Children with Attention-Deficit/Hyperactivity Disorder Perform Differently on Pediatric Concussion Assessment

Abstract

Abstract Purpose In the absence of recent concussion, youth with ADHD endorse many concussion-like symptoms, perform worse on cognitive tests, and are more likely to have balance difficulty, thus complicating the interpretation of concussion assessment results. This study compared uninjured middle school students with ADHD to precisely matched controls without ADHD on the Child Sport Concussion Assessment Tool Fifth Edition (Child SCAT5). Methods A cohort of 1,045 middle school athletes (ages 11-14) completed preseason testing. Students with self-reported ADHD were individually matched to students without ADHD based on age, gender, language spoken at home, number of prior concussions, sport, and school they attended. The final sample included 136 students (68 with ADHD and 68 matched controls), 104 (76.5%) boys and 32 (23.5%) girls. They were 12.7 years old on average (SD=0.9). Mann-Whitney U tests were conducted to compare students with and without ADHD on the Child SCAT5. Results Children with ADHD reported more symptoms (M=11.18, SD=5.94) and greater symptom severity (M=18.01, SD=11.66) compared to children without ADHD (total symptoms: M=6.54, SD=5.15; symptom severity: M=8.84, SD=7.79). Children with ADHD (M=2.88, SD=1.04) performed worse than children without ADHD (M=3.21, SD=0.94) on Digits Backwards (Cohen’s d=-.33). Children with ADHD committed more errors on the tandem stance than children without ADHD (median for both groups=1; d=.45) and children with ADHD (median=4) committed twice as many errors than children without ADHD (median=2) on single leg stance (d=.76). Conclusion Children with ADHD endorsed more concussion-like symptoms and performed worse on certain cognitive tasks and balance tests during baseline, preseason Child SCAT5 assessment compared to matched controls without ADHD.