Dyslexia, Autism spectrum disorder and ADHD

Dyslexia

Dyslexia is a type of learning disorder. In the UK, dyslexia is a disability as defined by the Equality Act 2010 because it is a long term impairment which can have an adverse effect on an individual’s ability to perform normal day to day activities. Someone with dyslexia should, therefore, be entitled to reasonable adjustments to enable them to obtain and remain in employment provided that it will not compromise safety.

It is considered reasonable for students of most disciplines to have help from a scribe, for example, when writing essays or sitting exams. The same may not be considered reasonable for a pilot to have to rely on someone else when carrying out activities such as reading checklists, weather reports, instrument displays and charts in flight.

Provided a pilot has been able to successfully complete the written work involved in training, they will have demonstrated a level of reading and writing ability sufficient to safely pilot an aircraft. If an applicant for pilot licensing is able to complete training without assistance with reading and writing, and with no adjustments, with current technology, then they may be able to pursue a career in aviation as a pilot or air traffic controller.

Autism spectrum disorder (ASD)

Given the variation in presentations, autism spectrum disorder (ASD) is not automatically disqualifying for aeromedical certification (Class 1, 2, 3 or LAPL). Applicants with ASD can apply for a medical certificate with an aeromedical examiner (AME). Providing copies of all neuropsychology, psychology or psychiatry reports undertaken will aid decisions that the AME may take. An up-to-date assessment with a neuropsychologist/aviation clinical psychologist may be required, but applicants should wait to be guided by their AME or the Civil Aviation Authority (CAA) medical department before obtaining such a report. Depending on the information provided, a medical certificate may be issued to enable the applicant to undertake flying/air traffic control training with reports on their progress.

Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a condition which in adults may be characterised by symptoms of inattention, impulsivity, and restlessness resulting in functional impairment. Adults with ADHD commonly have problems with working memory, remaining focused on task, restlessness and excessive involvement in activities or speech. Emotional issues such as mood fluctuation, irritability, angry outbursts and low frustration tolerance are sometimes seen. In adults, ADHD may be comorbid with psychiatric disorders related to mood and anxiety disorders, and certain personality disorders.

Research suggests that the condition, which is usually present in childhood, persists into adulthood in a proportion of cases (around 40-60% have problems in adulthood). Reduction or remission of symptoms have been reported amongst adults, although there is some debate on whether this reflects misdiagnosis in childhood. Other research is studying the possibility of an adult-onset subtype of ADHD but data on this is inconclusive.

Medication can be used to manage ADHD symptoms and these can be broadly categorised as stimulants or other medications. Stimulant medication is described as being more effective but will not be suitable for everyone with ADHD. Side-effects may include impaired perceptual, motor, and cognitive functions, and impaired recognition of fatigue. Adverse effects such as visual and tactile hallucinations or mania have been reported to occur at usual prescribed doses in certain cases. Behavioural changes have also been reported in some instances, including aggression. Medication effectiveness can be time-limited, which is of concern if a dose is missed or flying time exceeds the therapeutic impact of the drug. Such medications are therefore not currently accepted for medical certification by national aviation authorities.

Given the variation in symptoms and the possibility of reduction of symptoms or remission in adulthood, a previous diagnosis of ADHD is not automatically disqualifying for aeromedical certification (Class 1, 2, 3 or LAPL). Those who have no ongoing symptoms and who are not on medication can be considered. Those who have recently stopped medication are likely to require a period off treatment to assess the impact before certification can be considered. The process will usually involve applicants applying for a medical certificate with an aeromedical examiner (AME) and providing copies of all neuropsychology, psychology or psychiatry reports ever undertaken. An up-to-date assessment with a neuropsychologist/aviation clinical psychologist may be required, but applicants should wait to be guided by their AME or the Civil Aviation Authority (CAA) medical department before obtaining such a report. Thereafter, and depending on the information provided, a medical certificate may be issued to enable the applicant to undertake flying/air traffic control training with reports on their progress.