March 13, 2020 | Erin Bluvas, firstname.lastname@example.org
Members of the National Collegiate Athletic Association – Department of Defense (NCAA-DOD) Concussion Consortium have been presenting and publishing findings from a series of studies on concussions among athletes who have attention deficit hyperactivity disorder. The researchers found that athletes with ADHD (regardless of medication status) are more likely to incur concussions and are more likely to experience a more challenging recovery, including symptoms such as anxiety and depression and a longer recovery period, compared to athletes without ADHD.
“Previous research on athletes who incur a concussion typically evaluate normative individuals neglecting those athletes with neurodevelopmental disorders,” says Davis Moore, an assistant professor in the Arnold School’s Department of Exercise Science and a co-investigator on the studies. “Indeed, most concussion research typically screens out these individuals or only seeks to evaluate their injury incidence.”
Dedicated to improving assessment and treatment protocols for concussive injuries to make them accessible to everyone, Moore joined UofSC in 2016 to continue this research in his Concussion & Health Neuroscience Laboratory. Adopting an interdisciplinary approach, he collaborates with scientists from athletic training, sports medicine, neuroscience, psychology and other fields to coordinate comprehensive initiatives that focus on both research and clinical care, particularly for vulnerable and understudied populations such as non-athletes, military personnel, car accident survivors, youth and athletes with neurodevelopmental disorders (e.g., ADHD, learning disabilities).
The lack of research on high school and collegiate athletes with ADHD or learning disabilities is a critical shortcoming, according to Moore, who notes that 15 to 20 percent of this population have been diagnosed with one of these neurodevelopmental disorders and might require special attention following injury. With their recent research, the NCAA-DOD Concussion Consortium set out to learn more about the nature and duration of deficits incurred by these athletes in order to develop better assessment, management and rehabilitation protocols.
Using data from the NCAA-DOD Grand Alliance: Concussion Assessment, Research and Education (CARE) Consortium, the researchers examined the likelihood of incurring concussions among 429 athletes with learning disabilities, 1,513 athletes with ADHD and 323 athletes with both ADHD and a learning disability compared to more than 31,000 athletes without either of these neurodevelopmental disorders. They found that neurodevelopmental disorders are associated with increased odds and relative risk of incurring a concussion, and athletes with both a learning disability and ADHD appear to be most susceptible to concussions.
Analyzing data from the CARE Consortium once again, the authors evaluated 20 athletes taking ADHD medication with 20 athletes not taking ADHD medication – all of whom had been diagnosed with ADHD. They compared these individuals with 80 athletes who did not have ADHD. All of the 120 participants experienced concussions.
Moore and his team found that the athletes taking medication for ADHD experienced symptoms (12 days) for an average of two days longer than athletes with ADHD who did not take medication (10 days) and eight days longer than the athletes without ADHD (four days). All of the athletes with ADHD experienced greater increases in symptom severity and greater decreases in verbal memory compared to the athletes without ADHD. Further, athletes with ADHD but not taking medications had larger post-injury deficits and athletes taking medication for ADHD responded more slowly to visual motor speed tests compared to non-ADHD athletes.
“These findings suggest that following concussion, athletes with ADHD may experience longer recovery than those without ADHD, regardless of whether they take ADHD medication,” says Moore. “We were surprised to find that athletes with ADHD who were taking medication did not appear to have different recovery time relative to un-medicated athletes with ADHD.”
In a third study, the researchers investigated whether anxiety and depression were connected with athletes with ADHD who have experienced concussions. They gathered data from nearly a thousand NCAA Division I college athletes at UofSC, dividing the participants into four groups: those with ADHD who had experienced a concussion, those with ADHD who had not experienced a concussion, those with a concussion and no ADHD, and those with no concussion and no ADHD. The team found that the group of athletes with ADHD who had experienced concussions had significantly more anxiety and depression than any of the other groups.
“This study taught us that ADHD and concussion may have a cumulative effect on anxiety and depression beyond that of either ADHD or concussion alone,” says Moore. “Therefore, athletes with ADHD should receive extra care and monitoring, as they will likely experience more severe symptoms after a concussion than others.”