Acute effects of concussion among adolescents with attention-deficit/hyperactivity disorder

ABSTRACT

Adolescents with ADHD have a greater lifetime history of concussion and experience concussion-like symptoms in the absence of a concussion, complicating concussion assessment and management. It is well established that individuals who experience greater acute symptoms following concussion are at risk for slower recovery and persistent symptoms. We examined whether youth with ADHD experience worse acute effects, within the first 72 h following concussion, compared to youth without ADHD. We hypothesized that youth with ADHD would perform worse on neurocognitive testing and endorse more severe symptoms acutely following injury, but the magnitude of change from pre injury to post injury would be similar for both groups, and thus comparable to baseline group differences. The sample included 852 adolescents with pre-injury and post-injury ImPACT results (within 72 h); we also conducted supplementary case-control analyses on a subset of youth with and without ADHD matched on demographics and pre-injury health history. For both samples, there were significant interaction effects for the Verbal Memory and Visual Motor Speed composites (p < 0.01, η²=.01–.07, small-medium effect), such that youth with ADHD showed a greater magnitude of diminished cognitive functioning from pre-injury to post-injury testing. There were no significant differences in the magnitudes of changes from pre injury to post injury with regard to overall symptom reporting (i.e., total symptom severity scores, total number of symptoms endorsed); however, there were group differences in endorsement rates for several individual symptoms. Further research is needed to determine whether such differential acute effects are associated with recovery time in youth with ADHD.

KEYWORDS:

• Mild traumatic brain injury
• ADHD
• cognition
• sports

Disclosure statement

Dr. Nathan Cook has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs. Dr. Ross Zafonte has received salary support from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He serves on the Scientific Advisory Board of Myomo, Oxeia Pharma, and ElMInda. Dr. Grant Iverson serves as a scientific advisor for NanoDX®, Sway Operations, LLC, and Highmark, Inc. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs (including athletes and former athletes). He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has received research funding as a principal investigator from the National Football League, and subcontract grant funding as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members.

Additional information

Funding

This study was funded in part by the National Football League for a program of research entitled “The Spectrum of Concussion: Predictors of Clinical Recovery, Treatment and Rehabilitation, and Possible Long-Term Effects” (PI: Iverson). The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication. This work was also funded in part by the Goldfarb Center for Public Policy and Civic Engagement at Colby College, and the Bill and Joan Alfond Foundation (PI: Berkner). Dr. Nathan Cook acknowledges support from the Louis V. Gerstner III Research Scholar Award. Dr. Grant Iverson acknowledges unrestricted philanthropic support from the Mooney-Reed Charitable Foundation, Heinz Family Foundation, Boston Bolts, National Rugby League, ImPACT Applications, Inc., and the Schoen Adams Research Institute at Spaulding Rehabilitation. None of the above entities were involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.