Impact of ADHD on Sports Psychology from a Sports Psychiatrist

By Jeff Copper, MBA, PCC, PCAC, CPCC, ACG – January 23, 2023

Athletes who have ADHD often suffer from psychological issues such as depression or anxiety and other emotional challenges that stem from ADHD. These athletes may experience less than ideal performance on the playing field. As an ADHD and attention coach, this topic is significant as I coach sports players who suffer from symptoms of ADHD in their performance, both on the field and off.

I reached out to Dr. Andrew J. Cutler, M.D., who at that time was the sports physician and psychiatrist for the Tampa Bay Rays professional baseball team. Dr. Cutler shared insight about his work with professional athletes, particularly his experience with professional athletes who have ADHD. He works with the players to help keep them on a level playing field so they can demonstrate their true ability in the game.

The effect of ADHD on athletes can show up as what Dr. Cutler calls “TSI” – tired, spacey, and irritable. The brain uses two things for fuel – oxygen and glucose – and going too long without eating causes the brain start to fail, resulting in TSI. Athletes especially need to understand how the brain works and how it’s wired so they can do something about it when it starts to happen. Noticing these effects can help diminish distractions so they can stay involved in the game.

If you are an athlete with ADHD or love someone who is, please check out my interview with Dr. Cutler on Attention Talk Video, “The Impact of ADHD on Sports Psychology,” http://youtu.be/Pmt8Yb0czIY.

TRANSCRIPT:

Jeff Copper:
Welcome, everybody, to this edition of Attention Talk Video. I’m your host, attention coach Jeff Copper, and I’m here with Dr. Andrew Cutler. Dr. Cutler, you do some work with the Tampa Bay Devil Rays. Can you speak to that a little bit?

Dr. Andrew Cutler:
Sure. I’m a psychiatrist who specializes in ADHD. I do research and I do treatment, and I publish articles and speak quite a bit. I’ve been treating professional athletes in variety of sports for over 15 years now. I’m fortunate enough to get to work with the Tampa Bay Rays, the baseball team, and I work with other Major League Baseball teams. I’ve worked with the PGA Tour and with retired NFL players, so it’s very exciting. I’m a former athlete myself. I feel like I know about ADHD and I know about sports, so it’s fun to do.

Jeff Copper:
I’m interested from your perspective, because you’re working with athletes to optimize their performance. What are some of the things that you look at and focus on that are key?

Dr. Andrew Cutler:
Well, we should be very clear. I’m not a sports psychologist. I’m a psychiatrist. I’m a physician. I don’t work on, in general, improving performance. I work with athletes who have ADHD or depression and anxiety, or sometimes substance abuse issues. What I’m trying to do is help address those issues to put them on a level playing field so that they can show what they can do.

Jeff Copper:
It seems to me you want to get them on a level playing field, but I’m just kind of curious, from your perspective, from a psychology perspective, I would think that some of the things that they would struggle with more than the average person. One would be, I’m going to say, arousal, being able to say, “I need to be up now…”

Dr. Andrew Cutler:
That’s right.

Jeff Copper:
“… and I want to be down,” as opposed to reversing that. From your perspective observing, is that material?

Dr. Andrew Cutler:
From recent research, we know that there’s a very big problem with a part of the brain called the nucleus accumbens. This is a part of the brain that’s the pleasure center, the arousal center, motivation and reward. It’s a part of the brain that uses dopamine, and we know there’s a disturbance of dopamine.

Most of our medications that we use to treat ADHD are increasing dopamine. We know that people with ADHD have a lot of trouble managing reward, stimulation, and arousal. That’s one of the biggest things. I even say sometimes they only have two speeds, on and off. When they’re on, they’re really on. When they’re off, they’re really off.

Now, as far as baseball in particular, there’s a very good example. Most of the people I work with are tremendous athletes. They were just freaks of nature almost, growing up. They were usually multi-sport stars, and they settled on baseball.

When they’re coming up, they could play baseball. They could have fun with it. They could be in the moment, and they were so good at it. It came naturally to them. Then what happens when you become a professional athlete is now it’s a job. Now you have meetings you have to go to and coaches telling you what to do. You have to remember where you’re going. You have to plan for a trip if you’re going out of town.

What they tell me is now this becomes very difficult. It’s very hard to imagine. “I’m not just playing baseball. I have to deal with all the other stuff.” They get in trouble because they don’t remember what the coaches tell them to do. They aren’t showing up for a meeting at the right time, or they go to the wrong place when they’re supposed to be over here. That’s when they run into trouble…

Jeff Copper:
What’s interesting is…

Dr. Andrew Cutler:
… more off the field than on.

Jeff Copper:
It’s interesting to me because, in baseball, I didn’t play, but being able to look over for the signs of which you’re supposed to steal or not steal, or what you’re supposed to do, there’s a whole education around some of that stuff. But there’s also an amount of boredom that’s on the field to a certain extent, which is another area. It seems to me that those… The establishing of routine is really good for those with ADHD, but it seems to me… Let’s say you’re the second baseman. It’s really good to establish a routine out there to let your mind float around and then be able to bring it in…

Dr. Andrew Cutler:
Well, here’s the thing.

Jeff Copper:
… at that point in time.

Dr. Andrew Cutler:
Yeah. The people with ADHD often don’t have good internal discipline, internal motivation, and so they need external discipline and structure. Yet within that, they need variety, interest, excitement, if you will. That’s why sports is terrific. Also, people in the military, firemen, police have more ADHD for the same reason, very similar environment.

Now, what happens with baseball is it’s a 162-game schedule. Baseball is certainly fun, but what they say to me is sometimes it’s like Groundhog Day; it’s the same thing over and over again. Now the variety, the interest starts to wear off, and it becomes routine and mundane. Then it’s really hard to get aroused.
Also, certain positions on a sports field are not as good, necessarily. I usually advise people, you want be in a position where there is a little more action, for instance, pitcher and catcher.

You’re involved in more plays. Right field, when you’re growing up, is where they put someone who’s not going to get a lot of action, and that may not be as good, for instance.

Jeff Copper:
So pitcher and catcher would be good. Infield, you’re going to get more activity and more excitement…

Dr. Andrew Cutler:
Infield, you get a lot of action.

Jeff Copper:
… because the ball is coming a lot quicker.

Dr. Andrew Cutler:
That’s right.

Jeff Copper:
Outfield, there’s…

Dr. Andrew Cutler:
Outfield is hard. There have been a lot of great outfielders and baseball players who’ve had this, but very often they do have to learn techniques like you’re talking about, mental strategies to stay involved in the game.

I’ve worked with several of them, for instance, who will tell me, “I’m sitting there in the middle of the game, and I can hear everything the crowd is saying. I’m distracted by that.” One guy told me about, in the middle of a pressure-packed game, an airplane went overhead, and he just started watching the airplane instead of paying attention to the game.

Another common thing when they get referred to me, as you mentioned, they forget the out count, the pitch count. A pitcher I worked with one time told me, “When the catcher would come up to talk to me on the mound, by the time he got back behind the plate, I completely forgot what he talked about and I threw the wrong pitch.” Those kinds of things can happen.

Jeff Copper:
It seems to me that one of the keys for an athlete would begin to learn to be able to observe their attention as it’s unfolding and then begin to manage it, because only the individual who’s paying attention can actually observe it. For an ADHD athlete, it becomes more important to actually zero in on that stuff and build routines and those habits, to bring yourself to remember those things when that happened and spice some stuff up.

Dr. Andrew Cutler:
Well, I always say knowledge is power. The more you understand how your brain is working and how it’s wired, because the ADHD brain is wired differently, if you understand that, then you can be aware and catch it as it’s starting to happen. Then you have an opportunity to do something about it. If you’re not aware, it happens automatically.

Jeff Copper:
You can’t manage anything that you don’t understand. For ADHD athletes, any other tips or things that you’d…

Dr. Andrew Cutler:
Very quickly, there’s a very important tip, and that’s knowing how the brain works, the biology of this. The ADHD brain is less efficient. It has to work harder to do things. Anything that stresses the ADHD brain is not good.

The brain can only use two things for fuel, oxygen and glucose. Blood carries these to your brain. Blood is made of water. If you get dehydrated, that’s a problem. Also, if you don’t eat enough and you go too long without eating, people with ADHD can get hypoglycemia and your brain starts failing. The symptoms for this for athletes are TSI, tired, spacey, irritable, TSI. If that starts happening, grab something to drink and eat an energy bar. That’s something you can do right away to manage without medication.

Jeff Copper:
That’s something that’s new to me that I learned. Very good advice. Dr. Cutler, thank you very much.

Dr. Andrew Cutler:
Thank you.

Jeff Copper:
For those that want to learn more about you and your organization, website?

Dr. Andrew Cutler:
Yeah. Florida Clinical Research Center. You can look at www.flcrc.com, and our phone number is 941-747-7900. Thanks very much.

Jeff Copper:
Thank you much. Catch us for another great edition of Attention Talk Video. Take care.

Dr. Andrew Cutler:
Thanks, Jeff.

2 thoughts on “Impact of ADHD on Sports Psychology from a Sports Psychiatrist

  1. My ADHD and sports experience was terrible. It robbed me of something that should have brought me joy and left me trauma due to negative experiences with coaches. I really wish I could go back in time and help my younger self out by working with a sports psychologist who understood ADHD and could have given my the confidence to speak up and advocate for myself rather than let myself be a punching bag

    1. Exercise is great for those with ADHD. The environment can be challenging, especially on team sports and particularly when you have a learning disability with ADHD. Having to learn at the pace of others without help can be very traumatic. Thanks for your comment and for sharing your lived experience.

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