Do Learning Disorders Impact Clinical Measures Following Concussion?

Abstract

Evaluate differences in clinical testing following concussion between adolescents with no history of learning disorder (LD) and those with a history of dyslexia and/or ADD/ADHD. Learning disorders, such as ADHD, can affect ImPACT® baseline neurocognitive testing. The effect that ADHD has on other clinical measures is less well understood. Additionally, limited data exists on the effect of dyslexia on these measures. Data were prospectively collected from participants enrolled in the North Texas Concussion Registry (ConTex). Participants ages 10-18 years old, diagnosed with a concussion sustained within 30 days of enrollment were included and assessed for self-reported history of LD type (dyslexia and/or ADD/ADHD). Clinical findings examined included symptom scores (derived from SCAT5™), ImPACT®, King-Devick (KD) test, patient health questionnaire 8(PHQ-8) scores, and generalized anxiety disorder 7(GAD-7) scores. Mann-Whitney tests were used to compare groups. In total, 1,298 participants were included: 58 with dyslexia, 158 with ADD/ADHD, 35 with both (dyslexia and ADD/ADHD), and 1,047 with no LD. There was no difference in age, sex, time since injury, or history of concussion apart from the ADD/ADHD group, which had more males (p < 0.001). The dyslexia group had slower mean KD time (p = 0.011) and increased error scores (p = 0.028). In those with ADD/ADHD, impulse control scores on ImPACT® were significantly higher (p = 0.007), but no other ImPACT® score differences reached significance. PHQ-8 and GAD-7 scores were significantly higher in those with ADD/ADHD (p < 0.001). Participants with both dyslexia and ADHD demonstrated slower KD times (p = 0.009) and had higher PHQ-8 (p < 0.001) and GAD-7 (p = 0.001) scores. Participants with dyslexia and/or ADD/ADHD had worse scores on commonly used concussion clinical measures including ImPACT® impulse control, KD testing, and depression and anxiety screenings. Understanding the differences in these groups will aid providers in their evaluation and assist in counseling families regarding the injury.