Introduction: Sport-related concussions (SRC) are a significant cause of morbidity in young athletes in the US.1 Attention deficit hyperactivity disorder (ADHD) is common in the pediatric population2,3 with stimulant prescriptions in this population dramatically increasing.4 For return-to-play decision making after SRC, accurate interpretation of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) battery is important.1,5 ADHD and stimulants have been shown to affect baseline ImPACT scores.6-8 The purpose of this study is to assess whether a self-reported diagnosis of ADHD and stimulant use was associated with post-concussion differences in ImPACT scores.

Methods: 4373 athletes underwent baseline and post-concussion testing using the ImPACT battery. 277 athletes self-reported a history of ADHD with 206 reporting no stimulant treatment and 69 reporting stimulant treatment. Each group was matched with participants reporting no history of ADHD or stimulant use on several biopsychosocial characteristics. Non-parametric tests were used to assess ImPACT composite score differences between groups.

Results: Participants with ADHD had worse verbal memory, visual memory, visual motor speed, and reaction time scores than matched controls at baseline and post-concussion. Athletes without stimulant treatment had lower verbal memory, visual memory, visual motor speed, and reaction time scores than controls at baseline and post-concussion. Athletes with stimulant treatment had lower verbal memory and visual memory scores, but equivalent visual motor speed and reaction time scores versus controls at baseline and post-concussion.

Conclusions: A self-reported diagnosis of ADHD is associated with lower neurocognitive performance across all ImPACT domains at baseline and post-concussion. Athletes with stimulant-treated ADHD manifest better visual motor speed and reaction time scores than patients with non-stimulant treated ADHD. ADHD-specific baseline and post-concussion neuropsychological profiles, as well as stimulant medication status, may need to be considered when interpreting ImPACT test results. Further investigation into the effects of ADHD and stimulant use on recovery from SRC is warranted.

Patient Care: ADHD and stimulant use have the potential to affect how young athletes score on ImPACT tests, which help determine when athletes are ready to return to play. Given the wide array of cognitive effects of ADHD and stimulant medications as well as the prevalence of ADHD in young athletes, ADHD-specific neuropsychological baseline and post-concussion neuropsychological profiles as well as athletes' stimulant medication status may need to be considered when interpreting ImPACT test results. This projects helps further describe the normative baseline neuropsychological ImPACT profile of young athletes with ADHD as well as provides an initial attempt to assess for differential neurocognitive performance in athletes with ADHD post-concussion. The ultimate goal of this study is to suggest that further investigation into the effect of ADHD and stimulant use on recovery from sports-related concussion as assessed by neuropsychological testing warrants further investigation.

Learning Objectives: By the conclusion of this session, participants should be able to: 1. Describe the prevalence of sport-related concussion, attention deficit hyperactivity disorder, and stimulant use in the young athlete (< 21 years) population and their potential as modifiers in the assessment and management of SRC 2. Identify the importance of accurate neuropsychological assessment in return to play decision-making and how specific co-morbidities (i.e., ADHD) can affect the neuropsychological profiles of patient populations. 3. Recognize the need for further investigation into the effects of ADHD and stimulant medication status on recovery from sport-related concussion

References: 1. Harmon, K.G., et al., American Medical Society for Sports Medicine position statement: concussion in sport. British journal of sports medicine, 2013. 47: p. 15-26. 2. Kessler, R.C., et al., The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry, 2006. 163(4): p. 716-23. 3. Thomas, R., et al., Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics, 2015. 135(4): p. e994-1001. 4. Olfson, M., et al., National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA psychiatry, 2014. 71: p. 81-90. 5. McCrory, P., et al., Consensus Statement on Concussion in Sport: The 4th International Conference on Concussion in Sport Held in Zurick, November 2012. British Journal of Sports Medicine, 2012. 47: p. 9. 6. Elbin, R.J., et al., Individual and combined effects of LD and ADHD on computerized neurocognitive concussion test performance: Evidence for separate norms. Archives of Clinical Neuropsychology, 2013. 28: p. 476-484. 7. Zuckerman, S.L., et al., Baseline neurocognitive scores in athletes with attention deficit-spectrum disorders and/or learning disability. J Neurosurg Pediatr, 2013. 12(2): p. 103-9. 8. Yengo-Kahn, A.M. and G. Solomon, Are psychotropic medications associated with differences in baseline neurocognitive assessment scores for young athletes? A pilot study. Phys Sportsmed, 2015. 43(3): p. 227-35.