Baseline neurocognitive scores in athletes with attention deficit-spectrum disorders and/or learning disabilities
Zuckerman SL., Lee YM., Odom MJ., Solomon GS., Sills AK. Journal of Neurosurgery: Pediatrics. 2013; ahead of print.
Take Home Message: Athletes with attention deficit hyperactivity disorder and/or learning disabilities have lower baseline ImPACT neurocognitive scores compared to athletes without attention deficit hyperactivity disorder and learning disabilities.
Developmental, behavioral, and learning disabilities affect approximately 1 in 6 children in the United States. Children with attention deficit hyperactivity disorder (ADHD) suffer more head injuries compared with those without the disorder. Unfortunately, nearly all neurocognitive assessment studies exclude athletes with ADHD or learning disabilities despite the fact we need normative ImPACT scores for this population so we can adequately assess them. Therefore, the purpose of this study was to assess baseline neurocognitive differences between athletes with or without ADHD or learning disabilities and to establish normative data for these populations. The authors analyzed 6636 athletes previously completed baseline ImPACT scores that they defined as valid based on an impulse composite score of >30. From this sample the authors identified 1) 90 athletes with a self-reported history of learning disability, 2) 262 athletes with a self-reported history of ADHD, and 3) 55 athletes with a self-reported history of learning disability and ADHD. The authors matched these athletes to athletes without ADHD and learning disability based on age, sex, years of education, height, weight, and concussion history. Athletes with ADHD had lower verbal memory, visual memory, and visual motor process, as well as higher reaction time, impulse control, and symptom score compared with the matched athletes without ADHD and learning disability. Athletes with learning disabilities had a similar ImPACT score pattern as those with ADHD except they had similar impulse control compared with athletes with no learning disabilities and ADHD.
A baseline neurocognitive exam is a crucial part to the post-concussion assessment by helping clinicians assess when the athlete may return to play. Without valid baseline scores or normative data this can make evaluating and treating a concussion difficult. The current study suggests that athletes with ADHD or learning disabilities may have different ImPACT baseline scores on all 5 neurocognitive parameters and 1 symptom parameter. Additionally, the authors present preliminary baseline normative data for adolescents with ADHD and/or learning disabilities. However, further research may be needed to determine if the ImPACT scores from this study are representative of athletes with ADHD or learning disabilities around the country and in different age groups. Additionally, the authors did not note the frequency of invalid baseline tests. If the frequency of invalid tests is high within this special population then ImPACT tests may be an inappropriate tool for assessing concussions and deciding on return to play among these athletes. Medical professionals should be aware of the differences in baseline composite scores for those with learning disabilities and/or ADHD.
Questions for Discussion: When we use ImPACT tests among athletes with ADHD do you think medication use influences the results? Do you think athletes with ADHD or learning disabilities will ImPACT test differently if they are tested individually instead of in a group?
Written by: Jane McDevitt PhD, ATC, CSCS
Reviewed by: Jeffery Driban
Related Posts:Zuckerman SL, Lee YM, Odom MJ, Solomon GS, & Sills AK (2013). Baseline neurocognitive scores in athletes with attention deficit-spectrum disorders and/or learning disability. Journal of Neurosurgery. Pediatrics PMID: 23790088