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Multiple Self-Reported Concussions Are More Prevalent in Athletes With ADHD and Learning Disability

Nelson, Lindsay D. PhD; Guskiewicz, Kevin M. PhD, ATC; Marshall, Stephen W. PhD; Hammeke, Thomas PhD; Barr, William PhD; Randolph, Christopher PhD; McCrea, Michael A. PhD

Clinical Journal of Sport Medicine: March 2016 - Volume 26 - Issue 2 - p 120–127
doi: 10.1097/JSM.0000000000000207
Original Research

Objective: We evaluated how attention deficit-hyperactivity disorder (ADHD) and learning disability (LD) are associated with concussion history and performance on standard concussion assessment measures. Based on previous reports that developmental disorders are associated with increased injury proneness and poorer cognitive performance, we anticipated that ADHD and LD would be associated with increased history of concussion and poorer baseline performance on assessment measures.

Design: Cross-sectional study.

Setting: Clinical research center.

Participants: The study sample aggregated data from two separate projects: the National Collegiate Athletic Association Concussion Study and Project Sideline.

Interventions: We analyzed preseason baseline data from 8056 high school and collegiate athletes (predominantly male football players) enrolled in prior studies of sport-related concussion.

Main Outcome Measures: Measures included demographic/health history, symptoms, and cognitive performance.

Results: Attention deficit-hyperactivity disorder and LD were associated with 2.93 and 2.08 times the prevalence, respectively, of 3+ historical concussions (for comorbid ADHD/LD the prevalence ratio was 3.38). In players without histories of concussion, individuals with ADHD reported more baseline symptoms, and ADHD and LD were associated with poorer performance on baseline cognitive tests. Interactive effects were present between ADHD/LD status and concussion history for self-reported symptoms.

Conclusions: Neurodevelopmental disorders and concussion history should be jointly considered in evaluating concussed players.

Clinical Relevance: Clinical judgments of self-reported symptoms and cognitive performance should be adjusted based on athletes' individual preinjury baselines or comparison with appropriate normative samples.

*Departments of Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin;

Departments of Exercise and Sport Science, Orthopedics, and Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina;

Departments of Epidemiology, Exercise and Sport Science, Orthopedics, and Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina;

§Department of Mental/Behavioral Health, Milwaukee VA Medical Center, Milwaukee, Wisconsin;

Department of Neurology, New York University School of Medicine, New York, New York; and

Department of Neurology, Loyola University Medical Center, Chicago, Illinois.

Corresponding Author: Lindsay D. Nelson, PhD, Division of Neuropsychology, Department of Neurology, Medical College of Wisconsin, 9200 West Wisconsin Ave, Milwaukee, WI 53226 (

Supported in part by funding from the National Collegiate Athletic Association (NCAA) and the National Operating Committee on Standards for Athletic Equipment (NOCSAE), Center for Disease Control's National Center for Injury Prevention and Control, University of North Carolina Injury Prevention Research Center, Waukesha Memorial Hospital Foundation, National Academy of Neuropsychology, National Federation of State High School Associations, NFL Charities, Green Bay Packer Foundation, Milwaukee Bucks, Herbert H. Kohl Charities, Waukesha Service Club, Michael Emme, and the Medical College of Wisconsin General Clinical Research Center (M01 RR00058 from the National Institutes of Health).

The authors report no conflicts of interest.

Received November 26, 2013

Accepted December 10, 2014

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