Sports Medicine Research: In the Lab & In the Field: Preliminary Baseline ImPACT Data for Those with ADHD or Learning Disabilities (Sports Med Res)


Monday, July 22, 2013

Preliminary Baseline ImPACT Data for Those with ADHD or Learning Disabilities

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


Kelsey Croak said...

I think this post is very relevant when referring to today’s athletes. There are more kids than ever being diagnosed with ADHD and learning disabilities than ever before. Whether it is a growing prevalence of these disorder or better recognition tools is also part of the issue. Regardless of the reasons, it is something that needs to be taken into consideration when administering and evaluating ImPACT scores. I think that medication has a very large influence on the results of this test, and need to be considered when administering baseline tests and retests. The medications for this disorder affect the attention of an individual. The ability to focus and concentrate on specific directions and tasks are a huge part of the ImPACT test. Changes in concentration abilities would most certainly affect how well or poorly an athlete scores on this test. That being said, I don’t necessarily think that the scores would change if the athlete is tested in a room alone or with a whole group of people, as long as adequate space and visual or auditory barriers are provided in the testing site, but I think that should be standard throughout, not just for those with ADHD. What I think needs to be taken into consideration is if the athlete has taken the medication or not before the baseline test and retest. If the athlete had not taken medication before the baseline, then they should take the retest under the same condition and vice versa. Otherwise, I don’t believe that you would be able to accurately compare the two tests or determine the extent of cognitive deficits following a concussion. said...


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