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

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

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.

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:
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?

Jane McDevitt, PhD
by: Stephen Thomas


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