ADD/ADHD Medications and diving

[Mr. Bubble]

I would like to get my son diving in the next year or so, but he has been diagnosed with ADD/ADHD. He is taking a new medication called Vyvanse, as well as, a low dose of Risperdal.

Are there any known conditions associated with these medications when diving?

Thanks,

Mr. B

 

[DocVikingo]

Hi Mr. Bubble,

Hi Mr. Bubble,

Of significance to SCUBA, side effects of the stimulant drug Vyvanse (lisdexamfetamine dimesylate) include GI upset, blurred vision, skin rash, irritability, insomnia and dry mouth.

Of significance to SCUBA, side effects of antipsychotic drug Risperdal (risperidone) include mild restlessness, drowsiness, or tremor; sleepiness; blurred vision; dizziness; nausea; and dry mouth.

As with all drugs, these should be given an adequate topside trial to assess for possible adverse reactions.

The decision on diving with ADHD, medicated or not, is made on a case by case basis. An individual with this disorder would need formal medical clearance in order to proceed with scuba training of any sort.

The following introduction to diving with a mental/behavioral disorder written by Dr. Ern Campbell (aqua Scubadoc) provides a good orientation to the issues:

"Little research has been done to factualize the relationship between mental conditions and scuba diving. Other than the obvious proscriptions against someone diving that is out of touch with reality, severely depressed and suicidal or paranoid with delusions and hallucinations---one has to consider the many who can dive with everyday anxieties, fears and neuroses.

Successful divers have a profile that is positively correlated to intelligence, is characterized by a level of neuroticism that is average or below average, and score well on studies of self-sufficiency and emotional stability.

There are some actual psychological disturbances that are well known to all but which are poorly studied and documented as concerns the risks of scuba diving. These include the depressions, bipolar disorder, anxiety and phobic states, panic disorders, narcolepsy and schizophrenia.

In addition to the risks caused by the condition itself, one must add the possible hazards of effects and side effects of medications - either as taken singly or even more dangerous, in combination. Needless to say, there have been and probably will not be good scientific studies that will indicate the safety or danger of any given set of conditions and drugs. The role of medication in diving is usually less important than the condition for which the medication is being used. A mood-altering medication is plainly powerful and should be used with care in diving. Drugs that carry warnings as dangerous for use while driving or using hazardous equipment should also be thought of as dangerous for divers. The interaction between the physiological effects of diving and the pharmacological effects of medications is usually an educated supposition. Each situation will have to be carefully evaluated individually, and there is no general rule that applies to all.

Finally, every diver has his own personality makeup, which may respond differently to abnormal physiological states and changes in the environment from the effects of various gases under pressure. Such states as inert gas narcosis, carbon dioxide toxicity, oxygen toxicity, HPNS, deep water blackout all can cause reactions that are similar to a psychoneurotic reaction or one of the organic cerebral syndromes. Therefore the diver, the dive instructor and the certifying physician all must be aware of the all the possibilities and protean manifestations of each and every individual case before allowing or disallowing diving with psychological problems."


All divers must show attention, concentration, impulse control and behavioral modulation that are fully adequate to meet the demands of safe scuba, and this obviously is a concern with those diagnosed and treated for ADHD.

In addition, there are unanswered questions regarding the possible effects of powerful stimulant and antipsychotic drugs. High among them is what effect they may have on the development of oxygen toxicity secondary to the elevated partial pressures of 02 that are an inherent part of breathing compressed air, and more so nitrox, at depth.

Helpful?

Best regards.

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[Mr. Bubble]

Much!

Thank you. That does'nt sound too good. I sure hope he can develop better impulse controls as he matures. Hopefully we will be able to take him off of the medicine altogether. I don't guess I will try it while he is on the medicine. An adverse reaction to pressure on medication is more of a concern than his attention span and reaction skills.

Thanks Doc

 

[DocVikingo]

Hi Mr. Bubble,

IMHO, a very sensible decision.

About 50-70% of children on medications for ADD/ADHD are able to be taken off all psychotropic drugs by adulthood. You'll just need to wait and see.

Regards,

DocVikingo

 

[dschonbrun]

My half brother has had ADD for years, with anxiety complications, and is on a small amount of medicine (zoloft). Our Neurologist, GP, and a Dive Science Doctor discussed it, and based on his ability to focus and function, he was cleared for diving. We were cautious and took it slowly, beginning with shore dives of less than 10m. As he developed his skills and comfort, he's become a very focused and responsible diver.

As an option, you may want to have two experienced divers (yourself and another adult) dive as a trio with your son while he's learning. PADI does have guideline for allowing children and adults with various conditions to dive safely (under restrictions). You might consult them to get more details.

 

[Mr. Bubble]

Thanks for the input. My son is able to focus on what he wants to focus on. Just like the video games. He plays them all weekend long until his eyes are bloodshot. Its the school and homework where his attention disapates. The other medication is behavioral, and in a small dosage to take the "edge" off of him a little. He really wants to dive, and it will really upset him when I tell him he can't dive. I believe that he could handle learning to dive, but as I said before, I am more concerned about an adverse reaction to medication under pressure than anything right now.
I think as a young beginer, shallow dives with several DM's (myself included) and an instructor, could be done, but I would want him off the medications until further studies have been completed.

Thanks for your input.

B

 

[mfalco]

My son is able to focus on what he wants to focus on. Just like the video games. He plays them all weekend long until his eyes are bloodshot. Its the school and homework where his attention disapates.
B

Sounds just like most kids. Unfortunately ADD/ADHD is the most misdiagnosed condition (in my opinion) these days. It use to be believed that about 10% of children with ADD would go on to have Adult ADD. It turns out that now a lot of experts are starting to believe that the other 90% are misdiagnosed.

 

[Jim Lapenta]

THere was a time when these kids were called hyperactive but there was no easy acronim for it. Before that they were known as KIDS. Then came teachers who dole out too much homework, pychologists and psychiatrists who saw an easy buck to be made and the drug companies. Don't forget the video game people. When we were kids the solution was readily apparent to our parents. Stop sitting in front of the tv and get your ass outside and play! Running around on a ballfield for a couple hours, playing hide and seek for hours with 6 or more on a team, playing war with bb guns. You got rid of all that attention deficit. In the winter sledding and skating on an old pond wore you out as well. Now thanks to all the perverts out there who should be executed on sight we can't let our kids be kids. Thanks to all the frustrated parents who insist on watching them play ball and hiring 5 yr olds a hitting coach they can't play a pick up sandlot game. There is no ADD/ADHD- it's another name for too much energy that is not getting burned up by just being a kid. Want a good cure? enroll him in a good traditional martial arts school. A good instructor will channel that energy while teaching him respect for others as well as himself, to focus on the tasks at hand, and to think ahead and consider the consequences of his actions. Kids don't need analyzed, they need to be allowed to be kids. If he's destroying the house it's one thing, if he can't pay attention or is a little out of hand he just has too much energy and needs an outlet. I am not a doctor but I have kids including a son who was very hyper. No drugs- get out and do something. Today his attention deficit as it might have been called had we taken him to some quack seems to have gone away. Enough that the Air Force has been able to train him to be a Cryptologic Airborne Linguist specializing in Madarin Chinese. ADD? ADHD? BIG BS!

 

[Dr Deco]

Hello Readers

Diving does indeed require attention to detail, since what you are using is life support equipment. Concentration is important - as is attention to checklists.

ADD is real – in some people. It actually was first mention in the mid 1800’s and present to the British Medical Society about 1910. [This is described on the website of the National Institutes of Health.]

There are two theories on how to handle rambunctious children. Both of them don't work. As was once said, “Kids will be kids.” This is sage advice, and remains the best advice - but it is, alas, no longer fashionable.

When I was young, ADHA was mostly handled by making me stand in the hall or going to the principal’s office. I still have difficulty with concentration; my wife of 45 years will attest to this; you would not want me to handle details or be in charge of a checklist. I might get it – or I might not. Sixty-six years have proved that some tasks are not good for me. Possibly some children might also find SCUBA a problem.

I did not out grow it. ADHA was passed to some of my children, and I find that it now has appeared in some of my grandchildren. My progeny will inherit genes of ancestors who lived to be 90 – but they will also be fidgeters and forgetters.

I would have responded to this posting soon after reading it, but I forgot [seriously].

Happy New Year to all!



Dr Deco :doctor:

 

[DocVikingo]

Sorry, Dr Deco, but you must be mistaken as we have just learned that "There is no ADD/ADHD - it's another name for too much energy that is not getting burned up by just being a kid." And this from a recognized expert who uses terms so advanced that they aren't yet widely recognized in the field, such as "pychologists" and "acronim."

Despite respectable published research that ADHD appears to have a substantial genetic component, and especially the form that continues on into adulthood, whatever is being passed on to your progeny obviously must be something else.

Regards,

DocVikingo