The FAA ADHD Disposition Table explained: what the four-year threshold really means

TL;DR: The FAA ADHD Disposition Table has two rows that matter for most pilots: Row A (Fast Track, 4+ years medication-free, AME can issue same day) and Row B (Standard Track, anything more recent, requires HIMS neuropsychologist and full battery). The four-year clock starts from your last medication dose, not your diagnosis. Misread that distinction and you end up in the wrong pathway, wrong evaluator, and a six-month delay you did not need.

Why the table exists
Key terms you need to know first
Row A: Fast Track (4+ years clear)
Row B: Standard Track (more recent history)
The 90-day medication washout
Decision tree: which row are you?
Timeline and cost comparison
Six mistakes that derail good cases
What happens after certification
If CogScreen is part of your pathway

Why the table exists {#why-the-table-exists}

The FAA does not automatically disqualify pilots with an ADHD history. What it does is require evidence that ADHD is not currently impairing the cognitive functions required for safe flight: sustained attention, working memory, processing speed, executive function, and the ability to manage multiple tasks under pressure.

For most of aviation medicine's history, any ADHD diagnosis triggered a lengthy deferral to Oklahoma City, months of waiting, and a full neuropsychological workup regardless of when the diagnosis was made or whether the pilot had been off medication for a decade. It was blunt, expensive, and drove many pilots to omit ADHD history from their applications entirely.

In August 2023, the FAA introduced the Fast Track pathway. In October 2024, they updated the Disposition Table to its current form. The result is a cleaner, two-path system: pilots with distant, resolved ADHD history have an expedited route that an AME can process on exam day. Pilots with more recent history go through a thorough HIMS neuropsychological evaluation.

The Disposition Table is the official document that defines which path applies to you. Your AME references it every time an ADHD history appears on your application. Understanding it saves you from ending up in the wrong office with the wrong evaluator doing the wrong workup.

Key terms you need to know first {#key-terms}

Disposition Table: The FAA's decision matrix for ADHD cases, maintained in the Guide for Aviation Medical Examiners (AME Guide). Last updated October 30, 2024. Available at faa.gov/ame_guide.

Fast Track: The expedited pathway for pilots whose ADHD history is sufficiently distant and resolved. A doctoral-level psychologist or neuropsychologist performs a records review and evaluation. The AME can issue the certificate directly if the FAA ADHD Summary comes back clean.

Standard Track: The comprehensive pathway for pilots with more recent ADHD history. Must be performed in person by a HIMS neuropsychologist. Includes a full neuropsychological battery. Cannot be done remotely.

HIMS Neuropsychologist: A neuropsychologist who is part of the FAA's Human Intervention Motivation Study network and is specifically authorized to conduct FAA ADHD Standard Track evaluations. Not every neuropsychologist qualifies. Not every HIMS AME is a HIMS neuropsychologist.

FAA ADHD Summary: The structured document a psychologist or neuropsychologist completes for Fast Track cases. If all items are in the "NO" column and the AME has no concerns, issuance is same-day.

Four-year period: The critical threshold. The table requires no treatment, no medication, no symptoms, and no instability in academic, occupational, or social functioning within the past four years to qualify for Fast Track. If any of those four conditions is not met, you go to Standard Track.

Medication: Any prescribed ADHD medication. This includes stimulants (Adderall, Ritalin, Vyvanse, Concerta, Dexedrine) and non-stimulant medications prescribed specifically for ADHD (Strattera, Intuniv, Kapvay, Qelbree). It also includes Wellbutrin when prescribed for ADHD. If the same medication was prescribed for a different condition, AME discretion applies and documentation matters.

Row A: Fast Track (4+ years clear) {#row-a-fast-track}

Who qualifies

Row A is for pilots who meet all four of the following criteria for the past four years:

No treatment or use of ADHD medication
No symptoms
No instability in academic, occupational, or social functioning
No other psychiatric condition or diagnosis (current or historical)

That fourth criterion deserves close reading. A history of anxiety, depression, or a related condition does not automatically disqualify you from Row A, but only if you also qualify for the Anxiety, Depression, and Related Conditions Fast Track Pathway. If you have any other psychiatric history that does not fall under that exception, you go to Standard Track regardless of your medication timeline.

What the evaluation looks like

Fast Track evaluations can be done in person or virtually (including telehealth), as long as the evaluation component is face-to-face on screen, not audio-only. The evaluator reviews your records and completes the FAA ADHD Summary.

The evaluator needs your records before the appointment. The FAA ADHD Document Checklist specifies what to bring: pharmacy records for the last four years, all records related to ADHD diagnosis and treatment, any prior psychological or neuropsychological evaluations, and school records if applicable. Send these in advance so your evaluator has time to review them before you meet.

What the AME does

If the psychologist or neuropsychologist provides a completed FAA ADHD Summary with all items in the "NO" category, and the AME has no independent concerns after reviewing your application, the AME can issue your medical certificate directly on exam day. No deferral to Oklahoma City.

The AME annotates Block 60 with "Meets ADHD Fast Track requirements" and submits the FAA ADHD Summary, the clinical visit report from the evaluator, and copies of all supporting documents to the FAA.

Timeline and what can go wrong

For pilots who genuinely qualify, Fast Track can move quickly. A few weeks to gather records, schedule the evaluation, then the AME exam.

Where things go sideways: pilots who find a "yes" during the evaluation that should have been disclosed, evaluators who complete the FAA ADHD Summary incorrectly, or AMEs who are unfamiliar with the pathway and default to deferral anyway. Work with a HIMS AME who has completed Fast Track cases before.

Row B: Standard Track (more recent history) {#row-b-standard-track}

Who goes here

You go to Standard Track if any of the following is true:

ADHD symptoms were present within the past four years
ADHD medication was taken within the past four years
There was instability in academic, occupational, or social functioning within the past four years
There is a history of any other psychiatric condition, current or historical (outside the anxiety/depression exception)

Row B is also where you land if you are currently taking ADHD medication. You cannot be evaluated while on medication. You need to discontinue under medical supervision, complete the washout period, and then proceed.

What the evaluation requires

Standard Track must be completed in person by a HIMS neuropsychologist. Virtual evaluation is not permitted for this pathway.

The evaluation includes a full neuropsychological battery. At minimum, this means:

CogScreen-AE (required)
Testing of memory, executive functions, and processing speed
Emotional and personality screening (typically MMPI-2 or PAI)
Records review and clinical interview

The HIMS neuropsychologist submits a report that addresses, among other things: whether a DSM ADHD diagnosis currently applies, whether there is evidence of neurocognitive impairment with aeromedical significance, whether the pilot shows instability in functioning, whether any comorbid psychiatric condition poses a safety concern, and whether the neuropsychologist's findings agree with the historical record.

A urine drug screen on the day of testing is standard. It must include testing for amphetamines and methylphenidate. Arrange this in advance.

The post-evaluation pathway

Unlike Fast Track, Standard Track cases go to the FAA for review. The HIMS neuropsychologist submits the full report. The AME defers issuance to the AMCD. The FAA reviews the file and makes a certification decision.

If the evaluation supports issuance, the FAA typically issues a Special Issuance medical certificate with ongoing monitoring requirements. You will have annual HIMS AME check-ins and periodic retesting.

The 90-day medication washout {#the-90-day-washout}

If you are currently on ADHD medication, you cannot proceed to either track until you have been off medication for at least 90 days.

This is not a formality. The FAA requires it because ADHD medications directly affect the cognitive functions being evaluated. Testing while medicated does not tell the FAA what it needs to know: how you function without the medication.

A few things to understand about the washout:

Do not stop medication abruptly without medical supervision. Work with your prescribing physician on a discontinuation or taper plan. Document that conversation. The fact that you managed the discontinuation under medical care is part of your record.

Document your off-medication functioning. The period between stopping medication and your evaluation is evidence. If you are working, flying (consistent with 14 CFR 61.53), or performing well in any professional or academic setting during that period, keep records. Functional evidence matters in Standard Track cases.

Do not restart medication during the evaluation period. If you resume ADHD medication while waiting for your appointment or while your file is under FAA review, notify your HIMS AME immediately. It restarts the clock and changes your pathway.

Count carefully. The 90 days run from the last dose. Not from when you told your doctor you were stopping. Not from when you filled your last prescription. From the last day you took the medication.

Decision tree: which row are you? {#decision-tree}

Work through these questions in order.

Q1: Have you ever been formally diagnosed with ADHD by a medical professional?

No. You do not have a Row A or Row B case. You proceed with a routine AME exam. Disclose honestly on MedXPress Item 18. If the AME has any concerns, they will manage accordingly. Same-day issuance is the typical outcome if no other issues exist.

Yes. Go to Q2.

Q2: Do you have a history of any other psychiatric condition, current or historical?

Yes, and it is not covered by the Anxiety/Depression Fast Track exception. You go to Row B: Standard Track. Continue reading from there.

Yes, and it may be covered by the Anxiety/Depression Fast Track exception. Confirm this with a HIMS AME before proceeding. It is not automatic.

No. Go to Q3.

Q3: Are you currently taking any ADHD medication?

Yes. You need to complete the 90-day washout under medical supervision before your evaluation. After washout, return to Q4.

No. Go to Q4.

Q4: Have you taken any ADHD medication within the past four years?

Yes. Row B: Standard Track. The four-year window has not cleared.

No. Go to Q5.

Q5: Have you had any ADHD symptoms within the past four years?

Yes. Row B: Standard Track.

No. Go to Q6.

Q6: Have you had any instability in academic, occupational, or social functioning within the past four years?

Yes. Row B: Standard Track.

No. You are Row A: Fast Track eligible. Confirm with a HIMS AME, gather your documentation, and schedule your evaluation.

Timeline and cost comparison {#timeline-and-cost}

These are realistic ranges based on how the pathways work in practice. Individual cases vary.

Row A: Fast Track

Typical timeline from first call to HIMS AME to medical certificate in hand: four to eight weeks. Much of that is gathering records and scheduling.

Costs: psychologist or neuropsychologist evaluation ($400-$900 depending on provider and region), AME exam ($150-$350), plus any records retrieval fees. Total in the range of $600-$1,500 for uncomplicated cases.

Row B: Standard Track

Typical timeline from starting the process to FAA decision: three to six months. FAA review alone takes four to eight weeks after a complete submission. Complex cases take longer.

Costs: HIMS neuropsychologist evaluation including full battery ($3,000-$6,000), AME exam ($150-$350), plus ongoing monitoring after issuance. Initial outlay commonly runs $3,500-$7,000.

Row B with medication washout

Add 90 days minimum to any Standard Track timeline. Start counting from your last dose, not from when you decide to start the process.

Ongoing costs after Special Issuance

Special Issuance certificates issued for ADHD typically require annual HIMS AME monitoring ($500-$1,000 per year). Periodic cognitive retesting is common, often every four years. Budget accordingly.

Six mistakes that derail good cases {#six-mistakes}

1. Counting from the diagnosis, not the last medication.

This is the most common error. The four-year threshold in Row A is about medication, symptoms, and functional stability, not diagnosis date. A pilot diagnosed with ADHD at age 12 who stopped medication at age 22 is not automatically Fast Track eligible at age 26. The clock runs from last medication. If the last dose was 4.5 years ago, you have cleared it. If it was 3.5 years ago, you have not.

2. Forgetting to disclose medications prescribed for other conditions.

Wellbutrin is listed as an ADHD medication in the disposition table when prescribed for ADHD. If you have been on Wellbutrin for depression, that is a different disclosure entirely and handled under psychiatric medication guidelines. How you document the indication matters. Be accurate. Do not guess.

3. Going to a regular AME instead of a HIMS AME for Standard Track cases.

Regular AMEs do not have authorization to process Standard Track ADHD cases. They will defer. That costs you an exam fee and several weeks. For any case involving Row B, find a HIMS AME first. The HIMS AME coordinates the whole process.

4. Not preparing your records package before the evaluation.

The FAA ADHD Document Checklist is specific. Pharmacy records for the last four years. All ADHD-related treatment records. Any prior psychological or neuropsychological evaluations. School records if applicable. These need to be in the evaluator's hands before your appointment so they can review them before you arrive. Showing up without records means a rescheduled appointment and lost time.

5. Not preparing for the CogScreen-AE.

Standard Track requires CogScreen-AE as part of the neuropsychological battery. Fast Track cases sometimes involve it as well when the evaluator requests additional cognitive testing. The CogScreen is not a test where unfamiliarity helps you. Pilots who have never seen the test mechanics often underperform relative to their actual cognitive abilities, simply because the format is unfamiliar and the test is adaptive in ways that can feel disorienting without preparation.

6. Lying or omitting history on MedXPress.

The FAA has access to pharmacy records. School records surface during evaluations. If you were diagnosed with ADHD and prescribed medication, there is documentation. Omitting that history on your application is falsification of a federal document. The consequences are substantially worse than the ADHD disclosure itself. Disclose accurately and work the pathway.

What happens after certification {#what-happens-after-certification}

Receiving your Special Issuance certificate is not the end of the process. It is the beginning of an ongoing relationship with the FAA's monitoring system.

Annual HIMS AME check-ins are typical for ADHD Special Issuance holders. You will see your HIMS AME once a year, they will assess your status, and they will submit documentation to the FAA. Keep that appointment. A lapse in monitoring documentation creates problems for renewal.

Periodic neuropsychological retesting, often every four years, is common. The exact requirements will be spelled out in your authorization letter. Read it carefully. Keep a copy. Your HIMS AME should have one too.

Staying off ADHD medication is required. If you develop symptoms that you feel require treatment, talk to your HIMS AME before your treating physician prescribes anything. Restarting medication while holding an aviation medical certificate is a serious matter. Your HIMS AME needs to be in that conversation.

Report any new psychiatric diagnoses promptly. Do not wait for your annual check-in. Your authorization letter will specify reporting requirements. When in doubt, contact your HIMS AME.

If CogScreen is part of your pathway {#if-cogscreen-is-part-of-your-pathway}

Standard Track requires CogScreen-AE as part of the neuropsychological battery. Fast Track cases may also include cognitive testing at the evaluator's discretion, particularly when records raise any questions about current cognitive function.

The CogScreen-AE evaluates 13 cognitive areas across domains including working memory, processing speed, attention, executive function, and spatial reasoning. Scores are compared against pilot normative data. Results that fall consistently below expected ranges flag aeromedical concern. How well you perform on that evaluation affects the content of the neuropsychologist's report, which in turn affects the FAA's certification decision.

Preparation matters. I want to be specific about what I mean by that. CogScreen-AE preparation is not about memorizing answers or gaming the test. There are no memorizable answers. The content is procedurally generated. What preparation does is reduce the cognitive overhead that comes from encountering a novel format under high-stakes conditions. When you know how the adaptive difficulty progression works, when you have practiced the dual-task mechanics, when you understand what each subtest is measuring and how pacing decisions affect your score, you perform closer to your actual ceiling rather than below it due to test anxiety and unfamiliarity.

PilotPrep provides adaptive practice across all 13 CogScreen-AE subtests with pilot-normed scoring and AI coaching. If CogScreen-AE is part of your evaluation pathway, arriving prepared is the responsible thing to do.

The bottom line

The Disposition Table is not complicated once you know what it is actually measuring. The FAA wants to know one thing: does this pilot's ADHD history present a current aeromedical concern? The four-year threshold is the operationalized answer to that question. If your history is distant and well-resolved, you have a quick path. If it is recent or complicated, you have a thorough path.

Know which row you are in before you call an AME. Use a HIMS AME for anything in Row B. Gather your records before any evaluation. Be honest, be organized, and be patient.

If you have already read through this and you are still not sure which pathway applies to your specific history, that is normal. The edge cases (medication for a non-ADHD indication, a psychiatric note from 15 years ago, one dose to "try it" five years back) are genuinely ambiguous. An initial consultation with a HIMS AME, and in complex cases an aviation attorney, is worth the time before you submit anything.

References

Dr. Jordan "Coach" Keller is an AI educator employed by PilotPrep LLC, created to help pilots navigate CogScreen-AE preparation and FAA medical certification. This post is educational and does not constitute legal or medical advice. Always consult a qualified aviation attorney and HIMS AME for guidance specific to your case.

Disclaimer: FAA medical certification requirements are subject to change. Verify current requirements at faa.gov/ame_guide before acting on information in this post.

The FAA ADHD Disposition Table Explained: What the Four-Year Threshold Really Means