Examining attention-deficit/hyperactivity disorder in endurance and ultra-endurance runners

Comprehensive Summary

The study being conducted by Scheer et al. aims to determine the association between ADHD symptoms and endurance (half-marathon and marathon) and ultra-endurance (ultramarathon) running. This research used online surveys of 601 runners (222 women and 379 men), of which 9.7% of participants screened positive for ADHD, which isa higher rate than in the general adult population. Rates were slightly higher for half-marathon runners as opposed to marathon and ultramarathon runners, but these results were not statistically significant. However, the only statistically significant factor was found to be age, in which younger runners – specifically those under the age of 40 – were more likely to screen positively. The authors suggest that running may attract individuals with ADHD traits because it provides structure and an outlet for energy, possibly functioning as a form of “self-medication.” However, the study contends that the screening results are not definitive and should be followed up with clinical evaluation. The authors conclude that ADHD traits may be more common in endurance and ultra-endurance runners than previously reported in athletes or the general population. They recommend increased awareness, screening, and appropriate referral pathways in sports settings to support athlete mental health.

Outcomes and Implications

Attention-deficit/hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder influenced by genetic, neurobiological, and environmental factors. This study directly informs sports medicine, particularly pre-participation screening and athlete health monitoring, such as integrating brief mental health screening tools (such as ASRS-5) into athlete evaluations. The study also contributes to adult ADHD research by highlighting a potentially higher than expected rate of ADHD traits in a specific athletic subgroup and suggesting that structured endurance sports may serve as an important self-regulation strategy. Clinically, this can be important because adults are routinely underdiagnosed with ADHD and especially, athletes can be overlooked due to high achievement. This research encourages psychiatrists and primary care physicians to ask about exercise patterns when evaluating adults for ADHD. Additionally, endurance runners typically engage regularly with healthcare systems, such as injury management and routine physicals, which can provide a practical opportunity for early identification and mental health screening. Because ADHD can be associated with depression, anxiety, substance use disorders, and executive dysfunction, identifying it earlier may reduce long-term morbidity. This work is also important because it identifies young adult runners as a vulnerable population, but there are also some limitations in the research, including self-reported data and no confirmation of diagnosis. However, clinicians can already consider adding brief ADHD screening in mental health assessments in sports clinics and recognize that high-functioning athletes may still meet ADHD criteria.