Sports Medicine Research: In the Lab & In the Field: ADHD Prescription Treatment Needs to be Considered When Assessing and Treating Athletes for Concussion (Sports Med Res)

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Monday, November 21, 2016

ADHD Prescription Treatment Needs to be Considered When Assessing and Treating Athletes for Concussion

Comparison of baseline and post-concussion ImPACT test scores in young athletes with stimulant-treated and untreated ADHD

Gardner RM, Yengo-Kahn A, Bonfield CM, Solomon GS. Phys Sportsmed. 2016;ahead of print.

Take Home Message: Athletes with ADHD score lower on all neurocognitive modules at baseline and postconcussion and have higher sign and symptoms score at baseline compared to controls.

Athletes with attention deficit hyperactivity disorder (ADHD) display worse ImPACT scores at baseline compared to those that do not have ADHD. Additionally, many patients with ADHD are prescribed stimulant medications for their condition; however, researchers demonstrated that athletes using stimulants exhibited lower ImPACT visual motor speed scores and slower reaction times compared to those not taking stimulant medications. Currently, not much is known about the differences between ImPACT performance at baseline and postconcussion for patients with ADHD and/or using stimulant medications. Therefore, the authors collected retrospective baseline and postconcussion ImPACTs from 4,373 athletes (January 2013-February 2014) and stratified them into 1of 3 groups: 1. athletes who reported history of ADHD and are treated with stimulants (69 athletes), 2. athletes who reported history of ADHD without stimulant use (208 athletes), or 3. those that do not have either ADHD or stimulant use (controls; 4036 athletes) to determine whether history of ADHD and/or stimulant use is associated with differences on postconcussion ImPACT testing. Athletes without reported history of ADHD or stimulant use were matched to those with reported history of ADHD based on sex, age, body mass index, education level, concussion history, and days between injury and postconcussion ImPACT test. At baseline and postconcussion, all athletes reporting a history of ADHD performed worse on all the ImPACT neurocognitive modules compared to controls. Athletes with ADHD reported greater on the baseline signs and symptoms score but not the postconcussion score compared to controls. Athletes with treated ADHD had lower baseline verbal memory, and at postconcussion had lower visual memory scores compared to controls. Athletes with untreated ADHD had lower verbal memory, visual memory, visual motor speed, and reaction speed at baseline compared to controls, and at postconcussion had the same results except for verbal memory. Athletes with a history of treated ADHD had better visual motor speed scores, but reported a greater signs and symptoms score compared to untreated ADHD athletes.

The authors used a large retrospective cohort of ImPACT scores and found there are differences in those suffering from ADHD as well as differences in ImPACT scores between athletes that are treated and untreated for ADHD. Athletes with stimulant treated-ADHD had better neurocognitive scores compared to untreated ADHD athletes, which suggests that the medication is necessary for them to focus and be more accurately assessed using ImPACT. Though, athletes with ADHD still scored worse on both baseline and postconcussion ImPACT modules compared to controls suggesting that even with medication they score differently compared to controls. These results further describe the normative baseline ImPACT scores for athletes with ADHD. Medical professionals should be aware of stimulant medication status when interpreting ImPACT results. This research also highlights the need for further investigation into the effects of ADHD and stimulant medication throughout the recovery process of a concussion. It should be noted that this study utilized self-reported ADHD and treatment status.

Questions for Discussion: Are you aware of your athletes with ADHD? Do you ask or take into consideration whether or not they are being treated for ADHD in your concussion diagnosis or return to play plan?

Written by: Jane McDevitt, PhD
Reviewed by: Stephen Thomas

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Gardner RM, Yengo-Kahn A, Bonfield CM, & Solomon GS (2016). Comparison of baseline and post-concussion ImPACT test scores in young athletes with stimulant-treated and untreated ADHD. The Physician and Sportsmedicine, 1-10 PMID: 27736285

1 comments:

Lauren Krywy said...

Personally, I'm not aware of ADHD in athletes that I encounter during my clinical rotation as a student. I know during clinical rotations, the goal is to get as much experience as you can and practice the skills that you learn in the classroom so thinking outside of that box into other contributing factors I believe come later in experience when all "text book" options are no longer there. Never before would I have thought to consider ADHD treatment in athletes who sustained a concussion. I found this research information very interesting and definitely a future research direction. I can see how it can be a hard topic to approach with an athlete asking if they have ADHD or not. As an athletic trainer, you never want to put your relationship with your athletes in a comprisable situation. It would be great information to know but it is still a fine line of information to gather and in an appropriate way. I think self-report is a touchy area because based on the questions asked, it can make the participant really think about what is being asked of them and can trick them into a sense of having one of the signs/symptoms of ADHD when they don't. So in the future if at all possible, finding a way to gather this information without using self-report will add to the solid and great information that has been gathered. I personally found this blog post interesting and will put concussions in a new perspective for me when treating my athletes in the future.

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