Effect of Attention Deficit Hyperactivity Disorder and Stimulant Medication on Concussion Symptom Reporting and Computerized Neurocognitive Test Performance
Littleton AC, Schmidt JD, Register-Mihalik JK, Gioia GA, Waicus KM, Mihalik JP, Guskiewicz KM. Arch Clin Neuropsych. 2015. [Epub ahead of print]. doi:10.1093/arclin/acv043.
Take Home Message: Athletic trainers should be aware of an athlete’s medication at the time of baseline or post-concussion testing because they may influence neurocognitive testing results.
Concussions are serious injuries and concussion evaluations may be influenced by several factors including Attention Deficit Hyperactive Disorder (ADHD) and medication for ADHD. The purpose of this study was to examine the effects of ADHD and a common ADHD medication on neurocognitive testing results and symptom reporting among 44 healthy college students (22 with ADHD and 22 matched controls). Participants with ADHD were included if they had been diagnosed with ADHD at least 6 months prior to the study and completed an ADHD rating scale from the Diagnostic and Statistical Manual of Mental Disorders to confirm the diagnosis. They also had to provide proof of a prescription for an immediate-release stimulant medication and they had to have taken the medication at least 6 months prior to participation in the study. All participants in the ADHD group took Ritalin or Focalin with doses between 5 and 20 mg, with a half-life of ~1 to 3 hours. Both groups attended three sessions that were one week apart. The control group was asked to avoid any medication before each session, while the ADHD group was instructed not to take their medication 24 hours prior to the first 2 sessions, but to take their prescription 1-3 hours before the 3rd session. The participants completed a CNS Vital Signs Exam, which measured visual and verbal memory, finger tapping, symbol digit coding, Stroop testing, a shifting attention test, a continuous performance test and a non-verbal reasoning test. Everyone also completed a concussion symptom scale that asked about an array of symptoms including somatic, cognitive, and neurobehavioral issues. Researchers tracked the influence of the ADHD and ADHD medication on attention, reaction time, and motor control. Overall, results indicate that the reliability of the CNS Vital Signs is similar in participants with and without ADHD. When unmedicated, the ADHD group performed worse than the control group on the component of psychomotor speed (unmedicated mean: 99; control mean: 108), but when medicated, the ADHD group scores improved and were similar to control group scores (medicated mean: 109; control mean: 107). The medicated ADHD group also improved their scores on reaction time when compared to scores while unmedicated (medicated mean: 105; unmedicated mean: 98).
These findings identify the need for more education on the effects of these stimulant medications, particularly on their effect on neurologically related medical evaluation tests. Those athletes given prescriptions for stimulant medication to treat ADHD or other disorders may not achieve the same baseline or post-concussion scores on any type of neurocognitive test as compared to an athlete not ingesting these medications. Their results may indicate a concussion or testing error, which may be attributable to the stimulants or lack of stimulants in their system. Athletic trainers need to be aware of the medications that athletes are taking, as well as understand how each medication may alter the results of neurocognitive testing. Once the athletic trainer understands the reason for the possible changes in test score, they will be better suited to more accurately identify concussion indicators in the testing results and rule out pharmaceutical influence.
Questions for discussion: Do you think that athletes taking ADHD medication are more susceptible to concussions? Do you think that medications create false positive testing results indicating concussion?
Written by: Diana Marquez, Gerard Talbot-Paul
Reviewed by: Jeffrey Driban