Comparison of baseline and post-concussion ImPACT test scores in young athletes with stimulant-treated and untreated ADHD

ABSTRACT

Objectives: Baseline and post-concussion neurocognitive testing is useful in managing concussed athletes. Attention deficit hyperactivity disorder (ADHD) and stimulant medications are recognized as potential modifiers of performance on neurocognitive testing by the Concussion in Sport Group. Our goal was to assess whether individuals with ADHD perform differently on post-concussion testing and if this difference is related to the use of stimulants.

Methods: Retrospective case-control study in which 4373 athletes underwent baseline and post-concussion testing using the ImPACT battery. 277 athletes self-reported a history of ADHD, of which, 206 reported no stimulant treatment and 69 reported stimulant treatment. Each group was matched with participants reporting no history of ADHD or stimulant use on several biopsychosocial characteristics. Non-parametric tests were used to assess ImPACT composite score differences between groups.

Results: Participants with ADHD had worse verbal memory, visual memory, visual motor speed, and reaction time scores than matched controls at baseline and post-concussion, all with p ≤ .001 and |r|≥ 0.100. Athletes without stimulant treatment had lower verbal memory, visual memory, visual motor speed, and reaction time scores than controls at baseline (p ≤ 0.01, |r|≥ 0.100 [except verbal memory, r = −0.088]) and post-concussion (p = 0.000, |r|> 0.100). Athletes with stimulant treatment had lower verbal memory (Baseline: p = 0.047, r = −0.108; Post-concussion: p = 0.023, r = −0.124) and visual memory scores (Baseline: p = 0.013, r = −0.134; Post-concussion: p = 0.003, r = −0.162) but equivalent visual motor speed and reaction time scores versus controls at baseline and post-concussion.

Conclusions: ADHD-specific baseline and post-concussion neuropsychological profiles, as well as stimulant medication status, may need to be considered when interpreting ImPACT test results. Further investigation into the effects of ADHD and stimulant use on recovery from sport-related concussion (SRC) is warranted.

KEYWORDS:

• Attention Deficit Hyperactivity Disorder (ADHD)
• sports-related
• concussion
• ImPACT
• stimulant
• baseline
• post-concussion
• mild traumatic brain injury

Declaration of interest

CM Bonfield serves as an unaffiliated neurotrauma consultant for the NFL. GS Solomon receives consulting fees from the Tennessee Titans (National Football League or NFL), the Nashville Predators (National Hockey League or NHL), and athletic departments of several universities. GS Solomon is also a member of the ImPACT advisory board and receives reimbursement for expenses to board meetings. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Notes

1. Including Argentina, Australia, Bolivia, Brazil, Canada, Chile, China, Colombia, Costa Rica, Cuba, Denmark, Dominican Republic, Ecuador, Egypt, El Salvador, Finland, France, Germany, Haiti, Honduras, India, Ireland, Italy, Jamaica, Japan, Latvia, Liberia Mali, Mexico, New Zealand, Nigeria, Norway, Pakistan, Philippines, Poland, Portugal, Puerto Rico, Russia, Serbia, South Africa, South Korea, Spain, Sri Lanka, Swaziland, Sweden, Switzerland, Thailand, Turkey, United Kingdom, Uruguay, Venezuela, and Vietnam.

2. A study participant’s weight can change over time. To take this into account, participants were excluded if their weights were with either not reported or hugely inconsistent, which we defined as a difference of >100 kg, between baseline and postconcussion testing. For example, if the participant stated their weight were 80 kg at baseline and 180 kg at postconcussion, they were excluded.

3. From our 4373 participant cohort, the countries represented included Australia (1), Canada (64), Cape Verde (1), China (1), Cook Islands (1), Guam (1), Ireland (1), Japan (2), Mexico (1), Puerto Rico (1), Russia (1), South Africa (5), United Kingdom (5), and the rest from the United States. From the cohort reporting a history of ADHD, all participants were from the United States except two participants who were both from Canada.

Additional information

Funding

This article was not funded.