Posted inOxford News

Neurodiversity in Sport: ADHD and ASD

What is neurodiversity? And why is this article in the sports section?

When you think about sport, specifically competitive sport, “neurodivergence” doesn’t tend to be the first thing that comes to mind. But, research has shown a large population density of neurodivergent individuals in the global sporting community. Why is this? What does this mean both for the athletes and for sport in general?

What is it?

Firstly, what is neurodivergence or neurodiversity? www.verywellmind.com defines a neurodivergent individual  as someone who “has one or more ways in which their brain functions outside the ‘typical’ way”. This can manifest itself in ADHD (otherwise known as ADD), ASD (otherwise known as Autistic Spectrum Disorder), dyspraxia, dyscalculia, Tourette’s Syndrome or dyslexia. To be clear, this article will not be engaging with the question surrounding the use of the word ‘disorder’ in many of these diagnoses. Nor, will it deal with the societal aspects of neurodivergence outside of sport.

Important Things to Remember

Before diving in there are a few things that need to be stated. Firstly, all of the aforementioned examples of neurodiversity occur on a spectrum. My favorite way of visualising this is as an electronic board with hundreds of dials on it, where some might be set on zero whilst others are set to thirty-six or a hundred. The point here is that the majority, though not all, of the above examples are umbrella terms. Many individuals with ASD will have different behaviors that classify them as “autistic”, and among the individuals who have the same, or similar, traits will display them in different ways. The same goes for ADHD.

Essentially, what I am trying to say here is that there is no hard and fast checklist for neurodivergence. It’s a grey area, and as such easy to miss. This is compounded by the significant overlaps in stereotypical behaviors associated with different kinds of neurodivergence. Two good examples of this are the overlap between ADHD and ASD, and that Tourette’s is a co-morbid disorder with ASD.

Secondly, due to historical sexism and racism in the field of medical scholarship, the majority of research into neurodivergence has been done on Caucasian males by Caucasian males. Therefore, if you are not white and biologically male, the current working theories are less likely to be as relevant to that person as the demographic which was studied.

Finally, although it may be fairly obvious, it is important to underline that when someone has ASD, ADHD or any of the above this doesn’t make them contagious. These are neuro-developmental, meaning there they have a genetic component. To put it bluntly, you can’t “catch” ASD, ADHD or any kind of neurodivergence.

ADHD

Sport in Relation to ADHD

The acronym ADHD stands for ‘Attention Deficit Hyperactivity Disorder’, and a classic behaviour displayed is constant movement, be it constantly solving then un-solving a rubix cube, tapping, or playing with long hair. Typically, though not always, children with severe ADHD tend to excel in primary school but struggle in secondary school (after the age of eleven). Again, I would like to stress that this is not true for all individuals with ADHD, and that my example is an extreme case.

How this relates to sport is, on the surface, very simple: people with ADHD tend to prefer being active, which lends itself to sports. www.chadd.org released an article in 2019 that detailed this

In a nutshell, the article states that the tendency of people with ADHD to gravitate towards sport could be explained, in part, by neurotransmitters. Being active is known to increase the amount of neurotransmitters in your brain, which has the knock-on effect of temporarily reducing the severity of ADHD symptoms. However there is more to it than this. The article quotes Dr D.H Han, MD, PhD, stating that 4 to 8 percent of high-school athletes have ADHD and that 7 percent of college athletes “employ stimulant medication”. Whilst the study was conducted exclusively on baseball players, these figures may not be totally generalizable to other sports. However, given that an estimated 2.8 percent of the global population has ADHD, there seems to be a disproportionate amount of athletes with ADHD.

Another reason people with ADHD tend to gravitate towards sports is because of the endorphins released during exercise. Essentially, the Dopamine Deficiency Explanation of ADHD states that a lack of dopamine in the brain affects their ability to focus. This means that the two to three hours post-exercise are the most productive for people with ADHD. The increased endorphins in their system help them to focus, allowing them to better perform tasks they would otherwise struggle with.

ADHD in relation to sport

Given that we’ve already covered why people with ADHD would chose sport, let’s have a look at why sport would choose people with ADHD. www.reuters.com released an article in 2019 in which it quotes Dr. George Pujalte saying:

“ADHD might actually have positive effects on sports performance, and we need to study that more”

ADHD may be more common among elite athletes | Reuters

This could be linked to “hyper-focusing”, something that the article goes on to discuss. Essentially, “hyperfocus” is when an individual can zone everything else out and focus intently on a single, specific, task. It isn’t a switch you can turn on and off. Hyperfocus tends to apply to one thing, and one thing only, be it swimming, judo or physics. Given that elite sport requires intense focus, this could be a significant reason why so many elite athletes have ADHD, Michael Phelps and Simone Biles, to name just two. It should, however, be noted that ADHD is not a golden ticket to the Olympics, and that each athlete who competes there have put in years of dedication and hard work into their success.

An older article that investigates this was released by The Guardian in 2012 . Detailing the journeys of Michael Phelps, judoka Ashley Mckenzie and gymnast Louis Smith, the article highlights the saving grace that sport can be for children with ADHD. Mckenzie is quoted saying that judo gave him “a pavement instead of walking on the road”. Sport is notoriously regimented, with discipline being a key part of training sessions and the general life of an athlete. It then makes sense that people with boundless energy and difficulty focusing would benefit from the orderly world of competitive sports.

Complications with medication

However, there is a catch. The stimulant medication often prescribed to help people with ADHD regulate their symptoms, Ritalin or Methylphenidate, is on the Banned Substances in Sport list for the Olympics. This poses a problem for athletes. Do they pursue sport, where their neurodivergence is more accepted, at the cost of the medication that enables them to better control their ADHD symptoms? Or do they relinquish their desire to be part of the world of competitive sport, and take the medication?

It’s clear that this is a delicate and sensitive issue, that should be considered thoughtfully by experts. However, it is an integral part of the world of ADHD in sport, and therefore not to be ignored.

ASD

Having Autistic Spectrum Disorder does not mean that you are exactly like Sheldon from The Big Bang Theory. Like ADHD it runs on a spectrum, and the dials analogy applies here as well. Autistic people can be sporty, they can be artistic, they can be anything. However, if we were going to boil this down to a set of stereotypical traits they would include:

  • narrow areas of obsessional interest
  • resistance to change
  • a strict routine
  • binary thinking
  • difficulty in social situations
  • sensory issues

While these are the core traits, they can present in different ways. From only eating rice dishes, to the exact same outfit every day, these behaviors show themselves differently in different individuals. They are the people most likely to have “their” lane, spot, or a very intricate pre-exercise routine.

Elite Athletes with ASD

There is significantly less research and interest on ASD in  competitive sports. However there is an illuminating article by www.appliedbehaviouralanalysisedu.org  about the “Top 5 Athletes on the Autism Spectrum”. These athletes are Clay Marzo, Tommy Dis Brisay, Jim Eisenreich, Jessica-Jane Applegate and David Campion. The article focuses on a sub-section of ASD called Asperger’s Syndrome. Asperger’s is an old-fashioned term for a section of the Autism spectrum, which hasn’t been recognised as a diagnosis by the DMV (Diagnostic and Statistical Manual of Mental Disorders) since 2013. But the important thing here is that Asperger’s is considered a “high-functioning” form of ASD. Basically, “high-functioning” has nothing to do with intelligence, but means that the Autistic person can pass for a neurotypical person to the layman.

However, the article focuses on athletes with extreme autism symptoms. For example, Tommy Dis Brisay’s parents were told, when he was five, that he would never speak. They were wrong, but my point is this: many autistic people will fly completely under the radar for most of their lives. This is mainly due to the bias in research I discussed earlier. So who knows how many elite athletes have autism and either haven’t realised, or haven’t made it public? But given the high concordance rates between ASD and ADHD (an estimated 30 to 50 percent) and the overlap between their symptoms, it’s highly likely that many elite athletes with ADHD also have ASD.

Practicalities in Sport

Unlike dyspraxia (a ‘developmental co-ordination disorder’), autism doesn’t affect you physically, in that you can still catch, throw, swim, as well as the next person. Where it does come into play is in the intricacies of sport. For example, an autistic person might find it difficult to understand what a coach would mean with the term “best effort”. Do they want you to sprint? Do they want you to be consistent but not go as fast as physically possible? What (in some cases) time do they want you to hold? What heart-rate? And so on. This doesn’t make them stupid, it doesn’t mean they can never understand. It just means that they might need things explained differently. The best way to manage this is with patience and understanding. We aren’t trying to be difficult, or brains just work slightly differently.

Sport in ASD

As I mentioned before, a common trait of ASD is a love of routine and binary thinking. Given how structured sporting life tends to be, it is unsurprising that it can be a haven for autistic people. Particularly in making the jump from school to university, having that one thing that stays stable really helps with focusing, like having an anchor in your day.

Also, in most, if not all, sports there is a right and a wrong, a good and a bad, a fast and a slow. This can suit a binary way of thinking, and tends to make these sports quite accessible. Whilst there isn’t such a massive correlation between sport and ASD as there is with ADHD, as someone who may or may not (diagnosis pending) have medical autism, but definitely has more than a few traits, I’ve found that sports helps me focus and structure my day. It was very helpful just to have a known quantity in my life, when faced with the vast unknown that is fresher-life.

What’s my point?

Ultimately, neurodivergence just means that your brain is wired slightly differently than the ‘average person’. Everyone has some neurodivergent trait or other, but they tend to be quite mild in “neurotypical” people and less so in neurodivergent people. I do apologise for not covering more kinds of neurodivergence in this article, but I don’t think many people would want to read the small-sized thesis that it would become! Nevertheless, my advice to someone who is concerned that they might have ASD or ADHD is this:

Don’t rush into things. Before you get a diagnosis think about what will it do for you. How will it improve your quality of life? How will it help you function?

For ADHD, there is medication that can help you focus, and universities adapt to help you manage your ADHD in exams ect. But I will say that getting a diagnosis on the NHS takes a long time, just because of the waiting list. The same can be said of ASD, but to a lesser extent. There isn’t really any medication you can take, and a diagnosis would just help with self-understanding and access to information about coping strategies. But I realise that not everyone has between £400 and £1500 (ASD diagnoses are expensive) to spend on a private diagnosis. Below are the tests that I find best for self-diagnoses on ASD and ADHD.

Autism Quotient Test (psychiatryassociatespc.com)

10852_elto_question_fhp2.PDF (add.org)

IMPORTANT NOTE: These are guidelines and aren’t a substitute for a formal diagnosis. If you are seriously concerned go see a medical professional.

Finally, out of respect for the neurodivergent community please understand that an ADHD or ASD diagnosis is a serious thing, and can be considered a disability. It is not an quick route to extra exam time, and neither is it an excuse for bad behaviour. The above resources, and formal diagnoses, are primarily to help you understand yourself, and should not be used as a scapegoat. Please also be aware that you might have traits but not qualify for a diagnosis because they aren’t severe. I hope you found this article informative, and that it can help you understand yourselves and your sport.

Happy Hilary everyone.