Back to Season: Why the Transition Hits ADHD and Anxious Athletes Hardest

Every August, the same pattern shows up. An athlete who had a solid, manageable summer suddenly looks like they're falling apart in the first two weeks of preseason. Parents are confused. Coaches are frustrated. The athlete just feels like something is wrong with them.

Nothing is wrong with them. The transition itself is the problem, and it's a bigger deal than most people give it credit for.

The transition is the hard part, not the sport

For athletes with ADHD, summer often runs on low structure. No school schedule, no strict practice times, more freedom to self-regulate on their own terms. Then preseason hits and everything compresses at once: two-a-days, school starting back up, homework, curfews, film sessions, coaches expecting instant focus.

That's a lot of executive function demand landing all at once, and executive function is exactly what ADHD makes harder to access on command.

Here's the counterintuitive part: the sport itself tends to help. When researchers put teenagers with ADHD through a single session of aerobic exercise, their focus, working memory, and ability to plan all measurably improved afterward. And this isn't one small study. When two dozen studies of exercise in kids and teens with ADHD were pooled together, the same pattern held.

So athletes with ADHD often function better in season than out of it. The rhythm helps. The problem is the gap, the stretch between "no structure" and "settled into structure." That's where kids look like they're regressing, and it's exactly the window coaches and parents should be paying attention to instead of writing it off as an attitude problem.

Performance anxiety isn't just nerves, and it isn't rare

Some anxiety before a season is normal and even useful. Plenty of athletes get keyed up before competition and it never touches the rest of their lives. The problem is when it doesn't settle once games start, or when it starts eating into sleep, appetite, or willingness to show up at all.

When it crosses that line, there's a clear answer. Sports medicine's national guidance points to cognitive behavioral therapy as the first-line treatment for anxiety in athletes, and it specifically says that therapy should come from someone who has actually worked with athletes, not just someone who knows the technique. That distinction matters more than it sounds like it should.

That same guidance is careful about medication. It isn't off the table, but it has to account for how a given medication affects an athlete's body and performance. This is a conversation worth having with someone who understands how medications work in the context of sports and performance.

And this isn't a minor quality-of-life issue. Researchers followed nearly a thousand Division I athletes across four seasons, screening them before the season started and tracking every injury after. Athletes who came in with anxiety symptoms went on to get hurt at more than twice the rate of athletes who didn't, in both men's and women's sports. Interestingly, depression alone didn't predict injuries. Anxiety was the one that tracked.

That doesn't prove anxiety causes the injuries, but it's a pattern worth paying attention to.

For collegiate athletes, it's stress stacked on stress

College athletes absorb academic pressure and athletic pressure at the same time, often while living away from home for the first time. And we actually know when that combination bites hardest.

One group of researchers tracked nearly 200 university athletes over four years, watching their mood, sleep, academic stress, and training load. Two periods stood out as danger zones: exam weeks, and preseason, specifically when training volume jumped up sharply and suddenly. Lower mood, less sleep, and more academic stress each independently predicted getting hurt.

So the sense that the first weeks of August are a high-risk stretch isn't just something I've noticed in my office. It's measurable.

College athletes are also famously reluctant to ask for help. Across the research on this, only about one in five athletes with a mental health concern actually seeks formal help. The barriers aren't the usual ones, either, they're specific to sport. Not wanting to be the one who isn't mentally tough. Worrying about losing a roster spot. Not trusting that what gets said stays private.

That reluctance doesn't make the stress smaller. It just makes it less visible until it shows up as a slump, an injury, or a kid who stops answering their parents' calls.

What does move the needle: making these conversations normal inside the team, being explicit about what stays confidential, and athletes who've been open about getting help themselves.

What actually helps

The fix isn't "push through it." It isn't "sit the season out." It's building a plan before the season starts instead of reacting once things are already coming apart.

That looks like naming the executive function gap out loud instead of treating it as a discipline problem. Building in a short runway of structure before official practices begin. Having an actual plan for anxiety symptoms rather than hoping they fade. And, given what the research says about sudden training spikes, being realistic with coaches about what a sharp ramp in workload costs during the same two weeks everything else is ramping.

It also means working with someone who understands both the psychiatric side and the athletic side. Not a general provider who's never sat across from a kid worried about losing a starting spot. Not a coach who isn't equipped to treat a clinical anxiety disorder or manage medication.

There's a good wolf and a bad wolf inside every athlete. The one that wins is the one you feed, and the weeks before a season starts are exactly when that feeding happens, for better or worse.

If your athlete is heading into preseason and this transition has been rough before, it's worth a real conversation before week one instead of week four.

Dr. Stephen Morris is a board-certified psychiatrist and founder of Good Wolf Wellness, a sports and performance psychiatry practice in Chicago. He works with athletes, golfers, and high-performing professionals in person and via telehealth across Illinois. To schedule a free 15-minute introductory call, visit goodwolfwellness.com.

References

Kuo HI, Sun JL, Nitsche M, Chang JC. An investigation of the acute effects of aerobic exercise on executive function and cortical excitability in adolescents with attention deficit hyperactivity disorder (ADHD). European Child & Adolescent Psychiatry. 2024;33(12):4169-4183.

Song Y, Fan B, Wang C, Yu H. Meta-analysis of the effects of physical activity on executive function in children and adolescents with attention deficit hyperactivity disorder. PLoS One. 2023;18(8):e0289732.

Chang CJ, Putukian M, Aerni G, et al. Mental health issues and psychological factors in athletes: detection, management, effect on performance, and prevention. American Medical Society for Sports Medicine position statement. Clinical Journal of Sport Medicine. 2020;30(2):e61-e87.

Li H, Moreland JJ, Peek-Asa C, Yang J. Preseason anxiety and depressive symptoms and prospective injury risk in collegiate athletes. American Journal of Sports Medicine. 2017;45(9):2148-2155.

Hamlin MJ, Wilkes D, Elliot CA, Lizamore CA, Kathiravel Y. Monitoring training loads and perceived stress in young elite university athletes. Frontiers in Physiology. 2019;10:34.

Cosh SM, McNeil DG, Jeffreys A, Clark L, Tully PJ. Athlete mental health help-seeking: a systematic review and meta-analysis of rates, barriers and facilitators. Psychology of Sport and Exercise. 2024;71:102586.