Research highlights concussion challenges for athletes with ADHD
UM, Southern Miss researchers hope to improve concussion diagnosis, recovery and return-to-play decisions
New research from the University of Mississippi indicates that athletes with ADHD need even more scrutiny when head injuries are involved.
Athletics trainers, coaches and doctors have focused a lot of attention on detecting concussions among athletes and ensuring they have time to heal after suffering one.
Athletes with attention-deficit/hyperactivity disorder are more susceptible to concussions and have a longer recovery period, said Corbit Franks, assistant professor and clinical education coordinator for athletic training at the University of Mississippi. He collaborated on a literature study with Jeffrey Parr and Mary King, both of the University of Southern Mississippi.
"Our purpose was to bring together high-quality peer reviewed research into one singular review paper for clinicians, coaches and athletes and also see how much ADHD actually does affect the risk, the assessment and the recovery of concussion," Franks said.
For Franks and Parr, the research is personal. Franks was diagnosed with ADHD as a child, and Parr's stepson also has it.
"I've had ADHD my entire life and doing concussion testing wasn't really a thing when I was playing baseball and football while growing up in Tennessee," Franks said. "What we called back then, 'getting your bell rung,' I know now I had several concussions playing, but they were never assessed or diagnosed or anything else."
When Parr's stepson hit his head, some obstacles arose.
"My stepson has ADHD, and I noticed several of the symptoms he dealt with on a daily basis overlapped with what we see in sport-related concussions," Parr said. "Then when he fell and hit his head, I realized how difficult it was to differentiate between his normal ADHD symptoms and what we would consider concussion related symptoms."
The overlapping symptoms shared between ADHD and concussions include fatigue and sleep imbalances, emotional irregularity and difficulty focusing. Therefore, when an athlete with ADHD is concussed, it becomes difficult to determine which symptom belongs to which condition, as Parr and his stepson experienced.
ADHD affects 4.2 to 8.1% of young athletes. Evidence from the study indicates that athletes with ADHD may:
- Be 1.6 to 2.5 times more likely to sustain a concussion, possibly due to impulsivity and risk-taking behaviors
- Report more severe or prolonged post-concussion symptoms
- Experience differences in baseline neurocognitive testing, or pre-concussion testing, which can complicate concussion diagnosis and management.
Whether an athlete has suffered a concussion can be assessed in several ways, ranging from a series of questions and actions on the sideline to a computer test or an app on a handheld electronic device.
When Franks began administering concussion tests as an athletic trainer, he experienced what it was like for ADHD athletes.
"I would take the test just to make sure I understood what it entailed, to be able to explain it to coaches, parents and athletes, and I always struggled on those tests staying focused," he said.
"So when athletes would come in and they had ADHD, it helped me understand that taking this test for them on a computer is not going to look the same as the athlete that maintains their attention all the time."
The baseline concussion test results for an athlete with ADHD may not be accurate, causing them to be over- or underdiagnosed. This can hinder their care once a concussion occurs.
The study found that athletes with ADHD take four to six days longer to recover from a concussion, Franks said.
What comes next is trying to understand why athletes with ADHD have a longer time until they return to learning and return to sport.
"Return-to-learn strategies and return-to-play protocols may need to look completely different for that sector of individuals, rather than our traditional way we've all done things," Franks said.
Just as athletes are becoming more specialized and individualized in their training, including nutrition, training and psychology, concussion diagnosis and treatment should consider following suit, the Ole Miss professor said.
"When you look at athletics in general, for the last several years, we've started to attempt to treat athletes more as individuals, whether that's through mental health, counseling, their nutritional strategies, their performance strategies, strength conditioning, so why are we not looking at concussions more as an individualized thing?" Franks said.
"With ADHD individuals, it pushes further this idea that just like with learning or anything else, we don't fall into the normal box. So, we have to look at routes to implement different strategies for the diagnosis and the management of concussions and ADHD individuals."
Considering an athlete's ADHD plays an essential role in that individualized plan.
"Recognizing ADHD as a modifier can lead to more accurate diagnoses, better symptom interpretation and safer return-to-play decisions," Parr said. "It also highlights the need for athletic trainers to be particularly aware of which athletes have an ADHD diagnosis."
Journal
Clinical and Translational Neuroscience
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