Detecting ADHD symptoms in young athletes using ImPACT

Journal of the International Neuropsychological Society. 2018 Nov;


Miller, C., Zuccato, B. G., Scavone, A., Erdodi, L. A., Merker, B. M. and Abeare, C..



Objective: Attention-deficit/Hyperactivity Disorder (ADHD) is a common childhood psychiatric disorder. Parents often cope with child overactivity by enrolling them in sports. However, young athletes with ADHD are at higher risk for concussion, and their ADHD symptoms may subsequently interfere with recovery. Furthermore, the presence of ADHD may complicate the tracking of recovery. Because not all individuals with ADHD are diagnosed, a subset of athletes likely have undiagnosed ADHD, increasing their risk of concussion and complicated recovery. We examined the utility of ImPACT, a computerized battery commonly used in concussion management, for identifying individuals with self-reported ADHD. Participants and Methods: In a large sample of youth athletes (N= 7440; 50.1% female; mean age: 14.83 years) collected between 2010 and 2016 at a Midwestern urban medical center, 10.9% reported a history of ADHD. Age, gender, visual-motor speed, reaction time, impulse control, and cognitive symptoms were entered into a logistic regression with previous ADHD diagnosis as the dependent variable. Results: All variables except reaction time were significant predictors of ADHD status (p <.001). A conservative cut-off (> 0.25) had low sensitivity (.15), but high specificity (.97). A more liberal cut-off (> 0.15) improved sensitivity (.39) at the expense of specificity (.86). Conclusions: Acknowledging the limitations of using a dataset with uncertain diagnostic accuracy (ADHD status was determined based on self-report), our results indicate that the ImPACT has potential as a quick screening tool to identify young athletes with previously undiagnosed ADHD who might benefit from a comprehensive ADHD assessment prior to sports participation. Clinicians working with injured young athletes who use the ImPACT to monitor recovery should also be aware that the ImPACT is sensitive to both concussion and ADHD symptoms and therefore, and therefore clinicians should take these findings into consideration when assessing youth diagnosed with ADHD

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