Current Evidence in Management of Concussion Baseline Testing in ADHD and Learning Difficulties Patients: A Critically Appraised Topic

Fisher, Mindi; Tierney, Ryan; Russ, Anne C.; Mansell, Jamie

doi:10.1123/ijatt.2018-0089

Cited by 4 publications

(4 citation statements)

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“…Research suggests that premorbid factors including the presence of neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD) and learning disorder (LD) complicate the assessment of sport-related concussion (Collins et al, 1999; Elbin et al, 2013; Fisher et al, 2019; Poysophon & Rao, 2018). These disorders are characterized by onset of cognitive and other deficits in childhood due to abnormal developmental processes.…”

Section: Previous Systematic Reviewsmentioning

confidence: 99%

“…Indeed, several systematic reviews have previously detailed some of this literature (Alsalaheen et al, 2016; Fisher et al, 2019; Gaudet & Weyandt, 2017; Iverson et al, 2017; Poysophon & Rao, 2018; Pujalte et al, 2019; Zuckerman et al, 2018). Alsalaheen et al (2016) reviewed the validity and psychometric evidence for Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and described increased rates of invalid baseline classification for athletes with ADHD and/or LD as well as lowered baseline performance.…”

Section: Previous Systematic Reviewsmentioning

confidence: 99%

“…They found relatively few studies of ADHD medication use, but these generally supported only a marginal increase in performance on neurocognitive testing and no differences for symptom reporting. Similarly, Fisher et al (2019) reported findings from six studies that suggested athletes with ADHD and/or LD evidence of differences in baseline performance and symptom reporting compared to healthy athletes without ADHD and/or LD. Their review also found athletes with ADHD evidence higher rates of invalid baselines.…”

Section: Previous Systematic Reviewsmentioning

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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Section: Previous Systematic Reviewsmentioning

confidence: 99%

Section: Previous Systematic Reviewsmentioning

confidence: 99%

Section: Previous Systematic Reviewsmentioning

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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“…Fatigue, difficulty concentrating, difficulty remembering, lack of balance, and trouble sleeping are all concussion-like symptoms that individuals with learning disorders can experience. 18 Similarly, patients with migraine headaches can experience headaches, nausea, and sensitivity to light and sound. 19 Regardless of the reason for delay, females have been more willing to report concussion symptoms and disclose injuries than their male counterparts.…”

mentioning

confidence: 99%

Factors Associated With Delayed Concussion Reporting by United States Service Academy Cadets

Bookbinder

Houston

Peck

et al. 2020

Journal of Athletic Training

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Context Approximately half of individuals who sustain a concussion do not immediately report their injuries. Motivators for not reporting include thinking the suspected concussion was not a serious injury and wanting to continue participating in activity. Additionally, military personnel have concerns about how concussions may affect their careers. However, delayed reporting can prolong neurobehavioral recovery. Understanding the frequency of delayed reporting and contributing factors will aid in identifying individuals who may be more likely to delay reporting. Objective To describe the frequency of delayed concussion reporting by service academy cadets and determine if sex, injury setting, sport level, or medical history is capable of predicting delayed reporting. Design Cohort study. Setting Service academies. Patients or Other Participants A total of 316 patients with concussions were observed from January 2014 to August 2016. Main Outcome Measure(s) All cadets completed an annual concussion baseline collection of demographic, medical history, and sports participation information. Delayed concussion reporting served as the outcome variable. Predictor variables were sex, injury setting, and sport level, as well as concussion, headache, and learning disorder history. Frequencies were calculated to describe the proportion of participants who delayed reporting. Univariable and multivariable logistic regression models were used to assess if the predictor variables were associated with delayed concussion reporting. Odds ratios (ORs) and 95% confidence intervals were calculated for all variables included in the final model. Results Of the patients with concussion, 51% were classified as delayed reporting. In univariable models, females (OR = 1.70) and National Collegiate Athletic Association cadet-athletes (OR = 1.98) were more likely to delay reporting than males and intramural cadet-athletes, respectively. The multivariable model yielded similar findings. Conclusions Roughly half of the cadets who sustained a concussion failed to immediately report their injury. Specifically, our data suggested that female cadets, cadets injured outside of competition, and highly competitive cadet-athletes were almost twice as likely to delay reporting as others.

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Influence of Autism and Other Neurodevelopmental Disorders on Cognitive and Symptom Profiles: Considerations for Baseline Sport Concussion Assessment

Maietta

Kuwabara

Cross

et al. 2021

Archives of Clinical Neuropsychology

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Objective The presence of neurodevelopmental disorders (ND) such as attention-deficit/hyperactivity disorder (ADHD) and learning disorders (LD) have demonstrated effects on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) performance. No current research has directly examined whether autism spectrum disorder (ASD) has similar effects. The current study compared ImPACT cognitive and symptom profiles in athletes with self-reported ASD to other NDs and healthy controls using case-control matching. Method The current study compared ImPACT baselines of high school athletes with ASD to athletes with other NDs (ADHD, LD, and co-occurring ADHD/LD) and healthy controls on cognitive composites and symptom reporting. Participants included 435 athletes (87 controls, 87 with ASD, 87 with ADHD, 87 with LD, and 87 with ADHD/LD) selected from a larger naturalistic sample. Athletes were matched to the ASD group based on age, sex, and sport using randomized case-matched selection from the larger database. Results Results revealed that athletes with ASD performed more poorly than healthy controls on the Visual Motor Speed composite. No differences were found for Post-concussion Symptom Scale (PCSS) domain scores. Differences in cognitive and symptom profiles among the athletes with other NDs were also found. Conclusions Results elucidate patterns of baseline performance for athletes with ASD, demonstrating that there may not be significant differences between ASD and healthy controls on four of the five ImPACT composites, and no symptom reporting differences. Cognitive and symptom differences found for other NDs should be considered when interpreting baseline performance and for making return-to-play decisions in the absence of baseline assessment.

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Current Evidence in Management of Concussion Baseline Testing in ADHD and Learning Difficulties Patients: A Critically Appraised Topic

Cited by 4 publications

References 8 publications

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.

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.

Factors Associated With Delayed Concussion Reporting by United States Service Academy Cadets

Influence of Autism and Other Neurodevelopmental Disorders on Cognitive and Symptom Profiles: Considerations for Baseline Sport Concussion Assessment

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