ADHD May Associate With Reduced Tolerance to Acute Subconcussive Head Impacts: A Pilot Case-Control Intervention Study

Nowak, Madeleine K.; Ejima, Keisuke; Quinn, Patrick D.; Mickleborough, Timothy D.; Harezlak, Jaroslaw; Newman, Sharlene D.; Kawata, Keisuke

doi:10.1177/1087054720969977

Cited by 12 publications

(26 citation statements)

References 53 publications

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“…Because cognitive testing detects changes in memory and attention, the effects of RHI may have been obscured in athletes with concomitant attentional deficits. This was highlighted in a recent study that ADHD may induce reduced cognitive resiliency to RHIs such that soccer players with ADHD showed significant decline in memory functions after 10 short-term soccer headings, whereas soccer players without ADHD showed no remarkable change 37. In addition, cognitive studies that examined younger children were more likely to report no effect of RHIs on cognition, possibly due to children being outliers in age and cognitive ability.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review

Stephen

Hasman

Goldenberg

et al. 2022

Journal of Head Trauma Rehabilitation

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Objective: To summarize the evidence linking contact sports-related repetitive head impacts (RHIs) and short-term declines in neurologic function. Methods: A scoping review following the guidelines in the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and searching 3 databases (PubMed, EMBASE, and Web of Science) was performed. Peer-reviewed research articles were eligible for inclusion if they were full-length English language articles published between 1999 and 2019 examining athletes between the ages of 14 and 40 years exposed to RHIs, and reporting cognitive, vestibular, and/or oculomotor outcomes within 4 weeks of last head hit exposure. Results: Fifty-two articles met criteria for review: 14 reported oculomotor outcomes, 23 reported vestibular outcomes, and 36 reported cognitive function. Short-term RHI-related declines in neurologic function were reported in 42.9% of oculomotor studies, in 20.8% of vestibular studies, and in 33.3% of cognitive studies. Most of the 52 studies involved American football, soccer, or ice hockey athletes at the collegiate (n = 23) or high school (n = 14) level. Twenty-four (46%) studies involved only male athletes. Wearable sensors were used to measure RHIs in 24 studies (46%), while RHIs were not measured in 26 studies (50%). In addition, many studies failed to control for attention-deficit/hyperactivity disorder/learning disability and/or concussion history. Conclusion:The results of this scoping review suggest that the evidence linking RHIs to short-term declines in neurologic function is relatively sparse and lacking in methodological rigor. Although most studies failed to find a link, those that did were more likely to use objective measures of RHIs and to control for confounders. More careful trial design may be needed to definitively establish a causal link between RHIs and short-term neurologic dysfunction.

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Section: Discussionmentioning

confidence: 99%

Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review

Stephen

Hasman

Goldenberg

et al. 2022

Journal of Head Trauma Rehabilitation

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“…Of the 34 included articles, the vast majority relied on self-reported ADHD/LD status using ImPACT’s demographic history section or study-specific history questionnaires. Only three studies directly evaluated study participants’ neurodevelopmental history using either semistructured interview (i.e., Kiddie Schedule for Affective Disorders and Schizophrenia; Biederman et al, 2015; Iaccarino et al, 2018) or documentation of previous evaluation by a health care provider (i.e., neuropsychologist, psychiatrist, neurologist) and additional administration of an ADHD symptom checklist (Nowak et al, 2022).…”

Section: Resultsmentioning

confidence: 99%

“…Of these articles, 13 directly compared mean differences in performance on ImPACT Composite scores between ADHD and/or LD groups and healthy athletes (Biederman et al, 2015; Brooks et al, 2016; Cottle et al, 2017; Covassin et al, 2013; Elbin et al, 2013; Iaccarino et al, 2018; Kaye et al, 2019; Maietta, Kuwabara, et al, 2021; L. Manderino & Gunstad, 2018; Mautner et al, 2015; Peltonen et al, 2019; Salinas et al, 2016; Zuckerman et al, 2013), whereas five articles investigated additional aspects of baseline performance, for example, predictors of low performance (Brett, Solomon, et al, 2018; Brooks et al, 2018; Cook et al, 2017; Gardner et al, 2017; Houck et al, 2019) and one additional article utilized an experimental paradigm to assess ADHD effects on cognition post 10 soccer headings (Nowak et al, 2022). Table 2 provides details of these articles’ findings with a visual summary of the findings presented in Figure 2.…”

Section: Resultsmentioning

confidence: 99%

“…A major limitation of the extant literature is the reliance on self-report of ADHD and/or LD history as well as concussion history rather than expert-verified diagnosis of neurodevelopmental disorder and/or concussion. Indeed, only three studies (Biederman et al, 2015; Iaccarino et al, 2018; Nowak et al, 2022) directly assessed neurodevelopmental disorder diagnosis, whereas the remaining 31 articles utilized self-reported neurodevelopmental history. Of these, only one was included in the meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review and meta-analysis of factors influencing ImPACT concussion testing in high school and collegiate athletes with self-reported ADHD and/or LD.

Maietta¹,

Renn²,

Goodwin³

et al. 2023

Neuropsychology

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Objective: Sport concussion is a common injury, and athletes with attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD) are at increased risk and require specialized attention in clinical settings. Although systematic reviews of the relationship between ADHD/LD and concussion are reported in the literature, these reviews do not include quantitative syntheses. Additionally, no reviews have focused on the most commonly utilized concussion assessment, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The current review provides an update of sport concussion assessment in athletes with ADHD and/or LD from 2000 to 2021 on these topics: baseline and postconcussion performance on ImPACT, baseline and postconcussion symptom reporting using the Postconcussion Symptom Scale, invalid baseline classification on ImPACT, and self-reported history of concussion. Method: Meta-analyses were conducted on baseline ImPACT performance, symptom reporting, invalid baseline classification, and concussion rates. Thirty-four studies were included in systematic review and 19 were included in meta-analyses. Results: Decreased baseline performance was found for athletes with ADHD (trivial to small effects), LD (small-to-medium effects), and ADHD/LD (small-to-medium effects). Increased baseline symptom reporting was found for athletes with ADHD (small effect). Increased odds of invalid baseline performance (trivial effect) and self-reported concussion history (small effect) were found in ADHD. Conclusions: These results provide the first quantitative synthesis of the literature in this area. It is recommended that future research further examines these topics in athletes with LD and co-occurring ADHD/LD (given the focus on ADHD), as well as the effects that all of these conditions may have on concussion recovery and return-to-play decision-making. Key PointsQuestion: This systematic review and meta-analysis synthesize the sport concussion ImPACT literature in high school and collegiate athletes with self-reported attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD) with topics including baseline and postconcussion cognitive differences, symptom differences, invalid performance, and self-reported concussion rates. Findings: Meta-analysis results indicated that athletes with ADHD and/or LD had poorer cognitive performance and that those with ADHD had increased symptom reporting and were at higher risk for concussion and invalid baseline performance. Importance: Athletes with ADHD and/or LD may require increased attention in sport concussion assessment due to differences in cognitive performance and symptom reporting as well as higher rates of self-reported concussion history, particularly for athletes with ADHD. Next Steps:Neuropsychology

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“…While pyschostimulants methylphenidate (MPH) or amphetamines remain the first line of ADHD treatment [8][9][10], there is a growing appreciation for the beneficial role of nonpharmacological therapies. These include the use of physical activities such as exercise and sports [11][12][13]. A recent meta-analysis of 30 studies showed that moderate to intense aerobic exercise can be effective in the management of the cognitive and behavioral symptoms of ADHD [14].…”

Section: Introductionmentioning

confidence: 99%

Repetitive Mild Traumatic Brain Injury in a Perinatal Nicotine Exposure Mouse Model of Attention Deficit Hyperactivity Disorder

et al. 2021

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Attention deficit hyperactivity disorder (ADHD) increases the risk for concussion or mild traumatic brain injury (mTBI). At the same time, recommendations for the management of ADHD include participation in sports and other organized physical activities, including those that carry an increased risk of mTBI. Very little work has been done to determine the extent to which untreated ADHD adversely impacts behavioral outcomes of repeated mild concussions. Here, we used a perinatal nicotine exposure (PNE) mouse model of ADHD combined with a closed-head, repetitive mTBI model. The PNE mouse model carries significant construct, face, and predictive validity as a preclinical model of ADHD. Two-month-old PNE and control mice were subjected to closed-head repetitive mTBI or sham procedure once daily for 5 days. Object-based attention, novel object recognition memory, spatial working memory, and depression-like behavior were analyzed 1 day and 2 weeks following repeated mTBI. Consistent with our previous reports, mice in the PNE group showed significant deficits in object-based attention and working memory prior to mTBI. These deficits persisted following the repeated mTBI. Repeated mTBI produced a transient attention deficit in the control group but did not exacerbate the attention deficit that is characteristic of the PNE group. Although neither PNE nor repetitive mTBI alone influenced immobility in the tail suspension test, when PNE mice were subjected to mTBI, there was a transient increase in this measurement suggesting a synergistic effect of ADHD and mTBI on depression-like behavior. Thus, our data using the PNE mouse model suggest that ADHD may be a risk factor for transient depression following repeated mTBI and that repeated mTBI may be a risk factor for transient attention deficit.

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ADHD May Associate With Reduced Tolerance to Acute Subconcussive Head Impacts: A Pilot Case-Control Intervention Study

Cited by 12 publications

References 53 publications

Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review

Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review

A systematic review and meta-analysis of factors influencing ImPACT concussion testing in high school and collegiate athletes with self-reported ADHD and/or LD.

Repetitive Mild Traumatic Brain Injury in a Perinatal Nicotine Exposure Mouse Model of Attention Deficit Hyperactivity Disorder

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