Sport concussion and attention deficit hyperactivity disorder in student athletes

Abstract

BackgroundAttention deficit hyperactivity disorder (ADHD) is associated with impulsive behavior and inattention, making it a potential risk factor for sport-related concussion (SRC). The objectives of this study were to determine whether ADHD is an antecedent risk factor for SRC and whether ADHD complicates recovery from SRC in youth athletes.MethodsStudent athletes with a history of SRC were evaluated for the presence of ADHD using diagnostic interview and to determine whether ADHD symptoms began before or after SRC. Concussion-specific measures of concussive symptoms and cognitive function were compared in SRC + ADHD and SRC + No ADHD groups to assess SRC recovery between groups.ResultsADHD was overrepresented in youth with SRC compared with population rates. ADHD was found to be an antecedent risk factor for SRC, with age at ADHD onset earlier than the date of SRC. Student athletes with SRC and ADHD reported more concussive symptoms compared with athletes without ADHD and were more likely to have a history of greater than one concussion.ConclusionsThe results of this study support our hypothesis that ADHD is an antecedent risk factor for SRC and may contribute to a more complicated course of recovery from SRC. Future research should focus on determining whether screening, diagnosis, and treating ADHD in youth athletes may prevent SRC. Providers that care for youth athletes with ADHD should be aware of the vulnerabilities of this population toward SRC and its complications.

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

“…Attention-deficit/hyperactivity disorder (ADHD), which affects 6.4 million children (Visser et al, 2014) and nearly 2 million young adults in the United States (Kessler et al, 2006), is the most common neurodevelopmental disorder and is characterized by impulsivity, inattention, and hyperactivity (Centers for Disease & Prevention, 2005). ADHD has been shown to be an antecedent risk factor for concussion in high school and college athletes, with the concussion incidence increasing by 1.5-to 5-fold (Biederman et al, 2015;Iaccarino et al, 2018;Liou et al, 2018), accompanied by amplified concussion symptoms, prolonged recovery (Adeyemo et al, 2014), and impaired performance on working memory tasks (Biederman et al, 2015).…”

“…We used our soccer heading paradigm (Bevilacqua et al, 2019) to induce 10 controlled subconcussive head impacts while eliminating extraneous influences that is inherent in field studies, such as bodily hits, fatigue, strenuous exercise, and perspiration/hydration. Since individuals with ADHD have shown to respond adversely to concussion compared to non-ADHD counterparts (Adeyemo et al, 2014;Biederman et al, 2015;Iaccarino et al, 2018;Liou et al, 2018), we hypothesized that individuals with ADHD would also have a reduced tolerance to subconcussive head impacts, by exhibiting significant declines in cognitive function and increases in blood biomarker levels after 10 soccer headings, as compared to their non-ADHD counterparts. In addition, we conducted a post-hoc analysis to examine whether the cognitive decline would correlate with elevations in blood biomarkers in individuals with ADHD.…”

Interaction between Age, Sex, and Mental Health Status as Precipitating Factors for Symptom Presentation in Concussed Individuals

“…More and more work has shown a link between behavioural disorders (such as ADHD) and learning disabilities as contributing factors to concussion symptom and severity presentation [45][46][47][48]. As an example, participants with ADHD were significantly more disabled after suffering a concussion than were control participants without ADHD, even when controlling for age and sex [49][50][51][52][53].…”

Cognitive Disorders Among Incoming College Football Athletes: Legal and Medical Implications of Undisclosed Inclusion in Concussion Research

“…112 A 2017 study by Montenigro et al 113 using former high school and college football players was "the first in the literature to demonstrate a threshold dose-response relationship between estimated cumulative head impact exposure from football and later-life risk for cognitive and neurobehavioral impairment." Recently, Iaccarino et al 114 found that a) ADHD was over-represented in athletes with a sports-related concussion (SRC); b) the age of onset predated the SRC; and c) ADHD increased the risk of sustaining an SRC. The study authors conclude that these findings "…suggest that ADHD is an antecedent risk factor for SRC, is a risk factor for sustaining multiple head injuries, and contributes to complicate recovery from SRC."…”