Description
The military in the US has special requirements for anyone with a health condition which requires medication. This article reviews some implications for pediatric care
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Occupational outcomes in ADHD
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Counsel parents about the impact of ADHD diagnosis and treatment of potential military service
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Can Our ADHD Patients Get In (and stay in) the Military?
Two million young men and women have joined the military since the all-volunteer corps was established in the early 1970s. Many of them are attracted by the challenges, opportunities, and structure offered by the Armed Forces. Since there has been no military draft in this country for over 30 years, the branches of the Armed Forces are smaller and more highly selective. The downsizing of the military and the increasing technological skills required of the recruits has highlighted the military policy on ADHD.
Adolescents frequently ask their pediatricians whether they can get into the military if they are taking Ritalin (or another ADHD medication). Young adults with ADHD receive inconsistent information on this question from their military recruiters. The lack of consistency across the branches of the military on this issue makes it difficult for the pediatrician to give correct and informed advice to his or her patients. A search of the pediatric and general medical literature on this topic came up with essentially nothing other than an excellent article by William Hathaway, Ph.D., entitled "ADHD In the Military" in the October, 1997, ADHD Report Newsletter, edited by Russell Barkley, Ph.D.
The following information on this subject was obtained from telephone consultation with several military physicians, written materials that they provided, and the Hathaway article.
Selective Service Policy
The Selective Service Act allows individuals to be determined "unacceptable for service" in the Armed Forces based on certain mental or physical conditions. The Department of Defense (DOD) sets up physical standards for the appointment of officers and the enlistment and induction of non-commissioned officers and enlisted personnel. The DOD directive 6130.3, "Physical standards for enlistment, appointment and induction" of May 1994, provides general guidelines for determining when a physical or psychiatric condition is to be deemed service disqualifying. Each service branch has written guidelines, which implement this DOD directive.
Although ADHD is not specifically identified in the DOD directive, ADHD is subsumed under the category of specific academic skill deficits. This directive characterizes such deficits as involving a "chronic history of academic skills or perceptual deficits." The directive further states that, "Current use of medication to improve or maintain academic skills (example: methylphenidate) is disqualifying."
Other reasons for rejection for a military appointment, enlistment, and induction, are personality and behavior disorders, as evidenced by frequent encounters with law enforcement agencies, and/or antisocial attitudes and behaviors. While these might not be sufficient cause for administrative rejection, they are viewed as tangible evidence of impaired characterological capacity to adjust to military service. The DOD regulations also mention personality or behavior disorders where it is evident by history, interview, or psychological testing that the degree of immaturity, instability, personality inadequacy, impulsiveness, or dependency will seriously interfere with adjustment in the Armed Forces. This is demonstrated by repeated inability to maintain reasonable adjustment in school, with employers and fellow workers, and other social groups. A history of attempted suicide or other suicidal behavior is also disqualifying.
What Recruiters Say
Military recruiters give highly variable (and often erroneous) information to potential recruits on the ADHD question. Some recruiters will tell the young person that the ADHD diagnosis automatically disqualifies them; others will tell the individual who is currently taking a stimulant medication for ADHD that this is not a problem. Military physicians caution that recruiters may not give accurate information, as they feel pressured to make their monthly quotas.
The potential enlistee must demonstrate an aptitude for military service by achieving suitable scores on the Armed Forces Qualification Test. This test consists of subtests which seek to measure both academic and career aptitude in ten separate areas, including general science, arithmetic reasoning, work knowledge, paragraph comprehension, numerical operations, coding speed, auto and shop information, mathematics knowledge, mechanical comprehension, and electronics information. The tests are multiple choice, timed, and no accommodations are permitted.
ADA Does Not Apply
The federal courts have very limited powers to require or prohibit actions by the Armed Forces; the judiciary has no authority to make rules for the regulations of military forces. Therefore, the courts have generally refused to intervene in military matters. Consequently, the Americans with Disabilities Act does not apply to the Armed Forces disqualifying conditions definitions which can prevent an individual from entering the military or can be used as a reason for separation from the Armed Forces. The rationale for this military policy is that adaptations for learning impairments cannot always be made under tight time constraints or hazardous conditions. The position of the military is that technological skills and consistent good judgement must be accessible and reliable, without the aid of medication.
Military Service Medical Evaluation
The entrance examination at the Military Entrance Processing Station involves (among other things) a medical/psychiatric history and a physical examination performed by a physician. Problems arise when candidates misrepresent their history. If the recruit has not previously revealed that he or she has been treated for ADHD, and it comes out that they have misrepresented their medical/psychiatric history, this can be grounds for separation from duty.
The diagnosis of ADHD, per se, does not appear to be a disqualifying condition, depending on the problems that the individual has experienced, his/her history, and their status regarding medication. The military policy of disqualification for the use of daily medication applies to any chronic disorder or condition that requires daily medication (such as medication for thyroid disorders, asthma, and diabetes, as well as stimulant medication for ADHD). Again, the rational behind this military policy is that any condition requiring regular medication may place the individual at risk in a combat situation. The military must access only those service members who can be deployed worldwide without the need for specialized medical treatment or prescription medications. A military statement that is equally important however is, "Because Ritalin is a controlled drug with considerable abuse potential" it cannot be to be taken by recruits in basic or advanced training.
Waivers Available
The military does grant waivers to enter the service for conditions such as ADHD in certain circumstances. If the recruit with the history of ADHD has outgrown the need for medication and has be successful in school or employment for three years without being on medication and can pass all of the required entrance exams, the recruit may apply for a waiver. If the recruit is still in high school, a waiver may be granted if the individual has been in school and off ADHD medication for one to two semesters, is mainstreamed, does not require untimed tests, and does not have an Individualized Educational Plan in place. If the recruit is out of school, he or she must be off medication, show documentation of one year of stable employment, and have no history of significant problems with the law.
Various branches of the military have shown different degrees of strictness regarding the disqualifying policy and the granting of waivers for ADHD. The Army has a history of being somewhat less strict, while the Marine Corps is the strictest military branch in this regard. The most consistent part of the DOD policy (which applies to all branches) is that a person cannot join the military if they are on methylphenidate (or a similar medication) at the time of enlistment. The DOD directive is a minimum standard, which all Armed Forces must meet. Each branch of the military can set up more stringent requirements, based on the operational environment of the respective service.
The DOD is in the process of developing a more specific and consistent policy for all the branches of the Armed Forces regarding waivers. The Armed Forces have also clearly indicated, however, that these rules may be revised "in the event of mobilization or a national emergency" (DOD directive 1304.26).
Conclusion
How do we answer our patients with ADHD when they ask whether they will be able to join the military? It seems to depend on many individual variables, but is probably worth looking into. If the patient is thinking of entering the military while in the first years of high school, it may be wise to talk with him/her and the parents about planning to try discontinuing the stimulant medication for at least the last year of high school, with continued periodic medical monitoring during that time.
As always, as our patients with ADHD enter adolescence it is especially important to emphasize organizational, self-monitoring, and self-advocacy skills which will benefit them whether or not they continue taking medication or join the military.
Keywords: adolescent,adult,attention deficit disorder,attention deficit hyperactivity disorder,Military,Military service,occupational health
Publication date: Jan 9, 2002
Revise date: Jan 9, 2006
TextID: 758
