would be valuable to any professional athlete. But Ritalin and other stimulants also decrease appetite and may cause difficulty sleeping, two problems for any athlete. But the way, I have seen Attend improve reaction time in college athletes whose baseline reaction times were much better than the "middle of the bell curve" too. Perhaps these MLB players ought to look into Attend instead.

I have also seen major league players who certainly had ADHD. One player that I am thinking of pitched for me at the University that I coached at, and went on to play in the majors for several years. He was clearly ADHD, and I knew it before I ever heard of ADHD. Easily distracted, he couldn't focus for more than five innings without some kind of stimulation, like being yelled at. One baseball writer describes him this way, "(He) soon learned to harness his fastball, completing his array of pitches, but became known as somewhat of an underachiever. Despite winning 15 games for (his first team), just a year and a half after his debut, he never really achieved his full potential... He was also suspended for ten days in 1987 when he was caught using sandpaper to scuff the ball on the mound. Though the incident cost (him) some respect, it ended humorously three years later, when he called the commissioner's office to ask for his glove back."

If this player had known about ADHD, and legitimate treatment available for it, he would have been really good - perhaps even great. But instead he is described as an "under-achiever."

So, for what it is worth, let the players who have legitimate medical diagnoses for ADHD use whatever treatment they feel will benefit them the most during the course of their season and their career. Isn't that what any adult with ADHD wants? Doesn’t every adult with ADHD want to be able to choose the best treatment intervention for their particular type of ADHD?

But for the players who want to "get an edge" by using stimulants without legitimate medical reasons, let me suggest that you just use our ADHD eating program plus a cup of coffee before the game. You will get much the same benefit, but without giving a bad name to the players who actually need the treatment.

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