Abstract
The objective of this study was to determine whether adolescents with attention-deficit/hyperactivity disorder (ADHD) have prolonged return to school and sports following concussion compared to those without ADHD and whether medication status or concussion history is associated with recovery time. We hypothesized that having ADHD would not be associated with longer recovery time. This prospective observational cohort study, conducted between 2014 and 2019, examined concussion recovery among school sponsored athletics throughout Maine, USA. The sample included 623 adolescents, aged 14–19 years (mean = 16.3, standard deviation = 1.3 years), 43.8% girls, and 90 (14.4%) reported having ADHD. Concussions were identified by certified athletic trainers. We computed days to return to school (full time without accommodations) and days to return to sports (completed return to play protocol) following concussion. Adolescents with ADHD [median days = 7, interquartile range (IQR) = 3–13, range = 0–45] did not take longer than those without ADHD (median days = 7, IQR = 3–13, range = 0–231) to return to school (U = 22,642.0, p = 0.81, r = 0.01; log rank: = 0.059, p = 0.81). Adolescents with ADHD (median days = 14, IQR = 10–20, range = 2–80) did not take longer than those without ADHD (median days = 15, IQR = 10–21, range = 1–210) to return to sports (U = 20,295.0, p = 0.38, r = 0.04; log rank: = 0.511, p = 0.48). Medication status and concussion history were not associated with longer recovery times. Adolescents with ADHD did not take longer to functionally recover following concussion. Recovery times did not differ based on whether adolescents with ADHD reported taking medication to treat their ADHD or whether they reported a prior history of concussion.
Highlights
A concussion is a mild traumatic brain injury [1]
7, 10, 14, 21, or 28 days following injury did not differ between those who did and did not report a history of prior concussion. This is the first prospective study of concussion recovery designed to examine whether attentiondeficit/hyperactivity disorder (ADHD) is associated with worse outcome, the largest study to date examining whether youth with ADHD are at risk of worse outcome following sport-related concussion and the first to examine days to return to school as an outcome
There were no differences between adolescents with ADHD and those without ADHD in days to return to school full time without accommodations or days to return to sports following concussion
Summary
Primary care pediatrics is the most common initial point of concussion care for children [2]. In a recent survey of pediatricians, essentially all (99%) had treated at least one patient, and half (50%) had treated six or more patients for concussion in the previous year [3]. Youth with ADHD are at greater risk of bodily injuries [8,9,10,11] and have a greater lifetime history of concussions [12,13,14,15,16] compared to those without ADHD. Almost half of youth with ADHD (42%) receive treatment for their symptoms solely through their primary care physician [17]
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