Concussion Incidence and Recovery Among Youth Athletes With ADHD Taking Stimulant-Based Therapy
Ali M, Dreher N, Hannah T, Li A, Asghar N, Spiera Z, Marayati NF, Durbin J, Gometz A, Lovell M, Choudhri T. Orthop J Sports Med. 2021 Oct 8;9(10):23259671211032564. doi: 10.1177/23259671211032564. PMID: 34646894; PMCID: PMC8504242.
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Student-athletes that reported taking medication to treat their attention deficit hyperactivity disorder (ADHD) had a lower risk of concussion and less neurocognitive impairment at 7 days after a concussion than student-athletes without ADHD or student-athletes that reported no medication for ADHD.
Many risk factors are associated with increased risk of concussion, such as ADHD. However, many patients are receiving medication (stimulants) to treat their ADHD. It remains unclear if patients that treat their ADHD with medication have an increased risk of concussion or prolonged recovery.
Ali and colleagues conducted a cohort study to evaluate the association between incidence of concussion, post-injury recovery of symptoms, and neurocognitive dysfunction among student-athletes with ADHD and medication use.
The authors had data from 7,453 student-athletes (~15 years of age;12-22 years of age). Each student-athlete completed baseline (preseason) testing between 2009 to2019 in 1 of 4 communities (2 in Florida and 2 in Colorado). If someone experienced a concussion, they completed a post-injury assessment and another assessment 7 days later. All assessments included patient demographic and clinical history (yes/no about ADHD diagnosis, medications), concussion symptom checklist, and neurocognitive assessment. Researchers reviewed surveys and divided the student-athletes into 1 of 3 groups: 1) 167 students diagnosed with ADHD and taking medications (amphetamine/dextroamphetamine, methylphenidate, or lisdexamfetamine), 2) 354 students diagnosed with ADHD but not taking stimulants, and 3) 6,932 students not diagnosed with ADHD. Researchers evaluated concussion incidence (total number of concussions per total patient years) and recovery by assessing deviation from baseline to post-injury in the neurocognitive composite scores.
The student-athletes with ADHD that took medications had a lower incidence (37 per 100 patient-years) than students without ADHD (57 concussions per 100 patient-years) and students with ADHD without medications (53 per 100 patient-years) groups. Initially, all 3 groups had similar impairments in neurocognitive testing relative to their baseline results. However, 7 days later patients with ADHD that took medication performed had better outcomes than both non-ADHD group (verbal memory, visual memory, visual-motor skills) and non-medicated ADHD patients (visual memory, visual-motor skills).
Overall, the authors provide evidence that student-athletes that take medications for their ADHD are 50% less likely to suffer a concussion than their peers. This finding suggests that stimulant medication for those that have ADHD could help decrease concussion risk. Additionally, student-athletes with ADHD on medications had smaller score changes from baseline to 7 days after injury, which suggests lower neurocognitive impairment than the other 2 groups. However, it would be helpful to see these findings verified in a cohort where researchers can verify the self-reported diagnosis and medication use. Furthermore, the researchers could then know additional medication information such as when they started taking the medication after ADHD diagnosis, dosage, and when they last took their medication prior to an assessment. This level of detail would help ensure that student-athletes get correctly grouped into those diagnosed with ADHD without medication and those without a diagnosis of ADHD.
Clinicians should ask a patient before a season and after an injury if they have an ADHD diagnosis and receive medication. If a patient has an ADHD diagnosis but is not receiving medications, it may be beneficial to discuss treatment options with the patient and their healthcare team.
Questions for Discussion
Do you evaluate how medications can affect baseline and post-injury assessments? Do you think that medications create false positive or false negative results with clinical assessments?
1. ADHD Prescription Treatment Needs to be Considered When Assessing and Treating Athletes for Concussion
2. Preliminary Baseline ImPACT Data for Those with ADHD or Learning Disabilities
3. Attention Deficit Hyperactivity Disorder and the Influence of Stimulant Medication on Neurocognitive Test Performance
Written by: Jane McDevitt
Reviewed by: Jeffrey Driban