ADHD News & Research

Heads Up: Concussion Symptoms Are More Prevalent in Teens with ADHD

High school athletes with ADHD may show more concussion-related symptoms than those without the disorder.

November 3, 2016

Teens with ADHD may be more likely than their peers to show concussion symptoms, according to a new study — even if they didn’t report having a recent concussion.

The study, which was presented at the 2016 Annual Assembly of the American Academy of Physical Medicine and Rehabilitation (AAPMR), looked at 37,510 high school athletes from Maine who were about to begin their respective seasons. Of those, 2,409 students (approximately 6.4 percent) reported having a diagnosis of ADHD, and 786 of those reported taking medication. Concussion symptoms — like depression, nausea, headaches, and irritability — were measured using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) tool, which looks for the presence of 22 common concussion markers.

The results showed that teen athletes with ADHD were significantly more likely to report concussion-like symptoms than students without the disorder, with girls showing symptoms more often than boys. The reason for the gender disparity was unclear, researchers said. Though it was originally hypothesized that ADHD medication would have a confounding effect on self-reported concussion symptoms in the study’s subjects, there was no difference between the medicated and non-medicated groups.

The study’s authors point out that ADHD — particularly its hyperactive and impulsive symptoms — has long been linked to an increased risk of accidents. In fact, previous research has found that teens with ADHD have 3.5 times more risk of getting a concussion than teens without ADHD — making the results of the current study seem fairly straightforward. But none of the more than 37,000 participants reported having a concussion in the last six months — leading researchers to wonder where exactly these symptoms were coming from.

One explanation, said study investigator Donna Huang, M.D., could be differences in how teens with and without ADHD experience the long-term symptoms of a concussion — even one that happened more than six months in the past. Or, she added, the results may not be related to ADHD at all, but instead could indicate a fundamental problem with the ImPACT tool, which is widely used to address the effects of concussions.

“This may lead us to refine the ways we use baseline concussion tests,” she said. “Right now it’s a one-size-fits-all test.”

As of now, it’s hard to say how the study’s results will change clinical practice of concussion treatment, she said. If teens with ADHD are more likely to report concussion-like symptoms, regardless of their concussion status, it could be difficult for doctors to accurately assess which patients are still facing consequences of past concussions and which patients have fully healed.

“We don’t want to send someone with persistent symptoms back into play,” she said. “But whether they’re safe to return to play still isn’t entirely clear.”

Monica Rho, M.D., chief of musculoskeletal medicine at the Sports and Spine Rehabilitation Center at the Rehabilitation Institute of Chicago, was impressed by the study.

“These findings are fascinating,” she said. “Because ImPACT testing isn’t perfect, it’s important to get this type of information and have it be established.”

Others were less sure. Dinesh Kumbhare, M.D., from the Division of Physical Medicine and Rehabilitation at the University of Toronto, took issue with the fact that all 22 concussion-related symptoms were treated equally by the researchers, when some — like headaches or depression — could be totally unrelated to a past concussion.

“They all become equal in importance, and therefore equally diluted,” he said.

Neither Rho nor Kumbhare were involved in the study.