Can Children with ADHD Grow Up to Be Military Pilots?

What child doesn’t imagine or dream that they can fly like a bird? Many children solidify their imagination by deciding at an early age that they want to fly when they grow up. Often this is triggered by an event such as going to an airshow or watching a classic aviation movie like "Top Gun" (or more recently, "Sully"). Most military aviators have a story in which they are able to identify a defining moment connected to their motivation to fly, or they just grew up “knowing” that they wanted to fly.

Military aviation is synonymous with peak cognitive performance.

Source: Olga Steckel/Shutterstock

Military aviation, however, tends to be unforgiving. Anyone being considered for military flight status (this includes air traffic controllers, drone operators, and aircrew) must be able to maintain sustained vigilance even in the most boring of circumstances, attend to multiple things happening at once (i.e., divided attention), and process and organize incoming information quickly in order to form an effective, and frequently disaster-preventing, response. Unfortunately, these requirements tap the attentional deficits that can be seen in ADHD. Consequently, a legitimate diagnosis of ADHD in which there are continuing symptoms is always disqualifying for military aviation.

But the diagnosis of ADHD is unusual. While there are accurate tests for it (e.g., a neuropsychological evaluation), most people get the diagnosis via a quick computerized test, questionnaires, or sometimes simply by telling their doctor they are having problems paying attention. This has made it somewhat difficult for the military aviation community to determine what to do with an aspiring aviator with a history of ADHD.

During the most recent revision of its waiver guide for ADHD, the Naval Aerospace Medical Institute took a look at its ADHD waiver requests. After reviewing medical records, and with the clarity of hindsight, found that in approximately 50 percent of waiver requests, the applicant never met diagnostic criteria for ADHD. Approximately half of the misdiagnosed cases had no diagnosis—the motivation was improved grades or behavior—while the other half had a different diagnosis, such as depression.

Using the Navy and Marine waiver process as an example, for enlisted service members seeking a waiver for ADHD, a current mental health evaluation, including a childhood medical record review, is required which is geared towards evaluating for the presence of current ADHD symptoms and to verify the original diagnosis. If the childhood diagnosis of ADHD can be ruled out during this evaluation, this is all that is required in order to apply for a waiver. If ADHD cannot be definitively ruled out through the mental health evaluation, a comprehensive neuropsychological evaluation is required.

For Navy and Marine Corps officers seeking an ADHD waiver, college transcripts, a letter from the college/university disability services attesting that the individual in question neither qualified for nor received academic accommodations, and a letter from the service member attesting that they did not take any ADHD medication throughout college is all that is necessary. The four years of academic success, at a level commensurate for admission into the flight program, are considered a proxy for a clean neuropsychological evaluation.

In an environment where attentional abilities can literally mean life or death, and decisions must be made in milliseconds, the military aviation community takes histories of ADHD very seriously. However, given what we know about the over-diagnosis of ADHD and the potential for the symptoms of some individuals to wane over the course of childhood, all of the Services consider waivers for histories of ADHD on a regular basis.