Multiple Self-Reported Concussions Are More Prevalent in Athletes With ADHD and Learning Disability.
OBJECTIVE
We evaluated how attention deficit-hyperactivity disorder (ADHD) and learning disability (LD) are associated with concussion history and performance on standard concussion assessment measures. Based on previous reports that developmental disorders are associated with increased injury proneness and poorer cognitive performance, we anticipated that ADHD and LD would be associated with increased history of concussion and poorer baseline performance on assessment measures.


METHODS
Cross-sectional study.


METHODS
Clinical research center.


METHODS
The study sample aggregated data from two separate projects: the National Collegiate Athletic Association Concussion Study and Project Sideline.


METHODS
We analyzed preseason baseline data from 8056 high school and collegiate athletes (predominantly male football players) enrolled in prior studies of sport-related concussion.


METHODS
Measures included demographic/health history, symptoms, and cognitive performance.


RESULTS
Attention deficit-hyperactivity disorder and LD were associated with 2.93 and 2.08 times the prevalence, respectively, of 3+ historical concussions (for comorbid ADHD/LD the prevalence ratio was 3.38). In players without histories of concussion, individuals with ADHD reported more baseline symptoms, and ADHD and LD were associated with poorer performance on baseline cognitive tests. Interactive effects were present between ADHD/LD status and concussion history for self-reported symptoms.


CONCLUSIONS
Neurodevelopmental disorders and concussion history should be jointly considered in evaluating concussed players.


CONCLUSIONS
Clinical judgments of self-reported symptoms and cognitive performance should be adjusted based on athletes' individual preinjury baselines or comparison with appropriate normative samples.
*Departments of Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; †Departments of Exercise and Sport Science, Orthopedics, and Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina; ‡Departments of Epidemiology, Exercise and Sport Science, Orthopedics, and Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina; §Department of Mental/Behavioral Health, Milwaukee VA Medical Center, Milwaukee, Wisconsin; ¶Department of Neurology, New York University School of Medicine, New York, New York; and ‖Department of Neurology, Loyola University Medical Center, Chicago, Illinois.
Lindsay D
LD
Nelson
Kevin M
KM
Guskiewicz
Stephen W
SW
Marshall
Thomas
T
Hammeke
William
W
Barr
Christopher
C
Randolph
Michael A
MA
McCrea
D000293:Adolescent; D056352:Athletes / Q000706:statistics & numerical data*; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D001924:Brain Concussion / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000453:epidemiology*; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D057566:Self Report; D014481:United States / Q000453:epidemiology; D055815:Young Adult