Athletes with intellectual impairments and the anti-doping policy

As elite athletes start to gather in Paris for the 2024 Paralympics Games, the study, funded by the World Anti-Doping Agency, examined the anti-doping experiences of athletes with intellectual impairments. It found that the education they receive is too complicated, difficult to interpret, and distressing, and that there is a need to ensure anti-doping education for these athletes is made more accessible.

Participants in international sport competitions are bound by anti-doping policy. All athletes, as well as their support personnel e.g. coaches, doctors, parents, are required to follow the anti-doping rules. Athletes or their support personnel can still be sanctioned regardless of their intent or knowledge of these rules. As such, a cornerstone of World Anti-Doping Code (WADC) policy is anti-doping education, which aims to ensure that all athletes and their support personnel who compete under the WADC are aware of and have the decision-making capability to avoid intentionally and unintentionally failing an anti-doping rule violation.

Until now no research has specifically examined the anti-doping experiences of athletes with intellectual impairments. This study was the first to do so by interviewing athletes and their support personnel’s experience of anti-doping policy and practice.

Dr Philip Hurst is a Senior Lecturer in Sport and Exercise Psychology at Canterbury Christ Church University and co-author of the report.

Four themes emerged from the interviews:

1. Athletes had an awareness of anti-doping and believed it was important for ensuring fair play, displaying a strong enthusiasm to ensure they play by the rules, but they found it difficult to differentiate between prohibited and permitted drugs. They also had a limited deeper understanding of the rules enforced, such as anti-doping rule violations, refusing a drug test or how to apply for a therapeutic use exemption (TUE).

2. Athletes experienced negative emotional distress during drug testing where they felt they had done something wrong or believed that being selected for a drug test was a sign that they were cheating. They reported being ‘scared’, ‘nervous’ and that it caused ‘panic and’ distress’ for them.

Many athletes were diagnosed with neurodevelopment conditions, such as autism, with parents indicating there is ‘black and white thinking’ and a need to ensure ‘routine and structure in their day-to-day lives’. As such, when athletes were selected for a drug test, this changed their routine and led to distress.

3. The education delivered was a one size fits all approach which did not recognise variations in athlete impairments such as attention, independence, and emotional stability, as well as high suggestibility and compliance.

4. Anti-doping education is overly complicated for athletes to interpret and understand, and it needs to be made more accessible that is shortened, simplified and repeated over the season.

“The findings from our study have practical implications for anti-doping organisations,” continued Dr Hurst.

“Collectively, a need exists in tailoring anti-doping education for athletes with intellectual impairments. Sessions need to be shorter, ideally less than 20 minutes. They should also include peer-to-peer learning opportunities, be in smaller groups, be less reliant on text, involve experiential tasks and be free of technical jargon.

“Parents or guardians of athletes with intellectual impairments also play a significant role and it is vital that they too receive anti-doping education. Support personnel are central in reinforcing messages and guiding decision making to their athletes.

“Finally, to stop the distress caused by the testing procedure, doping control officers can ease concerns by showing empathy to athletes, explaining the process calmy and normalising it (e.g., all athletes at this level are drug tested). This is essential given the spectrum of intellectual impairment and it is important to recognise that the anti-doping rules may be contradictory to what they have been previously told. Such an example was shown in our study with one athlete being told not to open the door to people they don’t know. However, drug testers could turn up unexpectedly and if they do not answer the door, they could be banned from sport. Therefore, it is recommended that doping control officers are trained and educated in working with athletes who have an intellectual impairment that in turn, can help prevent negative emotional experiences with the doping control test and ensure their well-being

“Athletes with intellectual impairments are at an increased risk of maltreatment. It is therefore incumbent for the anti-doping community to ensure their safety and well-being is protected. That they are appropriately safeguarded, and that education programmes are adapted to athletes with intellectual impairments so that this information can be processed accordingly, and anti-doping behaviours can be adopted which protects athlete well-being and delivers compliance.”