Abstract:
Context: Concussion management relies on clinical judgment exercised on an individualized basis. Clinical judgment includes considering the patient’s personal and medical history. Learning disabilities (LD) and attention deficit hyperactivity disorder (ADHD) have both been identified as potential modifying factors that warrant consideration when assessing an athlete with a concussion. However, little research exists regarding the potential impact of LD and ADHD on the likelihood of sustaining a concussion. Objective: To investigate the relationship between self-reported learning disability (LD) or attention deficit hyperactivity disorder (ADHD) and self-reported history of concussion and sustaining a diagnosed concussion. Design: Prospective cohort. Setting: High school athletic training facilities. Patients or Other Participants: A convenience sample of 8811 adolescent athletes (2809 females, 6002 males, age=15.7±1.2 years, grade=9.3±1.1 level) participating in interscholastic contact sports. Interventions: All subjects completed the Immediate PostConcussion Assessment and Cognitive Testing (ImPACT), as part of a concussion baseline assessment protocol. Independent variables included self-reported LD or ADHD, as determined by the participants’ responses to questions about LD and ADHD within the ImPACT demographic section. Any participant sustaining a concussion during this 2year prospective study completed ImPACT within 48 hours of the concussion and serially during recovery as indicated by their respective athletic trainer. Main Outcome Measures: Dependent variables included the self-reported history of prior concussion as documented in the ImPACT demographic section and any subsequent concussion diagnosed by an athletic trainer that resulted in the participant completing at least one post-injury ImPACT test. The relationship between each independent and dependent variable was evaluated with separate Chi-Square analyses (P<.05). Results: A total of 158 participants (1.8%) indicated they had LDs; 375 (4.3%) noted they had been diagnosed with ADHD, and 1583 (18.0%) reported a prior history of concussion. A total of 632 concussions (incidence=7.2%) were diagnosed during the 2-year study period. Self-reported LD was significantly associated with a higher report of prior concussions (p<.001, 31.6% vs. 17.7%) and diagnosed concussions (p<.001, 14.6% vs. 7.0%). Likewise, participants with self-reported ADHD were more likely to report a prior history of concussions (p<.001, 27.7% vs. 17.5%) and sustain a newly diagnosed concussion (p<.001, 12.8% vs. 6.9%). Conclusions: These findings suggest that self-reported LD and ADHD are both associated with a higher rate of prior concussion and newly, athletic trainer-diagnosed concussion. Athletic trainers should ask about and document these comorbid factors as part of the preparticipation examination and consider them in assessing the potential for concussion, and the management of concussed athletes. Future studies should investigate the mechanisms underlying the increased rate of concussion associated with LD and ADHD. Funded by a grant from the National Operating Committee on Standards for Athletic Equipment (NOCSAE).