Symptom Provocation More Likely Following Vestibular/Ocular Motor Screening in Athletes with Attention Deficit Hyperactivity Disorder

Abstract

Vestibular and ocular-motor impairments are routinely reported in patients with a sports-related concussion (SRC) and may result in delayed return to play. The Vestibular/Ocular Motor Screening (VOMS), a brief clinical assessment for vestibular and ocular-motor impairments, has been shown to be a sensitive clinical assessment for identifying patients with a concussion. However, in athletes with attention deficit hyperactivity disorder (ADHD), the VOMS may not be indicated as these patients exhibit impairment of the ocular-motor system in the absence of concussive injury. Thus, VOMS findings in an athlete with ADHD may be overstated and a higher proportion of athletes reporting symptom provocation are likely. PURPOSE: To determine if differences exist between those athletes with and without ADHD in relation to symptom provocation during VOMS. METHODS: A retrospective chart review of patient (n = 223; 80 girls, 143 boys) records (age range: 11-19 yr; mean ± SD; 15±2) of those presenting with SRC from Jan - Dec 2014 was conducted. As part of the initial visit a VOMS assessment was performed by trained medical personnel who documented symptom provocation using a dichotomous scale (0=not present, 1=present). The VOMS used in this clinic consisted of the following domains: smooth pursuits (SMO_PUR), horizontal (HOR_) and vertical saccades (VER_SAC), horizontal (HOR_) and vertical vestibular ocular reflex (VER_VOR), convergence (CONV), and accommodation (ACCOM). Diagnostic history of ADHD was self-reported. χ2 analyses for categorical variables was used to examine relationship between ADHD and VOMS symptom provocation. RESULTS: ADHD was present in 14.3% of patients. A greater proportion of patients with ADHD reported symptom provocation in the following VOMS domains: SMO_PUR (57.6% vs. 36.6%; p = 0.023), HOR_SAC (69.7% vs. 48.7%; p =0.026), HOR_VOR (64.5% vs. 41.8%; p = 0.019). VER_SAC (69.7% vs. 53.8%; p = 0.089) approached significance. No difference was observed in proportion presenting with or without ADHD in domains of VER_VOR, ACCOM, or CONV. CONCLUSION: Athletes with ADHD may report symptom provocation during specific domains of the VOMS assessment more often than those athletes without ADHD. These findings may have important implications in the diagnosis and treatment of concussions in athletes with ADHD.