Attention deficit hyperactivity disorder (ADHD
) and other academically-relevant diagnoses have been suggested as modifiers of neurocognitive testing
in sport-related concussion, such as Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT
). These preexisting conditions may suppress ImPACT
scores to the extent that they are indistinguishable from low scores because of poor effort. The present study hypothesized that student athletes with history of ADHD
or academic difficulties produce lower ImPACT
composite scores and are more likely to produce invalid protocols than those without such conditions.
Midsized public university.
Nine hundred forty-nine National College Athletic Association athletes (average age = 19.2 years; 6.8% ADHD
, 5.6% Academic Difficulties, 2.0% comorbid ADHD
Three seasons of baseline ImPACT
protocols were analyzed. Student athletes were grouped using self-reported histories of ADHD
or academic difficulties taken from ImPACT
Dependent Variables: ImPACT
composite scores and protocol validity.
Student athletes in the academic difficulties and comorbid groups performed worse on ImPACT
composite scores (Pillai's Trace = 0.05), though this pattern did not emerge for those with ADHD
. Student athletes with comorbid history were more likely to produce an invalid baseline (10.5% invalid) (χ2
(2) = 11.08, P
= 0.004). Those with ADHD
were also more likely to produce an invalid protocol (7.7% invalid, compared with 2.6% in student athletes with no history) (χ2
(2) = 10.70, P
These findings suggest that student athletes reporting comorbid histories or histories of academic difficulties alone produce lower ImPACT
composite scores, and that those with comorbid histories or histories of ADHD
alone produce invalid protocol warnings more frequently than student athletes without such histories. Future studies should further examine invalid score thresholds on the ImPACT
, especially in student athletes with conditions that may influence test performance.
Student athletes with history of ADHD
or academic difficulties may more frequently fall below validity score thresholds, suggesting caution in interpreting test performance.