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
trainers should be aware of an athlete’s medication at the time of baseline or
post-concussion testing because they may influence neurocognitive testing

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

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

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Littleton, A., Schmidt, J., Register-Mihalik, J., Gioia, G., Waicus, K., Mihalik, J., & Guskiewicz, K. (2015). Effects of Attention Deficit Hyperactivity Disorder and Stimulant Medication on Concussion Symptom Reporting and Computerized Neurocognitive Test Performance Archives of Clinical Neuropsychology, 30 (7), 683-693 DOI: 10.1093/arclin/acv043