Maureen Salamon

October 28, 2016

NEW ORLEANS — Teenage athletes with attention-deficit/hyperactivity disorder (ADHD) are more likely than their peers to report concussion-like symptoms during preseason baseline tests, a new study suggests.

"This may lead us to refine the ways we use baseline concussion tests. Right now it's a one-size-fits-all test," said study investigator Donna Huang, MD, a resident at the Spaulding Rehabilitation Network in Boston, Massachusetts.

Previous evidence has established that the risk for concussion is elevated in the 11% of US children and adolescents with ADHD. This risk might be fueled by ADHD-related symptoms, such as inattention, impulsivity, or risk-taking behavior, explained Dr Huang.

"Research has shown that medications have an effect on cognitive scales" in patients with ADHD, she told Medscape Medical News, "but not on concussion-symptom reporting."

Dr Huang presented the findings of the study here at the American Academy of Physical Medicine and Rehabilitation 2016 Annual Assembly.

She and her colleagues set out to determine whether the use of ADHD medications affects the reporting of concussion symptoms in a cross-sectional study of 37,510 high school athletes from Maine.

None of the participants had reported a concussion in the previous 6 months, and all completed a baseline preseason health survey and symptom questionnaire.

ADHD was self-reported by 2409 athletes (6.4%), and ADHD medication use was self-reported by 786 of these (32.6%). The remaining athletes served as the control group.

All the athletes underwent Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) to rate their experience with 22 concussion symptoms. They rated each symptom on a scale of 0 to 6, and these severity ratings were then used to calculate total score.

Girls with ADHD reported higher levels of concussion-like symptoms than boys, but the reasons for this are unclear, Dr Huang pointed out.

Overall, however, both girls and boys with ADHD reported significantly more concussion symptoms than their peers without ADHD, irrespective of medication use.

It is not yet clear how these findings will translate into clinical practice, Dr Huang acknowledged. When student athletes do experience concussion, this information might reflect "how they report lingering symptoms," she said. But it will be "tricky" for physicians to decide how to act on such symptom reporting.

"We don't want to send someone with persistent symptoms back into play, but whether they're safe to return to play still isn't entirely clear," she pointed out.

We don't want to send someone with persistent symptoms back into play, but whether they're safe to return to play still isn't entirely clear. Dr Donna Huang

"These findings are fascinating," said Monica Rho, MD, chief of musculoskeletal medicine at the Sports and Spine Rehabilitation Center at Rehabilitation Institute of Chicago in Illinois.

"Because ImPACT testing isn't perfect," she said, "it's important to get this type of information and have it be established," she told Medscape Medical News.

Because of the effect ADHD symptoms might have on detail-oriented, intensive testing, it is not clear whether people with ADHD will consistently produce the same baseline scores, Dr Rho explained.

In addition, the scoring system used — in which all 22 concussion symptoms were given equal weight — is not a sound approach, said Dinesh Kumbhare, MD, from the Division of Physical Medicine and Rehabilitation at the University of Toronto, Ontario, Canada.

"They all become equal in importance, and therefore equally diluted," Dr Kumbhare told Medscape Medical News.

The study was funded by the Mooney-Reed Charitable Foundation. Dr Huang, Dr Rho, and Dr Kumbhare have disclosed no relevant financial relationships.

American Academy of Physical Medicine and Rehabilitation (AAPMR) 2016 Annual Assembly: Abstract S156. Presented October 22, 2016.

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